Sciatica: causes, treatment and how long it lasts
By Geoff Scott, Founder & Senior Physiotherapist, Hauora
By Geoff Scott, Senior Physiotherapist and founder of Hauora. Last updated 14 November 2026.
What is sciatica?
Sciatica is pain caused by an irritated nerve root in the lower back. You feel it in the buttock and down the back of one leg, often as far as the foot. It’s usually sharp or burning and can come with tingling, numbness or weakness. Most cases settle within a few weeks to a few months with movement, exercise and the right advice.
It’s one of the most common problems we see at our physiotherapy clinic in Primrose Hill. Desk workers from Camden and King’s Cross, parents in Belsize Park lifting toddlers and car seats, and golfers and runners from St John’s Wood and Hampstead all come to us with it. The outlook is usually good.
Sciatica at a glance
- Leg pain, not just back pain: sciatica is felt in the buttock and leg. Back pain on its own usually isn’t sciatica.
- Usually gets better: the NHS says most cases improve within a few weeks to a few months.
- Keep moving: staying active and doing regular exercises helps recovery. Long spells of sitting or lying down don’t.
- Some common medicines don’t help: NICE advises against gabapentin, pregabalin, oral steroids and benzodiazepines for sciatica, because there’s no overall evidence of benefit and there is evidence of harm.
- Know the red flags: numbness around your genitals or bottom, or new problems peeing or controlling your bowels, need A&E straight away.
Sciatica symptoms
- Pain in the buttock and down the back of one leg, often to the foot and toes
- Sharp, shooting or burning pain, sometimes described as an electric shock
- Tingling, pins and needles or numbness in the leg or foot
- Weakness in the leg or foot, such as a foot that catches or slaps when you walk
- Pain that’s worse when you cough, sneeze, bend or sit for a long time
The leg pain is often worse than any back pain. If your pain stays in your back, our guide to lower back pain from sitting at a desk is a better place to start.
What causes sciatica?
The sciatic nerve is the longest nerve in the body. It’s formed from nerve roots that leave the lower spine and run through the buttock and down the leg. Sciatica happens when one of those roots becomes irritated or compressed. The most common causes are:
- A bulging or herniated disc in the lower back pressing on a nerve root. This is by far the most common cause.
- Spinal stenosis: narrowing of the spaces the nerves pass through, more common in older adults
- Spondylolisthesis: a vertebra slipping forward slightly on the one below
- Irritation in the buttock, sometimes called piriformis syndrome, which is less common than people think
The disc bulge itself isn’t the whole story. The irritated nerve becomes inflamed and sensitive, which is why sciatica can be so painful even when a scan shows only a small bulge. As the inflammation settles, and as disc bulges often shrink over time, the pain eases.
How long does sciatica last?
The NHS says most sciatica improves within a few weeks to a few months, and many people feel noticeably better within the first month. For a smaller group the pain lasts longer, and it can come back. Staying active, building strength gradually and avoiding long periods of sitting all help you recover faster. Bed rest, being afraid to move and repeatedly aggravating the nerve all slow it down.
Sciatica red flags: when to call 999 or go to A&E
Rarely, sciatica-type symptoms are caused by severe pressure on the nerves at the base of the spine, called cauda equina syndrome. This is an emergency. Call 999 or go to A&E straight away if you have:
- Sciatica in both legs
- Severe or worsening weakness or numbness in both legs
- Numbness around your genitals or anus
- Difficulty starting to pee, being unable to pee, or losing control of your bladder, when that’s unusual for you
- Not noticing when you need to poo, or losing control of your bowels, when that’s unusual for you
Don’t drive yourself. Ask someone to take you or call an ambulance.
Sciatica treatment: what actually works
1. Keep moving, little and often
This is the single most important thing. Walking, gentle movement and getting on with normal activities as much as the pain allows all help recovery. The NHS advises against sitting or lying down for long periods, even when moving hurts. In professional sport we never put a player with sciatica on bed rest. We keep them moving within what the nerve tolerates and build back from there.
2. Find the movements that ease your leg pain
Most people have positions and movements that ease their leg pain and others that aggravate it, and a good assessment finds these quickly. A useful rule: if a movement makes the pain spread further down your leg, back off. If it makes the pain move up out of the leg towards your back, that’s usually a good sign, even if your back aches a little.
3. Build strength as the pain settles
As the nerve calms down, progressive strengthening for your back, hips and legs gets you back to full activity and makes it less likely to come back. NICE recommends exercise for low back pain with or without sciatica, and hands-on treatment such as massage or joint mobilisation only as part of a package that includes exercise.
