What Is Sciatica?

Sciatica is a common condition that results from irritation, inflammation, or compression of the sciatic nerve, which is the largest nerve in the body. The sciatic nerve extends from the lower back through the hips and down the legs. 

The most frequent cause of sciatica is a herniated or “slipped” disc that puts pressure on the nerve roots as they exit the spine. However, there are several other potential causes of sciatic pain, which will be explored in this article.

The majority of individuals experiencing sciatica can find effective relief through physiotherapy and conservative treatment approaches with only a small percentage of people needing more invasive intervention. 

That being said, symptoms of sciatica can be extremely debilitating and those experiencing persistent pain lasting a few weeks, especially if it’s affecting your sleep, work and daily quality of life should consider earlier interventions. In these cases a spinal injection can be an incredibly beneficial treatment option, as it can offer immediate pain relief and allow you to regain mobility.

Epidural spinal injections are a very safe and effective minimally invasive treatment. At Complete Injections, our team has extensive experience in treating sciatica, ensuring a speedy and full recovery for our patients.

Sciatic Nerve Anatomy

The sciatic nerve originates from the lowest five vertebrae of the spine: L4, L5, S1, S2, and S3. It is the longest and thickest nerve in the body, roughly the width of a finger.

Each side of the body has a sciatic nerve, running through the hips, buttocks, and down the back of the leg, terminating just below the knee. Beyond this point, the nerve divides into smaller branches, which continue into the lower leg, foot, and toes.

The spine’s intricate structures, including the lumbar vertebrae, facet joints, and nerve pathways, directly influences how pain and movement issues present in the body. 

Knowledge of the sciatic nerve’s course is particularly important, as this nerve often is often the cause of radiating leg pain and associated mobility limitations.

Understanding the anatomy of the spine and sciatic nerve allows your specialist to target the source of your pain —whether through physiotherapy exercises that help reduce nerve compression and irritation or when delivering a targeted caudal epidural injection that relieves pain and inflammation around the lumbar nerve roots. This level of precision leads to more effective, long-lasting relief and faster recovery.

What Triggers Sciatica?

Sciatica is not a medical condition itself but rather a symptom of an underlying issue affecting the sciatic nerve. It refers to pain that originates in the lower back and radiates into the buttock and down the leg. It can occur with or without accompanying back pain.

While irritation or compression of the sciatic nerve can lead to sciatic pain; actual nerve damage to the sciatic nerve is relatively rare.

A herniated disc is the most common cause, with the disc bulging outwards and pressing against the nerve root, leading to pain along the sciatic nerve. 

Other frequent causes of sciatica include:

• Spinal Degeneration – Wear and tear of the spinal discs or osteoarthritic changes in the vertebrae can irritate or compress the sciatic nerve.
• Spinal Stenosis – The abnormal narrowing of the spinal canal, often due to bone spurs, limits the space for the spinal cord and nerves. This condition is more common in people over 60.
• Spondylolisthesis – This occurs when one vertebra slips out of alignment with the one above or below it, narrowing the space where the nerve exits the spine.
• Piriformis Syndrome – This rare condition involves the piriformis muscle in the buttocks tightening and spasming, compressing the sciatic nerve.

Less common causes include:

• Lumbar spine tumours
• Direct trauma to the sciatic nerve (e.g., knife injuries)
• Pregnancy

Individuals aged 30 to 50 are at the greatest risk of developing sciatica. Even mild nerve irritation can cause significant pain, and because nerves are highly sensitive, they can take time to settle. It’s essential to seek expert care to ensure timely and proper treatment.

At Complete Injections, our experienced physiotherapists specialise in the treatment and rehabilitation of sciatica, aiming to alleviate pain and restore full functionality.

Recognising the Symptoms of Sciatica

Sciatic pain can vary widely, from mild discomfort to debilitating agony. It typically begins in the lower back or buttocks, affects only one side of the body, and travels down the thigh and leg. The pain may be described as burning or shooting. Depending on the severity and cause, it may even extend to the foot or toes. Sciatica may also cause muscle weakness, numbness, or tingling in the leg or foot.

Sitting and bending are common triggers that can worsen symptoms, while walking and gentle movement often provide some relief. Many people find that leg pain is more severe than back pain.

Common sciatica symptoms include:

• Moderate to severe pain in the lower back, buttock, and leg.
• Burning or shooting pain in the leg.
• Weakness in the leg or foot.
• Pain that worsens with sitting or bending.
• Numbness or tingling in the leg, foot, or toes.
• Leg pain at night.
• Difficulty dressing and putting your shoes on.

If you are experiencing these symptoms for more than a few weeks, and they are not settling with physiotherapy intervention; especially if they are affecting your sleep, your ability to work and causing low mood and emotional distress, then you should consider an assessment for a spinal injection.

Important: If you experience symptoms like severe bilateral leg weakness, numbness in the groin or genital area, or loss of bladder or bowel control, seek medical attention immediately. These could be signs of cauda equina syndrome, a medical emergency requiring urgent treatment. 

How Is Sciatica Diagnosed?

Accurate and timely diagnosis is really important for managing symptoms of sciatica and ensuring you are on the best treatment pathway. At Complete Injections, we can often provide next-day appointments when necessary.

