Patient Guide · Low Back Pain & Sciatica
Understanding Low Back Pain & Sciatica
A clear, straightforward guide to what might be causing your pain, when it needs urgent attention, and how it's usually treated.
Getting oriented
Back pain and sciatica are not the same thing
Low Back Pain
Pain that stays in your lower back, between your ribs and the top of your buttocks
Usually related to the muscles, joints or discs of the back itself
Sciatica
Pain that travels down one leg, from irritation of a nerve in your lower spine
Often felt below the knee, and may come with numbness or tingling
Knowing which one you have is the first step to the right treatment.
First steps
What we work out at your first visit
Is it urgent?
Sudden bladder or bowel changes, rapidly worsening weakness, or a history of cancer, infection or injury need same-day attention.
Is a nerve involved?
Pain running down the leg, numbness, or a specific pattern of weakness usually points to a trapped or irritated nerve.
Is it muscular or mechanical?
Pain confined to the back, worse with certain movements, without any leg symptoms, is usually the most reassuring pattern.
We rule out anything urgent first — everything else can be worked through calmly.
Your examination
What to expect when we examine you
Your story
Where it hurts, what brings it on, how it affects your day, and whether your bladder, bowel or sexual function have changed.
Stretch tests
Gently raising your leg while lying down can reproduce nerve pain and helps confirm where the problem is.
Strength checks
Simple tests of your knee, big toe and ankle movement show whether a specific nerve is affected.
Reflexes and sensation
Testing reflexes at the knee and ankle, along with light touch on the leg, helps pinpoint the level involved.
We'll also watch how you walk and stand — this often tells us as much as the examination on the couch.
When to seek help urgently
Warning signs you should never wait on
Don't wait until you can't pass urine at all
- New trouble starting or controlling urination
- A change in bladder sensation, stream, or awareness of a full bladder
- Numbness around the saddle area (inner thighs, groin or genitals), pain in both legs, or new sexual difficulty
- Weakness that is getting worse day by day
If any of these apply to you, go to an emergency department the same day.
About scans
Do you actually need an MRI?
You probably don't need one yet
Straightforward back pain or sciatica, without any of the warning signs above, usually settles with time and does not need a scan.
A scan may help plan your care
If symptoms are persistent and disabling, or we are considering a procedure, an MRI gives us the detail to plan the next step.
You need one urgently
If we suspect the warning signs above, an infection, or a tumour, imaging is arranged the same day.
If you do have a scan, we make sure it actually matches your symptoms before acting on it.
Your recovery
What getting better usually looks like
Understand
We explain what's actually going on, how long it usually takes to settle, and what to watch out for.
Keep moving
Staying as active as you comfortably can, rather than resting in bed, speeds recovery.
Rebuild
A gradual return to exercise and normal activity rebuilds strength and confidence in your back.
Check in
We follow up on how you're functioning day to day, not just how much pain you report.
Recovery doesn't mean resting and waiting. It's an active, supported process, and we check in along the way.
Your options
Treatment is matched to how much it's affecting you
The basics
Understanding what's happening, staying active, gentle exercise, and looking after sleep and stress — this helps almost everyone.
Medication
Simple pain relief is used only when it genuinely helps. We generally avoid stronger drugs like gabapentin, steroids or sedatives for sciatica, as the evidence for them is weak.
Injections
For severe, acute nerve pain, a guided injection around the nerve can sometimes calm things down while your body heals.
Surgery
Reserved for a true emergency, or when a clearly identified trapped nerve keeps causing significant disability despite everything else.
If surgery comes up
What a fair conversation about surgery looks like
Before we recommend surgery, we make sure
- Your symptoms and our findings clearly point to the same nerve
- The impact on your life is significant despite trying everything else — or the situation is urgent
- You understand what the operation can and can't do, and what the alternatives are
What the operation does well
Relieves leg pain caused by the trapped nerve
It is less reliable for long-standing numbness, weakness, or pain that stays in the back itself.
We won't promise you a “new back” — only realistic relief of the specific problem we've identified.
What to remember
Our approach to your back pain or sciatica
- 1Work out what kind of pain you have before deciding how to treat it.
- 2Always check for the warning signs, every time.
- 3A careful examination comes before any scan.
- 4Have an MRI only if it will actually change your treatment.
- 5We treat you and your symptoms — not just what a scan shows.
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