Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
It often starts with a small, nagging pain in the lower back that doesn’t seem serious. At first, it might come and go, or feel like a light pull through the hip or leg. Over time, however, the discomfort tends to build. The pain can become sharper, spreading further down the leg and making everyday movements like walking, sitting, or even resting more difficult. As this happens, it becomes clearer that the problem runs deeper than strained muscles and may involve the nerves that control movement and sensation.
This brings us to the sciatic nerve — the main nerve affected in this condition. It begins in the lower spine, passes through the buttock, and runs down the back of each leg. When this nerve is pressed or irritated near its starting point in the spine, pain travels along the same pathway. That’s why an issue in the lower back can lead to pain, tingling, or numbness that reaches the calf or foot. In many cases, this pressure develops because of a slipped disc or natural changes in the spine that narrow the space around the nerve. By understanding how this process works, you can see why sciatica pain behaves the way it does and why addressing the root cause early is important for long-term relief.
Sciatica pain doesn’t appear without reason. It often starts when pressure builds on the sciatic nerve, usually because of spine or muscle problems in the lower back. Knowing what causes this pressure helps you understand the source of your pain and what needs to be treated. Below are the main causes that can lead to sciatic nerve pain.
A herniated disc is the most common cause of sciatica. It occurs when the soft centre of a spinal disc pushes through a small tear in its outer layer. When the disc presses on a nearby nerve root, it irritates the sciatic nerve and causes pain, numbness, or tingling that travels down one leg.
Bone spurs are small bony growths that can form on the spine. Over time, they might press against the nerves that make up the sciatic nerve, leading to irritation, inflammation, and pain that can radiate down the leg.
Spinal stenosis happens when the space within the spinal canal becomes narrow, often because of age-related changes. As the space around the nerves shrinks, pressure builds on the sciatic nerve and causes symptoms such as pain, weakness, or tingling in the legs.
Spondylolisthesis occurs when one vertebra slips forward over another. This shift can pinch the nerve roots in the lower spine, resulting in pain that starts in the back and moves down through the leg.
The piriformis muscle, found deep in the buttock, can tighten or spasm and press on the sciatic nerve that runs beneath it. Unlike spinal causes such as disc or bone changes, this irritation starts in the muscle itself but produces similar nerve pain and tingling that travel down the leg.
A fall, accident, or sports injury can damage the lower back or surrounding tissues. In some cases, spinal fractures or disc injuries might directly compress or inflame the sciatic nerve. This can lead to sharp or persistent sciatic pain and often requires medical evaluation to prevent further complications.
Although rare, spinal tumour growths or infections in the spine can press on the sciatic nerve, causing pain and weakness. These conditions need prompt medical treatment to prevent further complications.
Understanding these causes shows how different problems in the spine or nearby muscles can trigger sciatic nerve pain. Recognising which one applies to your situation also helps explain why not all cases of sciatica feel the same. This is where the different types of sciatica become important to understand next.
Sciatica can show up in different ways depending on how long it lasts and where the pain is felt. Here are the main types of sciatica and how they differ:
Sciatica can be short-term or long-term depending on how long the symptoms last. Acute sciatica often starts suddenly after a strain, injury, or sudden pressure on the nerve and usually improves within a few weeks with rest, gentle stretching, and pain relief medication. Chronic sciatica, however, lasts longer or keeps returning. The pain might interfere with walking, sitting, or sleep and often requires physiotherapy, medication, or other targeted treatments to manage ongoing nerve irritation.
Aside from how long sciatica lasts, it can also differ based on where the pain occurs.
Unilateral sciatica is the most common type, affecting one side of the body. It happens when nerve compression occurs on one side of the spine, causing pain, tingling, or numbness that travels down one leg. Bilateral sciatica affects both legs and is less common. It develops when nerve pressure occurs on both sides of the spine, leading to pain, weakness, or numbness in both legs. Because this type can indicate more serious spinal issues, it often requires detailed medical evaluation by a specialist.
Understanding how sciatica differs from person to person also helps explain the symptoms it causes. Regardless of the type, most people share common signs of sciatic nerve irritation. The pain can range from a dull ache to a sharp, burning sensation and often changes with movement or position. Alongside pain, sciatica can also affect sensation and strength in the affected leg. Below are the main symptoms to look out for.
Sciatic nerve pain can feel shooting, throbbing, or electric. It often flares during coughing, sneezing, or sudden movement. Some people find sitting or standing for long periods makes it worse, while gentle movement might bring some form of brief relief.
Tingling sensations, often described as pins and needles, can appear when nerve pressure interferes with normal sensation. This might be paired with numbness in the leg or foot, making it harder to feel texture or temperature.
In more advanced cases, the affected leg might feel weak or unstable. Severe weakness, especially when combined with changes in bladder or bowel control (incontinence), requires immediate medical attention.
