Sciatica Physiotherapy in Bolton

Sciatica means pain caused by irritation or compression of a nerve root in the lower back, producing symptoms along the path of the sciatic nerve. The distinguishing feature is that the leg symptoms usually dominate over the back symptoms, follow a recognisable band down the leg, and often come with pins and needles, numbness or weakness rather than just ache.

A great deal of what gets called sciatica is not. Referred pain from the lower back, the sacroiliac joint or the gluteal muscles can produce buttock and thigh pain that feels similar but stops short of the knee, has no neurological symptoms, and behaves differently. The distinction matters because the expected timeline and the treatment emphasis are not the same — which is the first thing the assessment sorts out.

Sciatica is covered by NICE guideline NG59, Low back pain and sciatica in over 16s — the same guideline that covers low back pain, which tells you something about how closely related they are.

Its position, in short: stay active, avoid bed rest, and use exercise as the core treatment. Manual therapy is recommended as part of a package that includes exercise, not on its own. Imaging is not recommended routinely and should be reserved for cases where the result would change management — for example if surgery or injection is being genuinely considered.

One honest note on currency: NG59 was updated on 29 July 2026, withdrawing its previous recommendations on psychological therapy and on combined physical and psychological programmes. Anything you read online recommending those on NICE's authority now predates the change.

This is where expectations most often go wrong, so it is worth being blunt. Sciatica is generally slower to settle than ordinary back pain. Nerve tissue is irritable and recovers on its own schedule; a nerve that has been compressed takes time to calm down even once the pressure on it is reducing.

The encouraging part is the natural history. The majority of disc-related sciatica improves substantially over weeks to a few months without any procedure at all, and disc herniations frequently reduce in size on their own over that period. Being told you have a disc bulge is not a sentence, and it is not usually a reason to rush toward surgery.

What that means practically: if you are two weeks in and still sore, that is normal rather than a sign treatment is failing. If you are three months in with no change at all, that is worth reassessing — and that is a conversation Marcus will start rather than leave you to raise.

• Confirming what it is. Neurological examination — power, reflexes, sensation — plus movement testing to establish whether this is genuine nerve root involvement and which level is affected.
• Settling the irritability. Early on, finding the positions and movements that ease symptoms and the ones that flare them, so you can stay as active as possible without repeatedly provoking the nerve.
• Hands-on treatment. Useful for the associated back and hip stiffness and for short-term relief, delivered as part of a package rather than as the treatment itself.
• Progressive loading. As symptoms centralise — move out of the leg and back toward the spine, which is the sign you want — building back strength, hip strength and tolerance for sitting, bending and lifting.

Appointments run at Unit 28, Flexspace Bolton, with free parking, or as video sessions and home visits. Home visits are worth considering in the early acute phase when sitting in a car is the worst thing you could do.

Most people never need either. They become a genuine conversation when symptoms are severe and persistent despite good conservative management, when there is progressive weakness, or when the leg pain is not settling over a period of months and is materially limiting your life.

Marcus does not perform spinal injections or surgery, and has no financial reason to steer you toward or away from them. Where the picture suggests you need a specialist opinion, he will say so and write to your GP with the findings — which is a considerably more useful referral letter than a self-report.