Sciatica or lower back pain with leg pain

Sciatica is a common term used to describe pain that travels down the leg because the sciatic nerve has become irritated. The sciatic nerve is formed from nerves that leave the lower part of your spine before travelling through the buttock and down the leg. Symptoms occur when one of the nerves in the lower back that forms the sciatic nerve becomes irritated or compressed. Most cases settle naturally within 12 weeks. There is not always a known trigger of sciatica. Some people experience symptoms following an injury, whereas others have no obvious trigger.

The main symptoms of sciatica are:

• Pain from the lower back radiating down the leg and sometimes into the foot. Often pain is felt in the buttock area. The severity of the pain can vary. Some will experience severe symptoms and others mild
• Pins and needles or tingling affecting a part of the leg
• Some people notice that their leg feels weaker – if you notice significant weakness, you should seek attention from a healthcare professional

South Tees Hospitals NHS Foundation Trust have a useful Sciatica facts page for further information. 

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Know When to Seek Help

If you have symptoms that could suggest cauda equina syndrome, seek urgent medical assessment. This is usually through A&E because early assessment is important. If untreated, it can sometimes cause permanent problems affecting the legs, bladder, bowel or sexual function. You can download a cauda equina syndrome information card for further information.

There are many causes of back pain. Although the symptoms can be distressing, most do improve with time. There are circumstances where a medical opinion is appropriate. If you are experiencing any of the following, please contact 111 or your GP for advice.

• New weakness in one or both legs, or difficulty walking or coordinating your legs.
• Severe pain that is worse at night and not relieved by changing position
• Fever (temperature above 38 degrees) and severe back pain
• Pain that started after a serious accident, such as after a car accident
• Back pain and a history of previous cancer
• Back pain following a minor injury or lift if you have osteoporosis

Do I need further investigations?

Many people ask whether they need a scan. It is natural to think an MRI scan would be helpful to guide management and provide a diagnosis. In most circumstances it does not change treatment. An MRI scan shows detailed images of the back, however a scan is not usually needed to diagnose sciatica.

There are circumstances where further investigations are necessary. For example, suspected cauda equina syndrome, significant new muscle weakness, a serious underlying condition, or persistent sciatica symptoms. A healthcare professional would recommend further investigation in these contexts.

The information below is reproduced from NHS England's BestMSK patient advice to help explain what an MRI scan can and cannot tell us, and when an MRI may be appropriate.

Some important things you need to know about what an MRI scan can tell us and when it is appropriate

• MRIs provide a picture of the anatomy of the spine.

• MRIs cannot tell how someone feels and are not a diagnosis.

• MRIs can be used to plan treatment with you and rule out serious conditions such as cancer or fractures.

• MRIs are rarely needed for people with back or neck pain.

• MRIs should be requested after assessment by a specialist.

Some important things you need to know about your MRI scan report

• Some of the medical words used in MRI reports can be complex and may sound scary.

• For example, eight out of ten people aged 50 or over with NO pain have something called ‘degeneration of discs’ noted in their MRI report. However, findings such as this are more common as we become older and can be signs of a naturally maturing spine.

If you have any questions about having an MRI scan or need clarification on the report of an MRI scan, please discuss these with the clinician who sent you for the MRI.

Lifestyle factors that influence health

Symptoms associated with sciatica can be influenced by overall health. Physical activity levels, carrying extra weight, long-term stress, sleep quality and smoking can all affect recovery. Maintaining good general health can support recovery and improve long-term spine health. More support with health and lifestyle factors can be found on our Your Musculoskeletal Health webpage.