A diagnosis of sciatica is typically made through a clinical examination conducted by an experienced spinal physiotherapist or musculoskeletal specialist. They will take a detailed history of your symptoms, general health, and daily activities. 

A thorough physical examination, including specific clinical tests, will help pinpoint the problem. This examination may include:

• Assessing spinal and pelvic range of movement.
• Assessing your core and leg muscle strength
• Checking for sensory and motor deficits
• Testing your lower limb reflexes
• Analysing your spinal posture – both in sitting and standing
• Gently palpating the spine and surrounding areas to pinpoint areas of pain, and muscle spasms, and also assessing how your spinal joints are moving. 
• Conducting special tests, such as the straight leg raise and slump test which tests the sciatic nerve.

In most cases, these assessments are enough to diagnose sciatica. However, if symptoms persist or the root cause is unclear, further diagnostic tests like X-rays, diagnostic ultrasound or MRIs may be required. We can help arrange these scans for you.

Imaging for Sciatica

X-Rays: These only reveal bony structures and are not useful for diagnosing soft tissue or nerve damage. However, they may be necessary if a spinal fracture or bone pathology is suspected.

MRI: An MRI provides detailed 3D images of soft tissues, making it an essential tool if there is concern about more serious conditions, such as tumours or trauma-related injuries.

Please note that if you are having a spinal injection, then you will need to have an up to date MRI scan that has been done within the last 6 months. We can help arrange these for you if they are required – you don’t need to have a GP referral. 

Treating Sciatica: What Works?

Fortunately, most cases of sciatica respond well to conservative treatments within a few weeks or months. The primary goals of treatment are to reduce pain, restore movement, and prevent future injury.

Physiotherapy 

Physiotherapy plays a vital role in sciatica management. Your physiotherapist will develop a personalised treatment plan based on your symptoms and goals, incorporating pain relief strategies, stretching, strengthening exercises, core stabilisation, and posture education.

Managing Pain
Early physiotherapy treatment may include heat or ice therapy, soft tissue massage, and, when appropriate, acupuncture. Your physiotherapist will also advise on activity modification to prevent flare-ups while the pain subsides.

Medications
Over-the-counter NSAIDs like ibuprofen can reduce inflammation. For severe pain, muscle relaxants or prescription painkillers may be recommended. Always consult a healthcare professional before taking medication.

Soft Tissue Massage
Massage therapy can relieve muscle tension and spasms, promoting relaxation and reducing pain.

Acupuncture or Dry Needling
Research supports acupuncture as an effective option for relieving sciatic pain, reducing muscle spasms, and promoting overall nerve health.

Restoring Strength and Flexibility
Your physiotherapist will guide you through stretches and movement exercises to improve the range of motion in your spine, hips, and pelvis. Strengthening your core muscles will also be a key focus to enhance back stability.

At Complete Injections, we offer tailored rehabilitation programs to help you manage and prevent sciatica.

Preventing Recurrence and Long-Term Care

It’s not uncommon for sciatica to return. Recurrence often happens due to incomplete rehabilitation. 

Strengthening your core, improving back mobility, and understanding proper movement patterns are crucial to long-term recovery. 

Your physiotherapist will ensure you have a solid plan for self-management and ongoing exercise to keep symptoms at bay.

Ultrasound Guided Spinal Injections

If conservative treatment fails to alleviate symptoms, or if pain is too severe to engage in physiotherapy, spinal injections may be considered. 

Steroid injections combined with a local anaesthetic can help reduce inflammation and nerve irritation. However, these injections are not a stand-alone treatment—they are used to enable better participation in rehabilitation.

Ultrasound-guided spinal injections are a minimally invasive procedure used to manage sciatica, As previously discussed, sciatica may result from herniated discs, spinal stenosis, or other degenerative conditions. 

Several types of injections can be used depending on the cause of sciatica. For instance, nerve root injections are often administered to reduce inflammation around the nerve root, particularly in cases of disc herniation or foraminal narrowing.

In situations where pain is due to lumbar facet joint arthritis or inflammation, facet joint injections can provide relief. For more chronic or resistant cases, caudal epidural injections are used to target the irritated nerve directly.

Ultrasound guidance improves the precision of these injections, allowing real-time visualisation of surrounding structures to ensure accurate needle placement, minimising the risk of complications. 

Research supports the safety and efficacy of ultrasound-guided injections for sciatica. A 2020 review highlighted that ultrasound-guided injections have fewer complications compared to those guided by fluoroscopy or blind techniques, reducing radiation exposure and offering real-time monitoring. Studies also suggest that ultrasound guidance enhances the accuracy of the needle placement, potentially improving clinical outcomes. 

The success rate of these injections varies depending on the underlying cause, but many patients experience temporary but significant pain relief and some patients experience long term relief. While the duration of pain relief can be variable, the reduced reliance on opioids and improvements in mobility and general wellbeing are considered significant benefits of these interventions.

Surgical Options

Surgery is generally a last resort for sciatica and is only considered when other conservative treatments have been unsuccessful. However, immediate surgery may be necessary in cases like cauda equina syndrome, bilateral sciatica, tumours, or severe spinal fractures.

At Complete Injections, we work closely with leading spinal surgeons to provide comprehensive care for patients requiring surgical intervention, ensuring full support throughout the recovery process.

For appointments or for more information call 020 7482 3875 or email injections@complete-physio.co.uk.