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Low Back Pain and Sciatica
Including lumbar spondylosis, facet joint arthritis and nerve root irritation
Low back pain is very common, and most episodes get better. This page explains the common causes in plain words, how to ease the pain and when to get help urgently, and sets out a programme of gentle movements, strengthening exercises and walking: the main treatment.
Understanding low back pain and sciatica
Your lower back is made up of five bones, stacked on top of each other. Between them are discs, which act as cushions, and at the back, small joints on each side, called facet joints, link each bone to the next. Strong muscles and ligaments support the spine, and nerves run down inside it and leave through small openings between the bones, on their way to your legs.
As we get older, the discs and joints of the spine change, much as hair turns grey. This wear and tear is called lumbar spondylosis, and when it affects the small joints, facet joint arthritis. These changes are very common, and they show up on the scans of many people who have no back pain at all. So they do not always explain the pain, and they do not mean that your back is weak or that moving will harm it.
Pain from the back itself is usually an ache across the lower back, which may spread into the buttocks or thighs. It is often stiff first thing in the morning, and may be worse after standing for a long time or leaning backwards.
Sometimes a nerve in the lower back becomes irritated or pinched, for example by a bulging disc, or by thickening of the joints and ligaments that narrows the space around the nerve. This causes sciatica: pain that spreads from the buttock down the leg, often below the knee, sometimes with tingling, numbness or weakness in the leg or foot. If the space narrows over a longer stretch, the legs may ache, feel heavy or tingle when you walk or stand, and ease when you sit down or bend forward.
Most episodes of back pain get much better within a few weeks, and sciatica usually settles over weeks to a few months, without an operation. Staying active, and exercises that gradually build up movement and strength, are the main treatment. The exercises are set out below.
Everyday tips
- Keep moving, and carry on with your normal activities as much as you can, even if you have to do less at first. Resting in bed does not speed recovery, even with sciatica.
- Walk every day. Regular walking eases back pain as well as other exercise does, and helps to stop it coming back.
- Avoid sitting for long spells: get up and move around every half an hour or so.
- While your back is sore, keep loads light and close to your body, and avoid lifting and twisting at the same time.
- Sleep in whatever position is most comfortable. A pillow between your knees when you lie on your side, or under your knees when you lie on your back, can help.
- Being overweight and smoking are both linked with back pain that lasts. Losing weight and stopping smoking are good for your back, as well as for your general health.
Easing the pain
- Heat, such as a heat pack or a hot-water bottle wrapped in a towel, can ease the pain and stiffness. Use it for up to 20 minutes at a time.
- Painkillers, taken as prescribed by Dr Malik, can make it easier to keep moving and to do the exercises.
- A back belt is not usually needed. If one makes you more comfortable for a short time, for example on a long journey, it is fine to use it, but keep up the exercises and do not rely on it.
- For severe sciatica that is not settling, an injection around the irritated nerve (an epidural or nerve root injection) can ease the leg pain for a while, which makes it easier to keep moving while the nerve recovers.
- For pain from the facet joints, an injection into or around these joints, or a treatment that uses heat to quieten their small nerves (radiofrequency treatment), helps some people, but not everyone.
- Dr Malik does not give these injections himself, but if an injection might help you, he can refer you to a specialist who does.
If the pain is stopping you from moving or exercising, or you are worried about your back, contact the clinic on +91 99197 03477.
Contact the clinic if
- You have a fever, feel unwell, or are losing weight without trying.
- You have had cancer in the past, and the back pain is new.
- The pain began after a fall or an injury, or you have thin bones (osteoporosis) or take steroid tablets.
- The pain is severe and constant, including at night, and does not ease when you lie still or change position.
- You have numbness or weakness in your leg, or the leg pain is severe and is not settling.
- Your pain is not improving after 6 weeks, or is getting worse despite the exercises.
Go to the nearest emergency department straight away if
- You have sciatica in both legs.
- You have new numbness or tingling between your legs, around your back passage or genitals: the area that would touch a bicycle saddle.
- You have new difficulty passing urine, cannot feel when your bladder is full, or lose control of your bladder or bowels.
- You notice a change in sexual function or sensation.
