Sciatica

What is actually happening

The sciatic nerve is formed from the L4, L5, S1, S2 and S3 nerve roots as they leave the lower spine. When one of those roots is compressed, most often by a disc that has bulged or herniated backwards and to one side, the pain is felt not at the spine but along everything that root supplies. That is why a problem in your back produces pain in your calf.

The level involved is readable from the pattern. Pain and numbness down the outer calf into the big toe, with weakness lifting the foot, points to L5. Pain into the sole and little toe with a reduced ankle reflex points to S1. This is why examination matters as much as imaging: MRI findings are common in people with no symptoms at all, and treating the wrong level achieves nothing.

Symptoms we take seriously

• Pain radiating from the buttock down the back or outer aspect of one leg, often below the knee
• Sharp, electric or burning quality rather than the dull ache of muscular back pain
• Worse on sitting, coughing, sneezing or straining, all of which raise intradiscal pressure
• Numbness, pins and needles, or a heavy feeling in a defined strip of the leg or foot
• Weakness lifting the foot, standing on tiptoe, or climbing stairs

How we work out the cause

Your assessment takes 60 to 90 minutes. We take a full history (how it started, what makes it worse, how far you can walk before it stops you), then examine reflexes, power, sensation and straight leg raise to establish which root is involved and whether the deficit is static or progressing.

3D biomechanical imaging then shows how the segment is loaded: lateral deviation, disc height loss, facet arthropathy, pelvic obliquity. If you already have an MRI, we read it into the same model rather than sending you for another one. The consultant shows you the findings on screen and tells you plainly whether this is a case our protocol suits.

How we treat it

Decompression first. Acoustic wave therapy releases the paraspinal guarding holding the segment compressed, allowing disc height and foraminal clearance to recover. Sessions run 20 to 30 minutes, two to three times weekly. Most patients begin noticing that the leg pain retreats upward, from calf toward buttock, before it goes entirely. That centralisation is the signal we look for.

Inflammation, where it persists. If a root remains irritated after structural correction, a transforaminal epidural injection or selective nerve root block delivers anti-inflammatory medication precisely to the level involved. This is a day-care procedure under image guidance, and it is not the default, it is used when examination and imaging agree that inflammation, not mechanics, is now the limiting factor.

Then the part that prevents recurrence. Sciatica recurs because the movement pattern that produced it is unchanged. DNS retrains deep trunk and diaphragmatic control; hip hinge mechanics, gluteal strength and sitting tolerance are rebuilt progressively. This phase runs 4 to 12 weeks with formal review at 30, 60 and 90 days.

What recovery realistically looks like

Most patients with a first episode and a contained disc prolapse see meaningful change within the first three to four weeks. Long-standing sciatica with significant degeneration takes longer and may not return you to a completely pain-free state, the honest goal in those cases is function: walking distance, sitting tolerance, sleep.

Anyone who guarantees you a specific outcome before seeing your images is guessing. We give you an expected session count and a cost breakdown in writing after your assessment, and we revise it at review if the response is not what we predicted.