Creator: BP Chiro
Published: 2026-11-04T09:00:00

Sciatica is pain that runs from the lower back or buttock down one leg, often below the knee. It can feel like burning, an electric shock or a deep ache, and the leg often hurts more than the back. It is a symptom, not a diagnosis: something is irritating one of the nerve roots that join to form the sciatic nerve. Finding out what, and which nerve, is what guides care.

What sciatica feels like

Pain from the buttock down the back or side of the leg, usually on one side
Leg pain that is worse than the back pain
Numbness, tingling or pins and needles in the leg or foot
Weakness, such as a foot that catches or trouble standing on your toes
Pain that flares when you sit, cough, sneeze or bend forward

What causes it

The most common cause is a slipped (herniated) disc pressing on or inflaming a nerve root low in the back. In studies of people having surgery for sciatica, at least 95% of the discs involved were at the two lowest levels, L4/L5 and L5/S1 (Deyo, NEJM 2016).

Spinal stenosis, a narrowing of the space for the nerves, more common after 50. Leg pain often builds with walking and eases when you sit or bend forward.
Spondylolisthesis, where one vertebra slips forward on the one below
Narrowing of the side openings where each nerve leaves the spine (foraminal stenosis)
Rarely, infection, a tumour or a fracture, which is why warning signs matter

Not every pain down the leg is sciatica. The hip, the sacroiliac joint and the buttock muscles can all send pain into the thigh. A proper examination tells these apart.

Which nerve is involved?

Each nerve root supplies its own strip of skin and its own muscles, so the pattern of symptoms gives a clue to the level. These patterns overlap, so they are a guide, not a diagnosis.

Nerve root	Where you may feel it	What may be weak
L4	Front of the thigh and the inner shin	Straightening the knee; the knee reflex may be reduced
L5	Outer shin, top of the foot and the big toe	Lifting the foot or big toe; walking on your heels
S1	Calf, sole and outer edge of the foot	Rising onto your toes; the ankle reflex may be reduced

How long does sciatica last?

For most people it eases with time. In a trial of 183 people with sciatica, nearly 9 in 10 had improved by 12 weeks, whether or not they rested in bed (Vroomen, NEJM 1999). Reviews also report that about 20% to 30% still have some symptoms after one to two years (Koes, BMJ 2007), so it is worth getting help if it is not settling.

Pain that has lasted longer, and a strong belief that it will not get better, are both linked with slower recovery (Jensen, BMJ 2019). Understanding what is going on is part of getting better.

Warning signs: go to a hospital emergency department now

These can mean the nerves at the bottom of the spine are badly compressed (cauda equina syndrome), which needs urgent hospital care:

Numbness around the genitals, anus or inner thighs (where you would sit on a saddle)
New trouble passing urine, controlling your bladder or bowels, or loss of sexual sensation
Sciatica in both legs at once
Leg weakness or numbness that is quickly getting worse, or a foot that suddenly drops

Also see a doctor promptly if you have a fever, unexplained weight loss, a history of cancer, or the pain started after a major fall or accident.

Do I need an MRI?

Usually not at first. Sciatica is diagnosed from your symptoms and an examination (Jensen, BMJ 2019). An MRI helps when there are warning signs, when symptoms are not improving despite care, or when an injection or surgery is being considered. Disc bulges are also common in people with no pain, so a scan has to be read alongside your examination.

What research says about care

Staying active: two weeks of bed rest gave no better results than carrying on as normally as possible (Vroomen, NEJM 1999).
Exercise: reviews find exercise reduces leg pain in the short term, though the effect is small on its own (Jensen, BMJ 2019).
Spinal manipulation: in a trial of 192 adults with leg pain from the back, adding spinal manipulation to home exercise gave more leg pain relief at 12 weeks than exercise alone. At one year the difference was no longer clear (Bronfort, Annals of Internal Medicine 2014).
In a small trial of 40 people whose sciatica had not settled with medical care, about 6 in 10 who had spinal manipulation improved as much as those who had surgery. The rest went on to have surgery, which also gave good results (McMorland, JMPT 2010).
UK guidance recommends exercise, and manual therapy such as manipulation only as part of a package that includes exercise (NICE NG59).
Medicines: a trial found pregabalin no better than placebo for sciatica, with more side effects (Mathieson, NEJM 2017), and UK guidance advises against gabapentinoids and oral steroids for it (NICE NG59). Never stop a medicine without speaking to your doctor.
Surgery: compared with prolonged non-surgical care, early surgery gave faster relief, but results were similar after one year (Peul, NEJM 2007). Surgery is worth discussing when symptoms do not improve and the MRI matches them (NICE NG59).

In short, the evidence favours staying active and exercising, with hands-on care as part of that plan, while keeping a close eye on warning signs.

How BP Chiro helps with sciatica

A full assessment first: your history, how you walk and move, then reflexes, sensation, strength and nerve tension tests such as the straight leg raise
A clear explanation of which nerve seems involved and why, and whether you need an MRI or a doctor's review
Gentle chiropractic adjustment or Activator therapy, chosen to suit your assessment
Physiotherapy exercises that you can do at home, starting with positions and movements that ease your leg pain, then building strength
Soft tissue therapy for tight, guarding muscles in the back and buttock
Referral to a doctor or spine specialist if there are warning signs or progress stalls

Recovery differs from person to person. Your clinician explains the plan, and how progress will be checked, before you start.

What you can do at home

Keep moving. Short, regular walks are usually better than lying down.
Notice which positions ease the leg pain and use them; notice which make it travel further down the leg and limit those for now.
Break up long periods of sitting and driving.
A warm pack on the lower back or buttock for 15 to 20 minutes can ease muscle spasm.
Do not push through numbness or weakness that is getting worse. Get checked.

Common questions

Can sciatica go away on its own?

Often, yes. Most people improve over weeks to a few months, and many disc herniations shrink on their own over time (Chiu, Clinical Rehabilitation 2015). Care aims to keep you moving and comfortable while that happens, and to catch the cases that need more.

Is walking good for sciatica?

For most people, yes, in short bouts that you build up gradually. If walking makes the leg pain steadily worse and sitting eases it, mention it at your assessment, as that pattern can point to spinal stenosis.

Should I see a chiropractor or a physiotherapist?

Research supports hands-on care combined with exercise, so at BP Chiro the two work together on one plan. Whoever you see first will check for warning signs and refer you on if needed.

Sciatica care in Kuala Lumpur, Johor Bahru and Penang

Every first visit at BP Chiro starts with a full spinal assessment. Choose the clinic nearest you:

References

Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-1317.
Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019;367:l6273.
Deyo RA, Mirza SK. Herniated lumbar intervertebral disk. N Engl J Med. 2016;374(18):1763-1772.
Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA. Lack of effectiveness of bed rest for sciatica. N Engl J Med. 1999;340(6):418-423.
Bronfort G, Hondras MA, Schulz CA, Evans RL, Long CR, Grimm R. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014;161(6):381-391.
McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. 2010;33(8):576-584.
Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med. 2017;376(12):1111-1120.
Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-2256.
Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-195.
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). 2016, updated 2020.

Sciatica: what it is, how long it lasts and what helps