Sciatica that stops running your day
Sciatica describes pain travelling from the lower back into the buttock and down the leg, often with pins and needles, numbness or weakness.
“I came to him with chronic ongoing back pain. I have seen chiropractors and osteopaths previously who have done nothing to alleviate the pain. Before I saw Josh I couldn't even squat without extreme pain. In this short space of time this pain is now gone.”
It is a symptom, not a diagnosis
Sciatica tells you a nerve is irritated. It does not tell you why, and that distinction changes everything about treatment.
The same leg pain can come from a disc, from narrowing where the nerve exits, from deep hip tissue, or from a nerve that has simply become more reactive over time.
Identifying which of those you are dealing with is the entire point of the first appointment. Get that right and the plan almost writes itself.
Whether it has been labelled a slipped disc, a herniated disc or simply nerve pain, the requirement is the same: someone needs to work out which structure is actually involved before treating it.
Common drivers
Accurate assessment separates genuine nerve root involvement from referred pain.
Disc irritation
The most common driver. A disc bulge can chemically or mechanically irritate the nerve root as it exits the spine.
Lateral canal narrowing
Reduced space where the nerve travels. More common with age, often worse standing and walking, easier when seated.
Gluteal and deep hip tissue
The sciatic nerve passes close to deep hip muscles. Tension here can closely mimic true nerve root pain.
Nerve sensitisation
When symptoms have been present a while, the nerve becomes more reactive and less tolerant of ordinary load.
Settle the irritation, then rebuild tolerance
Manual therapy and graded nerve mobility work, followed by loading that the nerve can actually handle.
Why sciatica is a back problem
The leg is where you feel it. The lower back is usually where it comes from, and that changes what treatment has to cover.
The nerve is irritated at the spine
The sciatic nerve is formed from nerve roots that leave the lower back. When one of those roots is irritated or compressed there, the pain is felt down the buttock and leg. Plenty of people with severe leg pain have very little back pain at all, which is why sciatica is so often treated as a leg problem.
Leg first, back second
As the nerve settles, symptoms usually retreat up the leg towards the spine, and some people notice their back for the first time as the leg quietens down. That pattern is progress. It also means the back needs its own rehabilitation once the nerve has calmed, or the same episode tends to come round again.
When leg pain needs urgent attention
Most sciatica, however painful it feels, is not dangerous and settles with the right treatment. There are a small number of symptoms though that I would want you to act on the same day rather than wait for an appointment with me.
Please get urgent medical help the same day if you have any of these
- Numbness or altered feeling around the back passage, the genitals or the inner thighs
- Difficulty passing urine, or losing control of your bladder or bowels
- Numbness, pins and needles or weakness in both legs, particularly if it is spreading or getting worse
- Legs that feel unsteady or as though they are giving way underneath you
I would also want you to speak to your GP before booking in with me if your pain followed a significant fall or accident, if you feel generally unwell or feverish with it, if you are losing weight without trying, if you have a history of cancer, or if the pain is constant and clearly worse at night. I screen for all of this at every assessment, and if what you need is someone other than a physiotherapist, I will tell you and point you in the right direction.
Josh Devine, Specialist MSK Physiotherapist
“I went to Josh about having pains in my back. Not only did I walk away feeling so much relief at the time, he gave me a plan to ensure the pain did not come back.”
How we treat sciatica
Establish what is irritated
Neurological testing, movement assessment and a careful history to identify the source.
Settle the irritation
Positions, movements and manual techniques that reduce load on the nerve, plus clear guidance on what to avoid short term.
Restore movement
Graded nerve mobility work and loading that rebuilds tolerance rather than provoking symptoms.
Prevent recurrence
Address the loading pattern, strength and habits that allowed it to happen in the first place.
Long term spinal pain, twelve months on
Raffaela had persistent spinal pain. Here is how the approach differed.
- Whole picture assessed, not just the painful area
- Lifestyle factors addressed alongside treatment
- Real understanding of her own symptoms
- Tools to manage it long term
What our patients say
Chronic back pain, resolved
“I came to him with chronic ongoing back pain. I have seen chiropractors and osteopaths previously who have done nothing to alleviate the pain. Before I saw Josh I couldn't even squat without extreme pain. In this short space of time this pain is now gone.”
Thinking differently about pain
“After years of abuse at work and chronic back pain, Josh eased my mind and got me to think differently and manage my pain in a completely different way. I have stretching exercises and strength training. Can't recommend Josh enough.”
Sorted in two sessions
“2 sessions with Josh sorted my lower back pain, would highly recommend.”
What good looks like
Find us
Visit our private clinic in Medway for your assessment.
BetterMe Physiotherapy
9 Eastwood Meadow
Rainham, Gillingham
ME8 8FA
Parking
Dedicated parking is available for all our patients directly outside the clinic.
Opening hours
Mon - Fri 09:00 - 21:00
Saturday 09:00 - 18:00
Sunday 09:00 - 14:00
Get in touch
Get your sciatica assessed
Three quick questions and your number. Josh reads every enquiry himself and comes back within a couple of hours.
- No referral needed
- Evenings until 9pm plus weekends
- Free 10 minute call if you would rather talk first
- We will say if physiotherapy is not the right answer
Common questions
How long is an appointment and how many will I need?
Do you offer physio for sciatica?
How do you know it is sciatica and not just back pain?
Is sciatica serious?
How long does sciatica last?
Will I need surgery?
Can I exercise with sciatica?
Do I need a referral?
How sciatica recovery usually goes
Every case differs, but this is the shape of it. You will know where you are at each stage.
- First appointment
Find out what is irritating the nerve
Neurological testing to establish whether the nerve is genuinely involved, and what is compressing or irritating it. You leave knowing which it is.
- Weeks one to three
Settle the irritation
Positions and movements that unload the nerve, hands on work where it helps, and a clear list of what to avoid for now.
- Weeks three to eight
Rebuild tolerance
Graded loading through the back, hip and leg. This is the part that stops it returning, and the part most people never get to.
- From week eight
Back to normal loading
Lifting, sitting, driving and training without planning your day around it. Longer if it has been there for years, but the direction is the same.