- Your leg becomes weak and is getting weaker, for example your foot drops or slaps on the floor when you walk.
These are rare, but they can be signs of serious pressure on the nerves at the bottom of the spine, which needs treatment urgently. Do not wait for your clinic appointment.
Before you begin
- Start only when Dr Malik or your physiotherapist has told you to.
- Move slowly and gently, and never force a movement. Some discomfort during the exercises is expected and fine, as long as it settles within 30 minutes and is no worse the next day. If it is worse, do fewer repetitions next time, then build up again gradually.
- Watch your leg pain. If an exercise makes the pain spread further down your leg, or brings on numbness or tingling, stop that exercise and leave it out. If the leg pain moves up towards your back, that is a good sign, even if your back aches a little more.
- Stop, and contact the clinic, if the pain becomes sharp or severe, or you notice new numbness or weakness in your leg.
- Follow these exercises as they are written unless Dr Malik tells you otherwise.
- This information does not replace individual advice. If it differs from what you were told in clinic, follow the advice you were given there.
How to do the programme
- Do the gentle movements once or twice a day, and the strengthening exercises once a day, at a time when you are not rushed. Walk on most days.
- Use a firm surface: a mat or a folded blanket on the floor, or a firm bed if getting down to the floor is difficult.
- Keep going for at least 12 weeks, even when the pain eases: strength takes time to build, and keeping it up helps to stop the pain coming back.
- When an exercise feels easy, do a few more repetitions, or hold for a little longer.
- Keep a diary of the exercises and the walking you do, so that you can see your progress.
Part 1: Gentle movements
These ease stiffness and keep your back moving. Do them slowly, lying on a mat or a firm bed, with a pillow under your head if you like. Move only as far as is comfortable.
Knee rolls
Easing stiffness in the lower back with a gentle twist.
- Lie on your back with your knees bent, your feet flat, and your arms out to the sides.
- Keeping your knees together and your shoulders down, slowly let both knees roll to one side, as far as is comfortable.
- Bring them back to the middle, then roll them to the other side.
Pelvic tilts
Gently moving the lower back, and waking up the deep tummy muscles that support it.
- Lie on your back with your knees bent and your feet flat.
- Tighten your tummy muscles, and gently flatten the small of your back against the floor, so that your hips tilt back a little.
- Hold, then relax and let your back return to its natural curve.
Knee to chest
Gently stretching the lower back and the buttock.
- Lie on your back with your knees bent and your feet flat.
- Bring one knee up towards your chest, holding it with both hands behind the thigh, until you feel a gentle stretch in your lower back and buttock.
- Hold, then lower the leg slowly, and repeat with the other leg.
- When this is easy, you can bring both knees up together.
Rounding and arching the back
Moving the whole back gently, to ease stiffness.
- Kneel on all fours, with your hands under your shoulders and your knees under your hips. A cushion under your knees makes this more comfortable.
- Slowly round your back up towards the ceiling, letting your head drop.
- Then slowly let your back dip down, lifting your head a little. Move only as far as is comfortable.
- If kneeling is difficult, do it sitting on a chair: slump to round your back, then sit up tall.
Lying on your front (only if it helps)
Gently arching the back. This eases the pain for some people, but not for everyone, so read the whole card before you start.
- Lie on your front for a minute or two, with your arms by your sides and your head turned to one side.
- If that is comfortable, prop yourself up on your elbows, keeping your hips on the floor and your back relaxed, and stay there for a minute.
- If that is comfortable too, put your hands under your shoulders and gently straighten your arms to push your upper body up, keeping your hips down. Lower yourself slowly.
- Who it suits: arching the back often helps when a bulging disc is pressing on a nerve. Your leg pain may then move up towards your back.
- Who it may not suit: it often does not suit sore facet joints, or a narrowed space around the nerves (legs that ache when you walk or stand, and ease when you sit or bend forward). Arching the back presses on these areas and can make the pain worse. If you have been told that you have either of these, ask Dr Malik or your physiotherapist before you try it.
- When to stop: if your back or leg pain gets worse, the pain spreads further down your leg, or you feel tingling or numbness, stop and leave this exercise out. Carry on if it eases your pain, or your leg pain moves up towards your back, even if your back aches a little.
