Sciatica

Sciatica is nerve pain that travels down the leg, usually because a nerve root in the low back is being irritated or compressed. The leg, rather than the back, is what defines it — the radiating pain and the disability that comes with it are its main features.^[1]

The usual course is favourable: most of the pain and disability settles within a couple of weeks, though 20% to 30% of people still have problems one or two years on. Following 609 people through primary care, 55% had clearly improved at twelve months — which also means 45% had not. Sciatica often gets better. It does not always.^{[1, 2]}

That same study found that one of the strongest predictors of not improving was the person’s own belief that the problem would last a long time. What you are told about your back appears to matter to how your back does — which is a good reason to be wary of anyone who tells you your spine is failing and will need looking after indefinitely.^[2]

That is the direction the whole field has moved: passive treatments, bed rest among them, replaced with active ones and with advice and information that help you manage it yourself.^{[1, 3]}

A scan is not the first move. NICE advises against routine imaging outside a specialist setting — which is a rule against scanning by default, not a rule against ever scanning, and an examination that turns up warning signs is a different situation.^[3]

There is also a deadline, and it is worth knowing before you start: referral to a specialist — a neurologist, rheumatologist or spine surgeon — is indicated where symptoms have not improved after six to eight weeks of conservative treatment.^[1]