How sciatica differs from ordinary lower back pain
The word sciatica describes a symptom, not a diagnosis. We use it when pain runs along the course of the sciatic nerve – from the buttock down the back of the thigh, usually below the knee – often with altered sensation or loss of strength. Neurological deficits are not a requirement: radicular pain on its own, with normal sensation and strength, is still sciatica. That is what separates it from lower back pain, which can radiate into the buttock and thigh but stops above the knee.
The distinction matters in practice, because the two situations are managed differently. With an irritated nerve root the key is to find the direction of movement that pulls the symptoms back towards the spine, and to avoid positions that push them further down the leg.
What the assessment looks like
At the first visit we check sensation in each area of the leg, the strength of the muscles supplied by particular nerve roots, and the tendon reflexes. To that we add nerve tension tests and an assessment of lumbar and hip mobility. This part takes about fifteen minutes, but it decides everything we do afterwards – including whether this is a problem for physiotherapy at all, or whether you need to see a doctor first.
We also check the gluteal muscles. Tension in piriformis or trigger points in gluteus medius can produce pain that looks very much like radicular pain, yet responds to completely different management – often well to manual therapy and soft tissue work.
What to expect during treatment
The first weeks are mainly about reducing irritation: finding positions that offload, manual work, and learning to move without provoking the symptoms. This is not about avoiding movement, but about dosing it sensibly.
The next stage is rebuilding. We introduce exercise that improves nerve glide in the tissues, trunk control and gluteal strength, increasing the load step by step. The pace depends on how you respond – if the symptoms start travelling further down the leg, we take a step back.
The final stage is about getting back to what you do every day: picking up a child, working in the garden, training at the gym. This is the moment for correcting technique and agreeing a set of exercises you will realistically do at home.
When to come in
There is no need to wait until the pain becomes unbearable. The sooner we establish what is actually happening in the leg, the easier it is to avoid weeks of treatment that misses the point. If the symptoms have lasted more than a few days, or keep coming back, they are worth assessing. No referral is needed – details are on the Contact page.