Low back pain with sciatica

Sciatica is pain that travels down the back of the leg from the lower back or buttock to the foot. It is often accompanied by back pain, the leg pain can be worse than the back pain.

The nerves leave the spine through small tunnels made by the bones of the spine. The sciatic nerve can be irritated. If any of the nerves leaving the spine are irritated this can cause pain along the length of the sciatic nerve.

X-rays are rarely useful in diagnosing neck pain and don’t help to guide treatment, either from your GP or physiotherapist. Most x-rays will show normal, age related changes, which are not a cause for pain.

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Causes and symptoms

Symptoms of low back pain with sciatica

Radiculopathy describes symptoms produced by the pinching of a nerve root in the spinal column. Sciatica is one of the most common types of radiculopathy and refers to pain that originates in your lower back and travels to your buttocks and down the sciatic nerve. Sciatica is rarely the sign of a serious problem. It can however be very painful. The pain you experience does not mean ongoing damage is being done. It can cause the following symptoms:

Sharp shooting pain
Pins and needles
Numbness

The sciatic nerves send messages to the brain about the irritation and it makes the brain think the problem is the nerve itself and not in the back, which is actually the cause of the pain.

Remember 90% of cases resolve without specialist input and treatment and more than 70% people report improvements in their symptoms within four weeks.

Diagnosis of low back pain with sciatica

X-rays are rarely useful in diagnosing back pain and don’t help to guide treatment, either from your GP or physiotherapist. Most x-rays will show normal, age related changes, which are not a cause for pain.

When to seek urgent help

The following symptoms are rare, but if you experience them you should seek medical help.

You are unable to pass urine when you feel the need to go.
Have numbness around your bottom/saddle region.
Have loss of control of your bowels.
You are unable to get an erection.
You have pain in both legs and/or worsening weakness in the legs.

Self management of low back pain with sciatica

Keep moving

Try to remain active where possible and don’t sit in the same position for a long period of time. Keeping mobile with gentle exercises will maintain your back movements, preventing a long-term problem.

Exercises

You will be given advice on activities that will help you. It is common to have some degree of discomfort during recovery, but this is not harmful. Don’t do anything that causes excessive pain, but don’t be frightened of it either. You may have to accept some discomfort when you are trying to keep active and whilst doing exercises.

Pain relief

You may find that you need to take regular pain relief. This can help you to keep moving and exercising and also help you to sleep.

Pace yourself

Do not avoid movement, but pace yourself.

Talk to your GP/health professional

Remember if you have specific concerns it is important to discuss this with your GP or health care professional.

Relaxation

Try to relax and manage your stress – low mood, fear and anxiety can impact on pain. Mindfulness or relaxation techniques can sometimes help.

Exercises for low back pain with sciatica

Exercise 1: pelvic tilts

Lie on your back with your knees bent and your feet flat on the floor.
Put your hands on your hips. Slowly roll your pelvis – tilt your tailbone – upward and close the space between your low back and the floor.
You’ll feel a gentle stretch of your low back.
Return to the original position.

Exercise 2: knee rolls

Lie on your back. Keep your knees bent and together.
Keep your upper body relaxed. Roll your knees to one side, keeping both shoulders on the floor.
Hold the stretch in your back/hip and return to the starting position.

Exercise 3: hip flexion

Stand sideways
Make sure you are supported
Keep your knee straight
Take your leg forwards and back. Repeat

Exercise 4: standing side bend stretch

Start in a standing position.
Next, bend your trunk to the side as you slide your hand down the side of your legs.
Do not bend forward or back.
Repeat to the other side.
Keep your muscles relaxed during the movement.

Exercise 5: four point kneeling forwards weight transference

In four point kneeling.
Move your body forwards and backwards over your hands.
You should try to increase the weight through your arms.

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

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