What is sciatica, and what does it actually feel like?
Sciatica is leg pain caused by irritation of the sciatic nerve, typically producing pain that travels from the lower back or buttock down through the back of the thigh and into the calf or foot. Most cases resolve within 8 to 12 weeks with the right treatment approach and do not require surgery. The key is accurate diagnosis of what is compressing or irritating the nerve, then treating accordingly.
The pain itself varies enormously from person to person. Some patients describe a dull, constant ache. Others report an electric shock sensation triggered by coughing, sneezing, or simply sitting too long. Tingling, numbness, and weakness in the foot or toes are common. One patient may struggle to sit at a desk for ten minutes; another walks comfortably but can’t sleep on their back. That range of presentations is why a proper clinical assessment matters far more than an MRI alone.
A 2015 systematic review published in AJNR (Brinjikji et al.) found that disc abnormalities are remarkably common in people with no symptoms at all, with disc bulges present in up to 52% of asymptomatic 30 to 39 year-olds. Disc findings on imaging don’t always correlate with the pain a patient feels. This is one of the most misunderstood aspects of the condition.
What causes the sciatic nerve to become irritated?
Disc herniation remains the most common identifiable cause, accounting for roughly 90% of cases where a structural cause is found. The disc material presses against the nerve root as it exits the spine, producing inflammation and pain that radiates into the leg. But a disc bulge on an MRI doesn’t automatically mean the disc is the problem. A systematic review published in AJNR (Brinjikji et al., 2015) showed that 30% of people with no symptoms at all have disc protrusions visible on imaging.
Spinal stenosis, where the canal through which the nerve passes narrows with age, is another frequent cause, particularly in patients over 60. Piriformis syndrome, where a deep buttock muscle spasms and compresses the nerve, is often overlooked. Spondylolisthesis, pregnancy, and even prolonged sitting on a hard surface can trigger sciatic symptoms.
Patients living on the Costa del Sol often present with a specific pattern. Long flights to and from northern Europe, followed by sudden increases in physical activity on arrival, can aggravate a previously stable disc. Flora Muijzer, physiotherapist at Costa Health, sees this cycle repeatedly during peak travel seasons.
How does the McKenzie Method treat sciatica?
The McKenzie Method (Mechanical Diagnosis and Therapy) is one of the most evidence-based approaches for spinal pain and sciatica. It works by classifying patients according to how their symptoms respond to specific repeated movements and sustained positions during the assessment. This isn’t a set of generic stretches. It’s a diagnostic framework.
During a McKenzie assessment, the clinician will ask the patient to perform a series of movements, typically repeated extensions, flexions, and side-gliding of the lumbar spine. The clinician watches closely for what’s called “centralisation”: the phenomenon where leg pain retreats towards the spine and eventually disappears. A 2004 study in Spine journal found that patients who centralise during initial assessment have an 83% chance of a good outcome with conservative treatment.
Not every patient centralises. When symptoms peripheralise, moving further down the leg with testing, it signals a different mechanical pattern requiring a different approach. That distinction is what makes McKenzie assessment genuinely useful rather than a one-size-fits-all exercise prescription.
At Costa Health, the McKenzie approach forms part of a broader treatment strategy. Physiotherapy may include nerve mobilisation techniques, core stabilisation work, and progressive loading. When joint restriction is contributing to nerve irritation, chiropractic spinal adjustments can restore segmental mobility. Osteopathy addresses the wider kinetic chain, looking at how hip stiffness or thoracic restriction may be overloading the lumbar spine. Sports massage targets the muscular guarding that so often accompanies sciatica, particularly in the gluteal muscles and hamstrings.
Can sciatica go away on its own?
Many cases do resolve without treatment. The natural history is generally favourable, with most acute episodes settling within six to twelve weeks. But “settling” doesn’t always mean fully resolving. Patients frequently adapt their movement patterns to avoid pain, developing compensations that create secondary problems months later.
Self-management plays an important role. Staying active within pain tolerance is critical. Bed rest beyond the first day or two worsens outcomes. Walking is almost always helpful. Specific directional exercises, identified through a McKenzie assessment, can accelerate recovery significantly.
Ice and heat both have their place. Ice helps in the first 48 to 72 hours when inflammation is acute. Heat works better for the chronic muscular tension that develops around the affected area. Neither is a cure, but both can reduce the need for painkillers.
When does sciatica actually need surgery?
Surgery is genuinely needed in a small minority of cases. Cauda equina syndrome, where the bundle of nerves at the base of the spine becomes severely compressed, requires emergency surgical decompression. Warning signs include loss of bladder or bowel control, numbness in the saddle area (inner thighs and perineum), and rapidly progressive weakness in both legs. Anyone experiencing these symptoms should attend A&E immediately.
Outside of cauda equina, surgery becomes a reasonable consideration when a patient has persistent, severe leg pain that hasn’t responded to at least six to twelve weeks of quality conservative care, and imaging confirms a structural cause matching their symptoms. The word “quality” matters. Six weeks of rest and ibuprofen is not the same as six weeks of targeted rehabilitation.
Microdiscectomy has a success rate of approximately 85% for well-selected patients with confirmed disc herniation. However, a landmark trial published in JAMA (Weinstein et al., 2006), with follow-up data through eight years, found that surgery produced faster improvement but long-term outcomes were broadly comparable. A 2020 trial in the New England Journal of Medicine (Bailey et al.) reached similar conclusions for patients with sciatica lasting 4 to 12 months.
Common misconception: a large disc herniation on MRI automatically means surgery. Size alone doesn’t determine need. The clinical picture, the patient’s response to conservative treatment, the functional limitation, and the imaging findings all need to align before surgery is warranted.
What does a sciatica assessment at Costa Health involve?
A first appointment involves a thorough history taking, followed by orthopaedic and neurological testing. Range of motion, muscle strength, reflexes, and sensation are all assessed. Specific provocation tests, such as the straight leg raise and slump test, help determine the degree of nerve involvement.
Sarah Monaghan, chiropractor with over 20 years of clinical experience, and Flora Muijzer, BSc Physiotherapy and McKenzie-trained (Colfisio registration 13635), work together at Costa Health to build a clear picture of what’s driving each patient’s pain. Treatment might involve chiropractic adjustment one week and physiotherapy-led exercise the next, depending on what the patient needs at each stage of recovery.
Imaging is requested only when clinical findings suggest it’s necessary, not as a routine first step. When red flags are identified, referral for MRI or specialist consultation happens promptly. The goal is always to get the patient moving better, hurting less, and confident in managing their own condition long term.
For patients dealing with back pain alongside sciatica, or those whose symptoms overlap with conditions like facet joint dysfunction, the multidisciplinary approach at Costa Health ensures nothing gets missed.