Pain that doesn't stay in the back
Many people know back pain. Sciatica is different: the pain doesn't stay in the lower back but shoots into the buttock, the back or side of the thigh, and sometimes the calf and foot. It often comes with tingling, burning or numbness.
This pain is worrying, and that is understandable. Knowing where it comes from helps you live with it better and know when to act fast.
What is sciatica?
The sciatic nerve is the largest nerve in the body. It is formed by nerve roots leaving the lower spine, and runs through the buttock and down the back of the leg. We speak of sciatica when pain follows the path of this nerve.
Most often a nerve root is irritated or compressed at the level of the spine, for example by a herniated disc or, especially after 50, by narrowing of the spinal canal. Depending on which root is involved, the pain travels to slightly different parts of the leg and foot.
Sciatica is common. For context, the Swiss League against Rheumatism notes that four in five adults have back pain at least once in their life.
Why does the pain travel down the leg?
An irritated nerve root sends pain signals that are felt along the whole area it supplies. The brain therefore "places" the pain in the leg, although its origin is in the back. This is neuropathic-type pain: it may burn, prickle, feel like electric shocks or pins and needles.
Mechanical compression is often joined by local inflammation around the root. Over time the nervous system can also become more sensitive, which is why sciatica can turn into chronic pain (see also Why does pain become chronic?).
What an MRI does (and doesn't) show
According to the Swiss League against Rheumatism, a disc hernia visible on imaging is not necessarily linked to the pain felt. An MRI is mainly useful when warning signs are present or to answer a specific question. Read more: Lumbar MRI and disc hernia.
Warning signs: when to see a doctor without delay
Most sciatica is not serious. The following signs, however, need prompt or urgent medical attention:
Go to an emergency department immediately if you have:
- loss of strength in the leg or foot (foot drop, difficulty walking on heels or toes);
- new difficulty passing urine, or leaking urine or stools;
- loss of sensation around the genitals, buttocks or inner thighs ("saddle anaesthesia"): these signs may point to cauda equina syndrome.
These situations are rare, but they must be seen the same day.
See your doctor promptly if:
- the pain comes with fever or a general feeling of being unwell;
- it started after a fall or accident;
- you have a history of cancer with new or unusual pain, known osteoporosis or unexplained weight loss;
- the pain is getting worse, wakes you at night, or affects both legs.
In the vast majority of cases, none of these signs is present.
Recommended first steps
Staying active is the first recommendation. The Swiss League against Rheumatism points out that staying in bed for several days is ineffective and can even make things worse. In practice:
- walk for a few minutes several times a day;
- change position every 20 to 30 minutes;
- use heat or cold, depending on what helps.
What does the research say?
The UK NICE guideline on low back pain and sciatica (NG59) suggests, depending on the person's profile, advice to stay active and self-management, or more intensive support with exercise programmes, with or without manual therapy. Some medicines are less recommended for sciatica according to NICE; never stop or change a treatment without talking to your doctor.
The first consultation lasts 1 h 30 to 2 h. Bring your medical file, your examinations (MRI, reports) and a list of your medicines. We review your situation and build your plan together. We work alongside your GP and the other professionals who follow you.
Which approaches can fit at Centre Algos?
Depending on your situation, several approaches can be combined, always alongside medical follow-up and movement:
- Naturopathy: diet, sleep and stress management, to work on the lifestyle habits that can influence pain.
- Cupping: can help release muscle tension in the lower back and buttock.
- Breuss massage: a gentle massage along the spine that can support relaxation and back comfort.
- Percutaneous hydrotomy: subcutaneous micro-injections; it may be considered where appropriate, after assessment. Price on quotation, set at the first consultation according to your situation.
Everyone responds differently: the aim is to reduce pain and regain mobility, without promising a result. Read more on our Back pain and Neuropathic pain pages.
When to seek advice
What is going on in your case
This text describes general mechanisms. What explains your sciatica, in your own situation, deserves a real conversation rather than a generic answer.
A question before you decide? Book a free 10-minute call to see whether our approach suits you.