Part 2: If you have sciatica
Do this only if you have pain spreading down your leg. It helps the irritated nerve to move freely, and it should not hurt.
Nerve glide, sitting
Helping the irritated nerve to slide freely, without stretching it.
- Sit upright on a chair, with your hands resting on your lap.
- Slowly straighten your sore leg at the knee, pointing your toes up towards you, while you tip your head back to look up.
- Then bend the knee back down, while you bring your chin down towards your chest.
- Move smoothly, without holding at either end. Stop short of any tingling or pain in the leg; a mild pull is fine.
Part 3: Getting stronger
Add these when the gentle movements feel comfortable, usually after a week or two. They build up the muscles that support your back and hips. Keep doing the gentle movements.
Bridging
Strengthening the buttock muscles and the back.
- Lie on your back with your knees bent and your feet flat, hip-width apart.
- Tighten your tummy and buttock muscles, and slowly lift your bottom off the floor, until your body is in a straight line from your shoulders to your knees.
- Hold, then lower yourself slowly.
Arm and leg lifts on hands and knees
Training the back and tummy muscles to hold the spine steady.
- Kneel on all fours, with your hands under your shoulders, your knees under your hips and your back flat.
- Gently tighten your tummy muscles. Slowly stretch one leg out behind you, keeping your hips level and your back still.
- If you can, stretch out the opposite arm in front of you at the same time.
- Hold, then return, and repeat on the other side.
Sit to stand
Strengthening the legs, so that everyday movements put less strain on your back.
- Sit on a firm chair, with your feet flat on the floor, slightly apart.
- Lean forward a little and stand up, without using your hands if you can.
- Sit back down slowly, counting to 3.
- Use your hands on the armrests to help at first, if you need to.
Part 4: Walking
Walking is part of the treatment, not just exercise: keep it up every week, alongside the exercises.
Walking
Building up your fitness: regular walking eases back pain and helps to stop it coming back.
- Start with a walk you can manage comfortably, even if it is only 5 to 10 minutes.
- Each week, add a few minutes, until you can walk for 30 minutes on most days. You can split this into two or three shorter walks.
- If your legs ache, feel heavy or tingle as you walk, stop and rest: sitting down, or leaning forward on a rail or a shopping trolley, usually eases it. Then carry on.
- If walking is difficult, an exercise bike is a good alternative.
Getting back to work and sport
Stay at work, or go back as soon as you can, on light duties at first: you do not need to wait until the pain has gone completely. Avoid heavy lifting at first. It is built up only gradually, and planned separately for each person, depending on your work and what it demands of your back.
Your return to sport is built up gradually, and planned separately for each person, depending on the sport and what it demands of your back. Walking, swimming and an exercise bike can usually be started early.
What to expect
Back pain often eases a lot within the first few weeks. Sciatica can take longer, often a few months, to settle. Most people get better without an operation.
Back pain often comes and goes. A flare-up does not mean that your back is damaged: keep moving, ease off the harder exercises for a few days, then build up again. Keeping up the exercises and your daily walks makes flare-ups less likely.
If your back or leg pain is not improving after 6 weeks, or is getting worse despite the exercises, contact the clinic.
If the pain does not settle: surgery
Most people with back pain or sciatica do not need an operation. For back pain alone, from wear and tear of the discs and joints, an operation is rarely needed.
An operation can help when a pinched nerve causes severe leg pain that does not settle after several weeks of treatment, or when the leg is becoming weak. It takes the pressure off the nerve, for example by removing the part of the disc that presses on it, or by widening the narrowed space around the nerves, and it usually relieves the leg pain sooner than waiting for it to settle.
Dr Malik does not operate on the spine himself. If an operation might help, he will refer you to a spine surgeon, who will discuss whether it is right for you and what it involves.
Take it with you
Download this information to keep on your phone, or print it and keep it where you exercise.
If something does not feel right
Contact the clinic rather than pushing through. Adjusting your exercises early is straightforward.
Published October 2026 · This information is provided for patients under the care of Dr Aditya Malik. It does not replace individual clinical advice.