Sciatica: what it is, when it is serious and how I work

• Sciatica is a symptom of another health problem, not a disease in itself.
• It usually affects one buttock and one leg.
• It tends to improve over weeks or months, but can last longer or return.
• It is advisable to move as much as you can and avoid spending too long in bed.
• Some signs mean you need to call 112 or go to the emergency department.

Sciatica is pain along the leg caused by irritation or compression of the sciatic nerve, sometimes with tingling, numbness or weakness.

The nerve begins in the lower back and travels down the back of the leg towards the foot. Symptoms usually affect the buttock and the back of one leg, and may reach the toes.

Sciatica symptoms: what it can feel like

The pain may feel sharp, shooting or burning. There may also be weakness.

Symptoms can begin suddenly or develop gradually. Movement, a cough or a sneeze may make the pain worse. Sitting or standing can also aggravate it, as can straining when you open your bowels. Your back may hurt too, although the leg pain is usually stronger.

What causes sciatica

A herniated or slipped disc is the most common cause. Spinal stenosis is another possibility: this means a narrowing of the spinal canal. Spondylolisthesis describes a bone in the spine slipping out of position. A back injury can also affect the nerve.

Other causes include piriformis syndrome, involving a muscle in the buttock, and injuries or fractures of the pelvis.

The name describes where and how it hurts; diagnosis and tests belong to your doctor. Outside specialist care, imaging is not routinely recommended. Your doctor decides whether you need a scan based on your circumstances.

Usually not: it tends to improve with time, but it becomes urgent if the signs below appear.

How long does sciatica last?

Sciatica usually lasts a few weeks to a few months, but it can last longer. It can also come back after an earlier episode.

Loss of sensation, weakness and difficulty controlling your bladder or bowels need attention. They matter even when the pain has only just started.

When it is an emergency: cauda equina

At the lower end of the spinal canal is a group of nerve roots called the “cauda equina”, meaning “horse’s tail”. Compression or damage here can affect leg strength and control of urine or stools.

You may also lose feeling in the area that would touch a saddle: the genitals, anus and inner thighs. These signs need urgent assessment in hospital. Without urgent treatment it can cause paralysis of the legs. Do not wait for an osteopathy appointment.

When to make an appointment with your doctor

Speak to your doctor if an episode lasts beyond four weeks, differs from earlier episodes, is worse than before or prevents you from doing your usual activities. Unintentional weight loss also needs a medical review. You do not need to wait that long if symptoms are getting worse.

Seek medical attention promptly for unexplained fever with back pain, or pain that worsens when lying down or wakes you at night. Do the same for weakness or numbness in the buttock, thigh, leg or pelvis. For emergency signs, follow the box below.

Osteopathy doesn’t treat symptoms or injuries; its purpose is to help people, working on the body as a whole, as one indivisible functional unit.

If you come with sciatica, I listen to how it began and ask about previous episodes and your doctor’s diagnoses. I ask how far the pain travels and assess your mobility and how you are overall.

My work consists of thorough, hands-on sessions, considering the body as a whole. I give you personalised posture advice and home exercises. I explain them during the session, and we practise together so you can ask me anything you need.

I do not promise results.

Diagnosis and medical decisions

I don’t diagnose or prescribe, and I don’t change your medication: that is for your doctor. I won’t interfere with your doctor’s decision. If I have doubts, cannot work in your case or something is outside my competence, I advise you to see your doctor.

In Spain, osteopathy is not listed in Ley 44/2003, the law that regulates the health professions.

As general advice, avoid sitting or lying down for long periods.

Staying active without forcing a movement

Gentle movement can begin early, within what you can manage. Keep up everyday activities as far as you can manage, following any advice from your doctor, and do not force a movement that makes your symptoms worse. If symptoms spread further down your leg, stop and seek advice.

You may need to reduce activity at first. The return to your usual activities is then gradual. Avoid heavy lifting and twisting your back during the first few weeks.

If you are unsure which activity fits your circumstances, speak to your doctor. Follow their instructions if you have had an operation or have another health problem.

If a warning sign appears, seek medical attention before trying any more movements.

These four movements are common examples of gentle mobility exercises, described and drawn for this page. They have not been chosen for your circumstances or for any specific cause of sciatica, and they are not a prescription from me. Which exercise suits you depends on your situation. If you are unsure, ask your doctor or another healthcare professional.

In the drawings, grey marks the starting position and the dark line marks the end. Do not force yourself into the position.

1. Pelvic tilt

   Start: lie on your back with knees bent and feet flat, leaving the usual small curve under your lower back. End: gently tilt your pelvis to bring your lower back towards the floor, then relax.

2. Lying on your front, up on your forearms

   Start: lie face down with your forehead resting. End: raise your chest onto your forearms, keeping elbows under shoulders, hips on the floor and your neck long.

3. On all fours: round and hollow back

   Start: place hands under shoulders and knees under hips, with your back gently hollowed and your gaze slightly forwards. End: slowly round your back upwards and lower your head, keeping the movement small.

4. Seated buttock stretch

   Start: sit on a stable chair with feet flat, then rest one ankle on the opposite knee. End: lean forwards slightly from the hips with a straight back, until you feel a gentle buttock stretch; then change sides. Do not do this if it brings on leg pain.

1. You message me or call me

   On WhatsApp or by phone, on +34 672 29 91 22. Tell me whether you prefer to come to my practice in San Pedro de Alcántara or for me to come to your home.

2. I observe you and listen to you

   I ask how and when the pain started, whether it has happened before and whether it keeps coming back. I also ask whether a doctor has diagnosed disc bulges or herniations, and how far down your leg it spreads. Then I assess your mobility and how you are in general.

3. A first hands-on session

   I do a first hands-on session. I don’t work on one isolated area on its own: I look at your body as one single, indivisible unit. It isn’t possible to work in every case.

4. When I recommend seeing your doctor

   If I have doubts, can’t work on your case or something is outside my competence, I recommend you see your doctor, for example in case tests are needed.

The first visit is the Comprehensive Body Assessment: case history, full check and first contact.

Doctor or osteopath first?

With serious symptoms or any warning sign, the doctor comes first; what follows is about cases of doubt.

In my words (translated from Spanish):

“If in doubt, or if it is serious, it is best to see the doctor first and then the osteopath; if you decide to come to the osteopath first, I can also advise you on what to do first. I need to look into it and assess after the case history.”

If it is serious, see your doctor first. If you notice any of the emergency signs in the box, call 112 or go to A&E (urgencias): don’t wait to see me.

If you have reports or test results from your doctor or a specialist, bring them to the session; if not, that’s fine.

If you have had an operation: of course the doctor has the last word, and we start working once you have been discharged by your doctor, with all their indications and in safety.

• Comprehensive Body Assessment (first visit) — €70 at the clinic (60 min) · €120 at home.
• Clinic osteopathy session — €70.
• Home session — from €100.

You pay by bank transfer, Bizum or cash. I don’t work with insurers: we arrange the appointment directly.

The clinic is at C/ Ilusión 17, Fuente Nueva, San Pedro de Alcántara, by appointment only. There is a free unpaved car park 50 m away. How to get to the clinic in San Pedro de Alcántara.

For home visits I come to San Pedro and to every area of Marbella (Nueva Andalucía and Puerto Banús included). I also go to Benahavís and, with prior notice, to Estepona, up to the municipal boundary.

How I work in general: Osteopathy at the clinic and at home. All my prices: osteopathy prices at the clinic and at home.

For medical emergencies, call 112.