If you've got sciatica right now, I'd put money on two questions going round your head. How long is this going to go on for? And is there anything I can do to make it go faster?
You've probably already worked out which chairs you can sit in and which ones you can't. You put your socks on in a particular order, you brace yourself before a sneeze, and at night you're doing the slow shuffle to find the one position where your leg doesn't burn, buzz or ache all the way down to your foot.
I see a lot of people with sciatica, and most of them aren't as worried about the pain as they are about not knowing where it's going. So let's deal with that first, because the honest answer is a lot more hopeful than most people expect.
First, a quick recap
Sciatica isn't a diagnosis on its own. It's the name for pain travelling down the leg because a nerve root in the lower back is irritated, and the most common reason is a disc. I've already written a whole article on what sciatica is and what causes it, so I won't go over all that again here. You can read that article here if you want to know more. This post is about the question everybody asks next, which is how long.
Most sciatica gets better, and here's the evidence
Here's the good news first. For most people, sciatica does get better.
Some of the best evidence on this comes from a Dutch trial of 283 people who'd had severe sciatica for six to twelve weeks. Half of them were booked in for early surgery. The other half carried on with non-surgical care and only had an operation if they needed one. Surgery did get people's leg pain easing faster. But after a year, the two groups had ended up in much the same place, with around 95 in every 100 people in both groups saying they'd recovered. And of the people who started with non-surgical care, around six in every ten never needed the operation at all.
So if you're in the thick of it now, the most likely outcome by a long way is that you get better. What you're really trying to change is how quickly, and how well.
The bit that surprises almost everyone
This is something I explain in clinic nearly every week, and you can see people's faces change when it lands.
Most people assume that the worse their disc looks on a scan, the worse their chances are. It's often the other way round.
A review that pulled together the scan studies looked at how often a disc herniation shrinks back on its own, without surgery. For a simple disc bulge it happened in about 13 in every 100 people. Where the disc had pushed further out, it was around 41 in every 100. Where disc material had pushed right out through the wall of the disc, it was around 70 in every 100. And where a piece had broken off completely, it was about 96 in every 100.
Nobody's saying a nasty-looking scan is good news, and a scan only ever tells you part of the story. But if you've been lying awake worrying about the words on your MRI report, it's worth knowing that the dramatic-sounding ones are often the ones most likely to settle. And if you've got a scan report you're worried about, bring it in with you. I'll go through it with you line by line and tell you what it actually means for you.
What actually speeds it up
Keep moving. What I tell everyone is to carry on with as much of your normal day as you can, and not to sit or lie down for hours at a time. Moving with sciatica can hurt, but hurting isn't the same as doing damage. Going to bed and resting it, which is what a lot of us grew up being told, isn't the answer.
Find the movements that calm it down, not just the ones that set it off. Most people with sciatica have a very clear list of the things that hurt. Far fewer have a list of the things that help. That's usually where we start, because once you've got two or three positions or movements that ease your leg, you've got some control back and the worry starts to come down with it.
Build it up gradually. Too much too soon and you flare it, too little and everything around it gets stiffer and weaker. Getting that balance right for you, week by week, is a big part of the job.
Don't pin your hopes on tablets on their own. This one surprises people. A trial of 209 people with sciatica gave them either pregabalin, a nerve pain medicine that's often prescribed for it, or a dummy tablet. After eight weeks, and again after a year, there was no meaningful difference in leg pain between the two groups, and the people taking pregabalin had more side effects, dizziness in particular. Never stop or change a medicine without talking to whoever prescribed it, but it's worth knowing that tablets alone aren't the answer for most people.
When it's dragged on for months
Not everybody follows the usual pattern. Some people are still struggling four, six or nine months later, and they deserve a straight conversation rather than more of the same.
A Canadian trial looked at exactly that group, people whose sciatica had lasted between four and twelve months. Six months on, the people who'd had surgery were in noticeably less leg pain than the people who'd carried on without it, scoring 2.8 out of 10 on average compared with 5.2.
That doesn't mean everyone with long-standing sciatica needs an operation. It means that if yours has gone on for months without real progress, you need someone to look at it properly, tell you honestly where you are, and if it's right for you, help you get a surgical opinion. Sitting on it for another six months and hoping isn't a plan.
How we approach sciatica at BodyCare
We start with your story: when it began, what makes it better, what makes it worse and what you've tried so far. Then we test the whole picture, not just the spot that hurts, so that's your nerves, strength, sensation and how you move. We measure where you are on day one, so we can retest it and show you whether things are actually changing.
You'll get a straight answer on what we think is driving it and roughly how long it should take. Treatment usually mixes hands-on work with a plan you can follow at home, built up as your leg allows, and for disc-related cases we may talk to you about options like IDD Therapy. If we think you need an opinion from your GP or a spinal surgeon, we'll tell you so and help you get there. You can read more about how we treat sciatica.
When to get seen urgently
Most sciatica isn't dangerous, but a small number of symptoms need help the same day. Go to A&E or call 999 if you have sciatica in both legs, weakness or numbness in both legs that's severe or getting worse, numbness around your genitals or your bottom, or a new problem starting, stopping or controlling when you pee or poo. Don't drive yourself. Ask someone to take you or call an ambulance.
If this sounds like your leg
If you're a few weeks into sciatica and fed up of guessing, or months in and getting nowhere, you don't have to keep working it out on your own. Come and see us. We'll work out what's driving it, tell you honestly how long it should take, and you'll leave your first appointment with things you can start doing that same day.
The sooner we see you, the sooner you've got a plan instead of a guess. Book your appointment online or give us a ring on 01638 724042.