What Is Sciatica and How Does It Resolve?

The word sciatica is often used as if it were a diagnosis. In fact sciatica is not a disease but a set of symptoms that appear when the sciatic nerve — the longest nerve in the body — is compressed or irritated. The right question is not "do I have sciatica" but "what is compressing my sciatic nerve".

Symptoms

• Pain running from the lower back into the buttock and down the back of the leg
• Usually one-sided
• Numbness or pins and needles in the leg or foot
• Worse with prolonged sitting and with bending forward
• A clear flare when coughing, sneezing or straining

If the pain stays in the back and does not travel down the leg, this picture is usually not sciatica.

The four most common causes

Lumbar disc herniation. The best known cause; a shifted disc presses on a nerve root.

Piriformis syndrome. The piriformis muscle in the buttock lies across the sciatic nerve. When it tightens it can compress the nerve; in this picture the pain starts in the buttock rather than the back.

Spinal stenosis. A narrowing of the spinal canal. Typically the pain increases with walking and eases on bending forward.

Sacroiliac joint problems. Pain arising where the pelvis meets the spine can also travel down the leg.

The treatment for each differs. That is why the first session is given to assessment: which movement increases the pain, which position relieves it, plus reflex and strength testing.

What actually helps

In the acute stage the aim is to bring pain to a manageable level. Complete bed rest is not advised here: every day spent lying down costs muscle and slows recovery. Gentle movement within your pain limit beats lying still.

Once pain is manageable the programme rests on two lines: nerve mobilisation to restore free gliding of the nerve, and training the deep trunk muscles that carry the lower back. Hip and hamstring flexibility are an inseparable part of it.

When to see a doctor

Seek medical attention without delay if you have:

• Loss of bladder or bowel control
• Numbness in the inner thighs and around the groin
• Inability to lift the foot upward (foot drop)
• Fever, unexplained weight loss or severe pain that does not settle at night

These are rare but serious pictures that need urgent assessment.

How long does it take?

In a significant share of cases symptoms settle within weeks. But pain settling is not the end of the process: when a programme is abandoned before strength and control return, the complaint comes back within months. The decision to stop should rest on measurement, not on how you feel.

Fzt. Aydın Ali manages sciatic pain one-to-one, reviewing the programme at every session.