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Back pain is very common and normally improves within a few weeks or months. Pain in the lower back is particularly common, although it can be felt anywhere along the spine – from the neck down to the hips. In most cases the pain isn't caused by anything serious and will usually get better over time.
Compression or pressure on any of the nerve roots in the low back can cause pain, numbness or weakness along the different nerves as they travel down through the leg and into the foot. Because the sciatic nerve is commonly affected, leg pain and related symptoms are often generally referred to as sciatica.
The information below is based on the following NICE guideline:
With each new episode of low back pain with or without sciatica, consider using the 9 point STarT Back risk assessment tool to inform shared decision-making
Based on risk stratification, consider:
Click on the links below for useful patient information:
People with low back pain with or without sciatica should be encouraged to continue with normal activities. Provide advice and information (including the nature of low back pain and sciatica) to help them self-manage at all steps of the treatment pathway.
Consider an exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people's specific needs, preferences and capabilities into account when choosing the type of exercise.
Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy.
Consider psychological therapies using a cognitive behavioural approach for managing low back pain with or without sciatica but only as part of a treatment package including exercise, with or without manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage).
Combined physical and psychological programmes
Consider a combined physical and psychological programme, incorporating a cognitive behavioural approach for people with persistent low back pain or sciatica:
For recommendations on pharmacological management of sciatica, see formulary guidance on management of neuropathic pain.