Best evidence · Patient guide
How I assess and treat sciatica
My starting point is to understand what is causing your leg pain and how it affects your life. I then work with you on a treatment plan, with clear reasons for each step and a plan for reviewing progress.
Go to A&E immediately if sciatica affects both legs, you develop numbness around your genitals or bottom, new difficulty starting or controlling urine, loss of awareness or control of bowel movements, or severe or worsening weakness or numbness in both legs. These can signal serious pressure on the nerves. Do not wait for a routine appointment. Call 999 if you need an ambulance.
Before we meet
Bring a list of medicines and doses, details of treatments you have tried and any scan reports or images. Think about what you most want to get back to doing. A short account of how symptoms have changed is often more useful than trying to remember every painful day.
We begin with what matters to you
I ask you to describe the pain in your own words, show where it travels and explain how it affects sleep, walking, work and home life. We discuss what has helped, what has made things harder and any concerns about treatment.
We choose practical goals together. These might include walking to the shops, sleeping for longer or returning to a particular activity. They give us something useful to assess at follow-up.
I bring the findings together
I examine you and consider whether the symptoms, nerve function and any existing imaging tell a consistent story. I explain the likely diagnosis and any uncertainty. If another test is needed, I explain the question it is meant to answer.
The main sciatica guide covers the examination and possible causes. The MRI guide explains when a scan is useful and its limitations.
We make a plan you can use
I set out the options that fit your situation and help you weigh them against your goals. The plan may involve rehabilitation, a medication review or a targeted procedure. We discuss who will organise each step and how progress will be reviewed.
If an image-guided nerve-root injection is appropriate, I explain its place in your plan. The injection guide covers fluoroscopic (X-ray) guidance, my approach to sedation, expected benefits and risks. If a surgical opinion is indicated, I explain why and arrange referral; the surgery guide covers that decision in detail.
At follow-up, we check what has changed
We review your agreed goals, the effect of treatment and any side effects or new symptoms. If progress is disappointing, we reconsider the plan and, where necessary, the diagnosis. Continuing the same treatment is not automatic.
Before you leave, we clarify the next step and when to seek help sooner. For help interpreting published outcome figures, read what recovery statistics can tell us.
Evidence used
Evidence checked and clinically approved by Dr Oliver Seyfried · 5 September 2026