What we are talking about
Sciatica is not a diagnosis, it is a description: the pain follows the path of the sciatic nerve, from the buttock down the back of the leg. When instead it runs down the front of the thigh it is called femoral nerve pain and involves higher roots.
The most common cause is a nerve root irritated where it leaves the spine, often by a herniation or a stenosis. But not always: piriformis syndrome, a buttock muscle that irritates the nerve lower down, gives a similar picture and is treated differently. Telling them apart changes the programme.
What surprises the people who live with it is how capricious it is: one day you are fine, the next you cannot put a sock on. It follows a stepped pattern, and the trajectory over time matters more than any single bad day.
When it makes sense to get seen
The most frequent reasons:
- Pain running from the buttock down the leg, past the knee
- Tingling, numbness or an electric-shock feeling in a specific area
- You cannot sit for more than a few minutes
- Pain that wakes you and no position works for sleeping
- The leg feels weaker, or the foot slaps when you walk
- It has lasted more than a few weeks and is not improving
What can be done remotely, and what cannot
Here the assessment is made mostly of the right questions and of observation: two things that work well on a video call.
What can be done remotely
- Mapping exactly how far the pain travels, which is what steers the diagnosis
- Finding the direction of movement that relieves, and the one that aggravates
- Taking out of your hands the exercises that are making you worse in this phase
- Sorting out positions: how to sleep, how to sit, how to drive
- Progressing the load as the pain retreats back towards the spine
What cannot
- Manual therapy and neural mobilisation techniques performed by us
- Neurological strength and sensation tests carried out physically
- Injections and instrument-based treatments
If strength drops rapidly, or there are problems controlling bladder and bowel or numbness in the saddle area, this is a medical emergency: you go to A&E, you do not wait for a session.
Frequently asked questions
How long does sciatica last?
Most improve over weeks, but it improves in steps, not on a smooth downward line. The sign that things are going the right way is not the pain dropping, it is the pain climbing back: from the leg towards the back.
Does stretching help?
It depends, and this is where people most often hurt themselves. Aggressively stretching a leg whose nerve is already irritated usually makes things worse. In the acute phase something else is needed, and stretching comes later.
Heat or ice?
Neither changes the course. Use whichever gives you relief to get through the difficult hours, without expecting it to be a cure.
Should I stay still until it passes?
No, and this is the most common mistake. You avoid what clearly lights the symptom up, but tolerated movement has to be kept: prolonged stillness lengthens recovery and makes it more likely the thing becomes chronic.