After understanding the symptoms of sciatica, it helps to know how to manage the condition in daily life. Simple adjustments to how you move, rest, and care for your spine can make a difference in easing discomfort and preventing flare-ups. You can try the following approaches:
Building these habits can help relieve discomfort and lower the risk of future flare-ups. However, if the pain persists or begins to affect your daily routine, your specialist may recommend further treatment to address the underlying cause.
If home care and lifestyle changes don’t provide enough pain relief, the next step is to explore medical treatments suited to your condition. At this stage, the focus shifts toward easing pressure on the sciatic nerve and supporting long-term recovery. Treatment typically begins with conservative methods to manage pain and improve mobility, before progressing to more targeted approaches when symptoms persist. Below are the main treatments commonly used to manage sciatica pain.
Pain-relieving or anti-inflammatory medication might be prescribed to manage short-term discomfort. These medicines help reduce inflammation around the nerve, making it easier to move and take part in rehabilitation exercises.
When inflammation near the affected nerve root is more severe, corticosteroid injections can help reduce swelling and irritation. This provides temporary relief, giving patients a window to continue physical therapy and maintain mobility while recovery progresses.
Physiotherapy plays a central role in pain management. A tailored exercise plan can strengthen the back and core muscles, improve flexibility, and support better posture. These improvements help relieve strain on the sciatic nerve and reduce the chance of future flare-ups.
When pain persists despite conservative care or when nerve compression causes significant weakness, surgical treatment would be recommended. Performed by an orthopaedic spine specialist, surgery precisely targets the source of pressure such as a herniated disc or bone spur to relieve irritation and restore function. In suitable cases, it can provide lasting relief and help patients return to an active lifestyle with greater confidence.
While the treatment options for sciatica are well established, their success depends on selecting the right approach for each patient and performing it with precision. This is where specialist care becomes important. A detailed evaluation of the spine, imaging results, and symptom patterns helps determine the most suitable path forward and ensures that every stage of treatment supports safe recovery.
Sciatica can arise from a range of spinal conditions, and lasting pain relief begins with understanding the exact cause of nerve compression. At Oxford Spine & Neurosurgery Centre, Dr Colum Nolan takes a comprehensive approach that combines clinical evaluation with detailed imaging analysis. By examining how spinal alignment, disc integrity, and nerve pathways interact, he can determine how these changes relate to the specific pattern of pain and movement limitation. This close attention to the relationship between structure and symptom forms the foundation of precise diagnosis and tailored care.
Building on these findings, Dr Colum Nolan develops a treatment plan that targets the root of the problem rather than just the symptoms. Each plan is shaped around the individual’s condition, recovery goals, and overall spinal health, aiming to restore comfort, movement, and confidence over time. To arrange a focused consultation and review your options, contact us for a consultation today.
Sciatica occurs when the sciatic nerve is compressed or irritated, most often in the lower spine. Common causes include a herniated disc, bone spurs, spinal stenosis, or vertebral slippage that narrows the nerve’s pathway. In some cases, muscle tension in the buttock, such as piriformis syndrome, or injury to the lower back can also trigger inflammation and radiating leg pain.
Sciatica symptoms usually begin with pain that starts in the lower back and travels through the buttock and down one leg. The pain can feel sharp, burning, or like an electric jolt, and might worsen when sitting, coughing, or moving suddenly. Other symptoms include tingling, numbness, or weakness in the leg or foot. Severe cases might cause difficulty walking or standing for long periods.
Yes. Although sciatica is often linked with ageing, it can also affect younger adults. Prolonged sitting, sedentary routines, poor posture, and lack of exercise can strain the lower back and increase pressure on spinal discs, leading to nerve irritation. Factors like sports injuries, obesity, or existing spinal conditions may also contribute. Recognising persistent leg or back pain early allows for timely assessment and prevents long-term nerve problems.
Preventing sciatica starts with keeping the spine strong and supported. Regular exercise helps build core and back strength, which stabilises the lower spine and reduces strain on the nerves. It also helps to limit long periods of sitting by taking short breaks to stretch or walk. Alongside this, maintaining a healthy weight, practising good posture, and avoiding smoking all support long-term spinal health and lower the risk of sciatica.
Treatment depends on the cause and intensity of the pain. In many cases, medication, physiotherapy, and guided rehabilitation help ease inflammation and improve movement. However, when severe pain persists or nerve compression leads to weakness or numbness, surgery is often recommended to relieve pressure on the affected nerve. A detailed assessment by a spine specialist helps determine when surgical treatment offers the best chance for recovery.
Dr Colum Nolan is a Senior Consultant Neurosurgeon with over 20 years of experience, specialising in minimally invasive spine (keyhole) surgery and other spine procedures.
A graduate of the Royal College of Surgeons in Ireland, Dr Nolan underwent neurosurgical training in Ireland and Australia, followed by a fellowship in complex spine surgery at Addenbrooke’s Hospital, Cambridge, as well as rotations at the Orthopaedic Spine Unit in Norfolk and Norwich Hospital.
Dr Colum is committed to delivering compassionate, patient-centred care, combining surgical precision with a genuine dedication to improving his patients’ quality of life.
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