Sciatica: A Pain in the Butt (Literally!) – 5 Facts You Need to Know

In my last blog, we explored osteoarthritis and how to manage it. If you missed it, you can catch up here. Today, we’re diving into sciatica—a term many people hear but don’t fully understand. Sciatica symptoms vary widely, making it tricky to identify. This guide will help you recognize the signs and understand the causes.

1. Sciatica Is a Symptom, Not a Diagnosis

Sciatica isn’t a condition itself—it’s a way of describing pain along the sciatic nerve. A true diagnosis should explain why you have sciatica. If you’re told you have it, ask your healthcare provider: What’s causing it? (See point 4 for common causes.)

2. Sciatica Can Affect Different Parts of the Body

The sciatic nerve starts in the lower spine (L4-S3), runs through the buttocks, and extends down the back of each leg. Near the knee, it splits into two nerves:

  • Tibial nerve – Travels down the back of the calf (lower leg) and into the foot.
  • Common peroneal nerve – Runs along the outside of the lower leg.

Symptoms can appear in any of these areas, or even multiple spots at once, including:

  • Lower back
  • Buttock
  • Back of the thigh
  • Calf (back or side)
  • Foot
  • Toes (especially the big toe)

Interestingly, not everyone with sciatica has lower back pain!

Sciatica can make your lower back painful, but not always.

3. Sciatica Feels Different for Everyone

Sciatica doesn’t always feel the same. Some people experience a dull ache, while others describe sharp, shooting pain, burning, tingling, or numbness. It can range from mildly annoying to severely debilitating. Typically, it affects one side of the body, but in rare cases, it can occur on both.

4. There Are Many Causes—Most Aren’t Serious

Sciatica is common and usually temporary. Here are some of the most frequent causes:

  • Piriformis syndrome – A tight or spasming piriformis muscle (deep in the buttock) can press on the sciatic nerve.
  • Disc herniation – A bulging disc may irritate the sciatic nerve roots. While it sounds alarming, most cases improve without surgery.
  • Degenerative disc disease – Common with ageing, this causes slight disc shrinkage, reducing space for the nerve. Many people find relief by leaning forward (e.g., using a shopping trolley).
  • Joint irritation – Inflammation in the spine or pelvis (facet joints or sacroiliac joint) can temporarily aggravate the nerve.

Osteopathy is often effective in managing these conditions.

In most circumstances osteopathy is an effective method in managing sciatica symptoms.

5. Most Cases Aren’t an Emergency—But Watch for Red Flags

Sciatica usually improves with a mixture of self-care manual therapy and advice. However, in rare cases, it can signal a serious medical issue. Seek immediate help (A&E) if you experience:

  • Sciatica symptoms in both legs simultaneously
  • Severe or worsening numbness/weakness in both legs
  • Numbness in the saddle region (inner thighs, genital, or anal area)
  • Difficulty urinating or loss of bowel/bladder control
  • Severe pain worsening at night
  • Major trauma (e.g., a fall or accident)

Acting quickly in these situations can make a huge difference in recovery.

Need Help?

If you’re unsure about your symptoms or want advice on managing sciatica, I’m here to help. A consultation allows us to find the cause of your pain and create a treatment plan tailored to you. If necessary, I can also refer you for further medical evaluation. Book an appointment today to start feeling better!

Published 21/12/2022

Last updated 14/03/2025