When to seek emergency care
Some warning signs need urgent attention
Go to an emergency department if you develop new difficulty passing urine or controlling your bladder or bowels, loss of sensation around your genitals or anus, or severe or worsening weakness or numbness in both legs. Sciatica symptoms on both sides also require urgent medical attention. These signs may indicate a problem that needs immediate assessment in hospital. [C1]
First, identify what is happening
Sciatica may involve pain travelling down one leg, tingling or changes in sensation. Not all back pain is sciatica. A discussion and examination help identify the possible cause: when it began, where it spreads, what makes it worse and whether there is any loss of strength. Having this information organised makes the consultation more useful. [C1] [C3]
An MRI scan needs a question to answer
Imaging tests are not a compulsory first step. They are considered when the result could change how the condition is managed. The decision depends on symptoms, examination findings and how the condition develops; not being referred for an MRI at the first visit does not mean the problem is being ignored. [C2]
Stay active with a tailored plan
Prolonged rest is not usually the answer. The aim is to maintain or return to activities you can tolerate and adapt those that limit you. Exercises are chosen according to your abilities and needs, and may form part of physiotherapy. You do not need to copy an exercise plan from the internet: you need to know what to do, how to progress and when to seek further advice. [C1] [C2] [C3]
If symptoms do not improve, review the next step
If pain gets worse, persists or interferes with everyday life, the plan should be reviewed. The clinician can assess options for managing symptoms and, in selected cases, other procedures. Surgery is considered in certain situations, for example when non-surgical treatment does not improve pain or function and imaging findings are consistent with the symptoms. Having sciatica does not automatically mean needing surgery. [C1] [C2]
Three questions to take away
What activity can I continue, and what should I adapt? What changes should I report? When will we review my progress? The aim is to leave the consultation with a clear next step, rather than a list of decisions you have to make alone. [C3]
Sources for further reading
