Sciatica
Does the pain start in your lower back or deep in the buttock? Does it travel down the leg, sometimes as far as the foot?
If that sounds familiar, you are probably dealing with sciatica. It is one of the conditions we see most regularly, and for most people it responds well to the right treatment.
What's actually happening: The sciatic nerve is the longest in the body, running from the base of the spine through the buttock and all the way down the leg. Sciatica is what happens when that nerve is irritated or compressed somewhere along its course. The result is a pain that tends to travel, usually down one side, and may come with tingling, numbness, or a weakness in the leg that can feel unsettling if you have not experienced it before. Some people feel it mainly deep in the buttock; others get it all the way to the foot. It can range from a dull, persistent ache to something sharp and unpredictable, and it often behaves inconsistently, better on some days and much worse on others.
It is worth knowing that the term sciatica describes a set of symptoms rather than a single condition. The underlying cause varies from person to person, which is one of the main reasons a proper assessment matters before any treatment begins.
Why it starts
A common cause is a herniated disc in the lower back, where the soft inner material of a spinal disc pushes out and presses on a nearby nerve root. But sciatica can also be triggered by a tight muscle deep in the buttock known as the piriformis, by age-related changes in the joints or discs of the lower spine, or by postural and movement patterns that place repeated load on the nerve over time. In some cases, more than one factor is contributing at once. Understanding what is actually driving the symptoms matters because it shapes how treatment should be approached. The right approach for a piriformis problem is quite different from the right approach for a herniated disc, even though both can produce very similar-feeling pain down the leg.
How we approach it at BTC
The right starting point for sciatica is an osteopathic assessment. Our osteopaths are trained to identify where the compression is coming from, how the surrounding structures are contributing, and what the best course of action is for your specific presentation. Treatment typically involves hands-on work to restore movement and reduce tension in the lower back, pelvis, and surrounding tissues, alongside practical advice on how to manage day to day while you recover.
Depending on what the assessment finds, shockwave therapy may also be part of the picture. It is not the right approach for every presentation of sciatica, but for certain cases it can be a very effective addition to hands-on treatment. All of our osteopaths who carry out shockwave are fully registered with the General Osteopathic Council and have received additional specialist training in its use. If your osteopath recommends it, it will be because they have assessed it as clinically appropriate for you.
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You do not need a diagnosis to come in
A lot of people with sciatica are not entirely sure that is what they have. The shooting pain down the leg could be sciatica, referred pain from a hip or joint problem, or something else that needs looking at. None of that needs to be resolved before you book. If something is travelling down your leg and making your life difficult, that is enough reason to come and see us. Our osteopaths will assess what is going on from scratch and go from there.
Questions people ask us
How will you work out what is causing my sciatica?
Your osteopath will take a full case history and carry out a thorough physical assessment, looking at how your spine, pelvis, and hips are moving, testing sensation and nerve function in the leg, and building a clear picture of where the problem is most likely originating. It is this assessment that shapes everything that follows, which is why we do not recommend jumping straight into treatment without it.
Do I need to have had a scan before coming in?
No. Many presentations of sciatica can be assessed and treated effectively without imaging. If you have already had a scan, that information is genuinely useful and your osteopath will take it into account. If they feel a scan would be helpful, they will explain why and advise you accordingly.
My sciatica has been going on for months. Is it too late to get help?
No. Longer-standing sciatica can take more time to fully resolve than an acute episode, but it absolutely responds to treatment. A thorough assessment will establish what is still driving it, and a treatment plan is built from there.
Can sciatica come back after treatment?
Yes, it can, and being honest about that is important to us. Conditions like sciatica can recur, which is why completing your recommended course of treatment matters rather than stopping as soon as you feel better. Your osteopath will put together a plan for you, and keeping to that, including any maintenance appointments they suggest, gives you the best chance of a lasting recovery and reduces the likelihood of ending up back at square one.
Related Conditions
Disc herniation: a herniated disc is one of the most common underlying causes of sciatica, and the two often need to be considered together .
Still Not Sure?
If you're in pain and wondering whether we can help, that's exactly why we're here. You don't need to know what the problem is. You don't need a referral. You just need to take the first step. Book online today or call 020 7733 9944 to speak to us.