Sciatica: what is normal, and what is an emergency

Sciatica is not a diagnosis. It is a description: pain travelling down the leg along the path of the sciatic nerve, usually because something in the lower back is irritating a nerve root. That distinction matters, because the treatment depends on what is doing the irritating.

Start here: the symptoms that cannot wait

Go to a hospital emergency department today, not to a physiotherapist, if you have any of these:

• Numbness or altered sensation around the groin, genitals, buttocks or inner thighs — the area that would touch a saddle.
• Difficulty starting or stopping urination, or not knowing when your bladder is full.
• Loss of bowel control.
• Sudden weakness in both legs, or weakness that is getting worse quickly.

These can indicate cauda equina syndrome, where the nerve bundle at the base of the spine is being compressed. It is rare. It is also time-critical, and waiting for a physiotherapy appointment to discuss it is the wrong call.

What normal sciatica looks like

Pain down the back or side of one leg, sometimes past the knee, sometimes to the foot. Often worse than the back pain itself. Frequently accompanied by pins and needles or a patch of numbness. Worse on sitting for many people, worse on standing for others, and usually easier when you change position.

That picture, in a single leg, with no red flags, is the ordinary version. It is unpleasant and it is not dangerous.

The timeline

Roughly three quarters of cases settle substantially within six to twelve weeks. Most of the improvement happens without an injection and without surgery. Knowing that is genuinely useful when you are in week two and it feels like it will never end.

What helps

Keep moving. Bed rest was standard advice for decades and it turned out to make outcomes worse. Frequent short walks, changing position often, and staying at work in some capacity if you can are all associated with faster recovery.

Find your directional preference. Many people with disc-related sciatica have a movement direction that reduces the leg symptoms and pulls the pain back towards the spine. Finding it is one of the more valuable things an assessment does, because it turns a general instruction to exercise into a specific one.

Manage the pain properly. Uncontrolled pain keeps you still, and staying still is the thing that slows recovery. Pain relief is not a failure of nerve; it is what makes the movement possible.

Then load it. Once symptoms are settling, strength work for the hips, trunk and legs is what reduces the chance of it happening again. Recovery that stops at "not in pain any more" tends to be temporary.

What does not help as much as people think

Long courses of passive treatment with no exercise. Traction as a standalone answer. Waiting for a scan before starting anything. And repeated imaging in the absence of new symptoms — a disc bulge on a report is not a prognosis.

When to get it looked at

Book an assessment if the leg pain has lasted more than a week or two, if it is stopping you sleeping or working, or if you have had it before and want to stop the cycle. Go to hospital instead if any of the red-flag symptoms above are present.