Sciatica
Why does pain shoot down my leg from my lower back?
Leg pain from an irritated nerve root in the lower back, often worse than the back pain itself. Many cases settle with the right activity and exercise.
What it feels like
Pain travelling from the buttock down the back or side of the leg, often below the knee and sometimes into the foot, with tingling, numbness or weakness. The leg pain is often worse than the back pain and can be aggravated by sitting, bending, coughing or sneezing.
What is actually happening
Sciatica usually means a nerve root in the lower back is irritated, most often by a disc bulge or herniation, sometimes by narrowing around the nerve. Many people with sciatica improve with conservative care, and disc herniations can shrink over time.
When to see a doctor urgently
Go to an emergency department straight away if you have numbness around the groin, genitals or inner thighs, new difficulty passing urine or controlling your bladder or bowel, sexual dysfunction, or weakness in the legs that is getting worse. These can be signs of cauda equina syndrome, which needs emergency treatment.
How it is assessed
Assessment includes the pattern of leg symptoms, what eases and aggravates them, a neurological examination of strength, reflexes and sensation, and nerve tension tests. It screens for the warning signs above and tracks the neurological findings over time.
How it is treated
The NICE guideline on low back pain and sciatica suggests considering an exercise programme suited to your needs, manual therapy only as part of a package that includes exercise, and support to stay active and keep working where possible. It advises against treatments such as traction, belts and corsets. Treatment typically combines positions and movements that ease leg symptoms, progressive exercise, nerve mobility work where appropriate, and a gradual return to sitting, lifting and activity. If symptoms are severe or not improving, I write to your family doctor, who can arrange a surgical opinion if it is needed.
What to do first
Keep moving within comfort and avoid long periods of bed rest. Short walks and changing position often usually helps. Have it assessed early, especially if you have numbness or weakness.
Where this is assessed
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 2:00 PM Book at Athlete's Care
- Push Pounds Sports Medicine Downtown Toronto · Tue/Thu · 8:30 AM – 6:30 PM Call Push Pounds to book
- Country Lane Physio Home office & virtual · Sat · By appointment only Message me to book
References
This page is based on the following clinical practice guidelines and research.
- National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. 2016, updated 2020.
- Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-7.
- George SZ, Fritz JM, Silfies SP, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60.