4. Be realistic about medicines
Speak to your GP or pharmacist about pain relief. The NHS notes that paracetamol is unlikely to help sciatica and that the evidence for anti-inflammatories such as ibuprofen is unclear. NICE advises doctors not to offer gabapentinoids such as gabapentin and pregabalin, other anti-epileptics, oral steroids or benzodiazepines for sciatica, and not to offer opioids for long-standing sciatica.
5. Injections and surgery, for the few who need them
NICE says an epidural injection of local anaesthetic and steroid can be considered for acute, severe sciatica, and spinal decompression surgery when non-surgical treatment hasn’t helped and a scan matches your symptoms. In a landmark Dutch trial, early surgery relieved leg pain faster than continued non-surgical care, but by one year the results were similar. That’s why most people start with a structured rehab plan.
Sciatica exercises to start with
These are safe starting points for most people. Move slowly, keep any increase in leg pain mild and short-lived, and stop any exercise that makes the pain spread further down your leg.
- Walking: short, frequent walks, adding a little distance each day
- Knee rolls: lying on your back with your knees bent, gently rolling them from side to side
- Nerve sliders: sitting tall, straighten one knee as you look up, then bend it as you look down, 10 slow repetitions
- Glute bridges: lifting your hips off the floor with control, building to 3 sets of 10
- Bird dog: on your hands and knees, reaching out one arm and the opposite leg, then swapping sides
Everyone’s sciatica is different, so we tailor these and add others. For example, some people’s leg pain eases when they arch backwards, and they do well with extension exercises.
When to see a physio about sciatica
Book an assessment if your leg pain isn’t clearly improving after a couple of weeks, if it’s getting worse, if it’s stopping you working, sleeping or exercising, or if you have numbness or weakness in your leg or foot. If you have any of the red flags above, go to A&E rather than booking a physio. You can read more on our back pain and sciatica page.
How we treat sciatica at Hauora
Your first appointment is a 45-minute assessment (£155). We screen for warning signs, test the strength, sensation and reflexes in your legs to see how the nerve is affected, and find out which movements ease or aggravate your pain. You leave with a clear explanation, a plan for the next two weeks and exercises you can start that day. Treatment combines hands-on techniques, graded exercise and advice on work, sleep and sport, with our strength and movement coaching to finish the job. If you need a scan, an injection or a surgical opinion, we’ll tell you and arrange the right referral. You’ll be seen by Geoff Scott or Jason Oliveira, both senior physiotherapists with elite-sport backgrounds.
Frequently asked questions
How long does sciatica last?
The NHS says most sciatica improves within a few weeks to a few months, and many people feel noticeably better within the first month. Some people have pain for longer, and it can come back, which is why a structured rehab plan is worth it.
Is it better to rest or keep moving with sciatica?
Keep moving. Gentle activity, short walks and regular exercises help recovery. Long periods of sitting or lying down tend to make sciatica worse and slow recovery, even though moving can hurt at first.
What is the best sleeping position for sciatica?
Most people find that lying on their side with a pillow between their knees, or on their back with a pillow under their knees, eases leg pain at night. Try both and use whichever lets you sleep longest.
Do I need an MRI scan for sciatica?
Usually not at first. NICE advises against routine imaging for back pain with or without sciatica. A scan is useful if you have red flags, or if your symptoms aren’t settling and an injection or surgery is being considered.
Can a physiotherapist help with sciatica?
Yes. Physiotherapy, including exercise advice and hands-on treatment, is one of the main treatments the NHS lists for sciatica. A physio also checks for warning signs and builds a plan to get you back to work, sport and sleep.
Is walking good for sciatica?
Usually, yes. Short, frequent walks keep the nerve moving and your back mobile. Start with what you can manage comfortably, even five or ten minutes, and add a little each day.
Related reading: lower back pain from sitting at a desk, strength training after 40 and returning to sport after injury.
Sciatica physio in Primrose Hill, St John’s Wood and Belsize Park
If sciatica is stopping you working, sleeping or training, book an assessment at Hauora, an independent physiotherapy clinic at 44 Gloucester Avenue, Primrose Hill, London NW1 8JD. We’re close to Chalk Farm and Camden Town stations and easy to reach from St John’s Wood, Belsize Park, Swiss Cottage, Hampstead, Regent’s Park, Marylebone, Kentish Town and Maida Vale. Book online at hauora.com/book or call 020 4541 8924.
Finding us: Hauora is based inside the At The Core building, but we’re a separate business from At The Core. We share the building and the phone number, so when you call, please ask for Hauora.
This article is general information, not a diagnosis. If you’re injured or unwell, see a doctor or physiotherapist.