Most people treat sciatica like a leg problem.
But here’s the truth:
Sciatica: The Ultimate Guide by Dr. Rajesh, Spine Surgeon in London
Sciatica is a problem in the lower back, but it often shows up as pain in the leg
It starts when your sciatic nerve — the largest and longest nerve in your body, about the thickness of your thumb — gets pinched at its root, deep in your lower spine.
From there, the pain follows the path of the sciatic nerve:
Down to your buttock, your thigh, your calf, sometimes even to your foot and toes.
📍 Sciatic Nerve Route:
🔸 Starts from the L5 to S1 lumbar plexus
🔸Combines to form the sciatic nerve in the pelvis
🔸Travels through the glutes, back of the thigh, and splits at the knee
🔸Ends in the foot
Quick Sciatica symptoms checklist
✅ Sharp, burning, or shooting pain in one leg
✅ Tingling or numbness in your foot
✅ Pain worsens with sitting, bending, or coughing
✅ Pain that improves when lying down or walking
✅ Weakness in your ankle, foot, or even entire leg
Sometimes, your back feels perfectly fine.
It’s your leg that cries out — but your spine is the source.
And unless you know where to look, you could spend months treating the wrong thing.
Why Does Sciatica Happen?
The most common cause is a herniated disc in your lower spine pressing on a nerve root.
But it’s not the only one.
👨⚕️ How I Diagnose Sciatica at My Clinic in London
Mangattil Rajesh
I am one of the best spinal surgeons in London and the Head of the Department of Complex Spine Surgery at The Royal London Hospital. With 3 advanced Fellowships in Complex Spine Surgery, I’ve dedicated my life to helping those who suffer from Back pain and Neck pain.
Your health and well-being are at the heart of everything I do. Together, we’ll find the best path to recovery.
I understand the need for flexible consultation options. Whether you prefer an online session from the comfort of your home or an in-person visit at the clinic, I accommodate your needs, ensuring you receive the best possible care.
Most sciatica cases are clinical diagnosis + confirmed imaging.
1. History
“It started in my back… now it’s in my leg.”
“I can’t sit long. Walking helps.”
- Any sudden worsening of pain and weakness?
- Any Weakness in your leg?
- Difficulty in emptying your bladder?
- Loss of Bladder or Bowel control?
- How much it hurts to walk and work?
These are classic sciatica patterns
2. Physical Examination
I carefully assess for:
- Walking assessment to check limp
- Nerve tension (SLR Test)
- Pattern of altered Sensation
- Assess muscle weakness
- Extent of pain and difficulty
3. MRI Scan
An MRI gives a real-time look at:
- Size and Location of Slipped Disc
- Extent of the Disc Rupture
- Nerve root compression
- Spinal canal narrowing
Sciatica Treatment Options
Here’s what I tell my patients:
“Most cases of sciatica don’t need surgery. But they do need the right diagnosis — and a structured plan.”
With conservative care, most patients improve within 6 weeks
It is the combination of the Spine steroid injection and physiotherapy that offers lasting pain relief and rapid return of function
When Surgery Is Needed
Surgery becomes an option when:
- Failure of Conservative management – Physiotherapy and Steroid injections
- Back and Leg Pain lasts more than 3 months
- Painful limp – difficulty in walking and working
- Nerve compression causes leg weakness or foot drop
- MRI shows clear disc herniation causing pressure on the nerve
👨⚕️ Common Procedures:
1. Microdiscectomy
- Minimally invasive
- Removes only the disc fragment pressing on the nerve
- 💡 Most patients walk home the following day
2. Laminectomy
- For spinal stenosis-related sciatica
- Removes small parts of bone, which irritates the nerve causing pain
Sciatica Recovery Timeline
How to Prevent Sciatica From Coming Back
🧘 Stretch hamstrings and glutes regularly
🧍 Use a standing desk or take frequent walking breaks
🏋️♂️ Lift with your legs, not your spine
🪑 Maintain ergonomic seating
🥗 Maintain a healthy weight
“Sciatica can interrupt your life — but it doesn’t have to control it.”
If you’re feeling:
- One-sided leg pain
- Numbness in your toes
- Or tingling that seems to travel…
…don’t wait for it to “go away.”
📌 A precise scan and a tailored plan could save you weeks — or even years — of misdiagnosis.
📞 Book a Consultation
- 🩺 Dr. Rajesh – Spine Surgeon in London
- 📍 spinesurgeon.london
- 📅 Booking takes less than a minute
- 📍 Harley Street, Central London
- 📲 WhatsApp Us Anytime
…… and don’t wait for it to “go away.”
5 Star Patient Reviews
JolitaV
Mr Rajesh was excellent and I count myself very fortunate that he is my consultant surgeon. I could not have asked for a more courteous and professional experience. I could not fault anything. Mr Rajesh was very professional he explained everything in detail on all my visits. From initial consultation to post op Mr Rajesh took care of everything.
Eloise Morse
Mr Rajesh is the best spine surgeon I have seen and I wouldn’t hesitate to recommend him. I have had chronic issues with my pelvis and lumbar spine for years but was referred to Mr Rajesh for a disc herniation in my neck. His care was faultless. He is technically excellent with brilliant, practical advice beyond just surgical solutions. Read more…
Terri Spires
When it became necessary to have a discectomy decompression in my lower spine Mr Rajesh explained the procedure very clearly and in a way I understood, he is very good at putting your mind and nerves at ease. Mr Rajesh is an excellent surgeon who cares for his patients and goes the extra mile. I wouldn’t hesitate to recommend him to anyone.
Sciatica FAQs – Answered by Dr. Rajesh
For many patients, the fastest relief comes from a combination of:
- Anti-inflammatory medications – paracetamol, neurofen, cocdamol and naproxen
- Physiotherapy focused on posture and core strength
- Guided movement like walking or gentle stretching
In more severe cases, a spinal injection may provide quicker relief.
But remember: the key is accurate diagnosis — not just symptom relief
Sciatica typically causes:
- Sharp or burning pain down one leg
- Pain that worsens when sitting or bending forward
- Numbness or tingling in the foot
- Weakness of the leg with a limp
If your pain is across both legs, another condition called Cauda Equina may be the cause
A clinical exam + MRI can confirm the diagnosis.
You should consult a spine specialist if:
- Pain lasts more than 2 weeks
- You experience numbness, weakness, or difficulty walking
- Pain interferes with sleep or daily function
- Worsening trend with pain and difficulty at work
You notice any bladder or bowel issues (seek urgent care)
Most people do not need surgery
Over 80% recover with:
- Physiotherapy
- Posture correction
- Anti-inflammatory medication
- Spine Steroid Injection + Physiotherapy
Surgery may be recommended if:
- Pain continues beyond 3 months
- There is nerve damage or foot weakness
- MRI shows severe compression that’s not improving
- Worsening pain and not able to go to work
Yes. Sciatica can flare up, then settle down.
Triggers include:
- Long sitting or driving
- Lifting incorrectly
- Poor posture or spine instability
If you’re experiencing flare-ups more often, it may simply indicate that the disc is pressing on the nerve again. With the right treatment, this can usually be managed effectively.”
Most patients describe it as:
- A sharp, burning, or electric pain
- Running from the lower back or buttock down one leg
- Sometimes numbness or tingling in the foot or toes
Pain is usually on one side and can worsen when coughing or bending.
Yes — movement helps in most cases.
Recommended:
- Walking on flat surfaces
- Gentle back and hamstring stretches
- Physiotherapist-supervised exercises
But Avoid….
- Heavy lifting
- Twisting motions
- Long periods of sitting or standing
