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Sciatica

  1. What is the Sciatic Nerve?
  2. What are the symptoms of Sciatica?
  3. How does the sciatic nerve get injured?
  4. Disc bulge compressing on the sciatic nerve
  5. How do we treat disc bulges that cause Sciatica?
  6. How do we diagnose sciatic nerve injury?
  7. The role of rehabilitation in sciatica

1. What is the Sciatic Nerve?

The sciatic nerve supplies sensation (via dermatomes) to the back, buttocks, thigh and foot, and supplies power (via myotomes) to the hamstrings, calf, ankle and foot. Please see the LBSM guide on Peripheral Nerve Injury and Entrapment to learn more about spinal nerves, dermatomes and myotomes.

sciatic nerve

2. What are the symptoms of Sciatica?

When the sciatica nerve gets injured or inflamed, it causes Sciatica. As with any peripheral nerve injury, sciatica may have sensory or motor symptoms. Please see the LBSM guide on Peripheral Nerve Injury and Entrapment to learn more about sensory or motor symptoms.

Sensory symptoms

The sensory symptoms described below are usually experienced along the dermatomal distribution of the sciatic nerve and can be felt anywhere from the lower back to the sole of the foot.

  • PAIN. Pain symptoms can range from sharp to dull, persistent to intermittent, and remain in one location or radiate to other parts of the body
  • NUMBNESS. This may present as a partial or complete loss of feeling or touch sensation
  • PARAESTHESIA. This essentially means “pins and needles” and can be associated with numbness
  • LOSS OF PROPRIOCEPTION. Ankle balance can sometimes be affected with sciatica.

Motor symptoms

The motor symptoms described below are usually experienced along the myotomal distribution of the sciatic nerve and can occur anywhere from the lower back to the toes. With more chronic sciatica, weakness may be very subtle and take weeks or months to become apparent. Wasted muscles are often lacking in strength but usually can be built up again.

  • WEAKNESS. The most common motor sign in sciatica is a reduction in power in the gluteal, hamstring and calf muscles. With acute sciatica, weakness can come on quite quickly. With more chronic sciatica weakness may be very subtle and take weeks or months to become apparent.
  • MUSCLE WASTING. The muscles that are supplied by an injured nerve may become smaller in size or completely wasted over time. In sciatica, this includes the gluteals, hamstrings and calf muscles. Wasted muscles are often lacking in strength but usually can be rebuilt.
  • HYPOTONIA. The tone (ability to contract) of muscles can also be affected from sciatic nerve injury. This may leave muscles flaccid, floppy and unable to produce forceful contraction.
  • SLOW REFLEXES. Motor nerves are also responsible for providing muscles with their reflex responses. Reflexes can become slower and more sluggish after nerve injury. This can be tested in clinic with a tendon hammer.

“IF YOU EXPERIENCE ANY OF THE SENSORY OR MOTOR SYMPTOMS DESCRIBED ABOVE, PARTICULARLY AROUND THE GENITALS OR BACK PASSAGE AREAS, THIS MAY BE A SIGN OF SERIOUS SPINAL CORD COMPRESSION AND NEEDS URGENT MEDICAL ATTENTION”

3. How does the sciatic nerve get injured?

There are many ways in which the sciatic nerve can be injured (please see LBSM Peripheral Nerve Injury and Entrapment guide) but by far the most common is through nerve entrapment. Below is a summary table of the causes of sciatic nerve entrapment with examples.

CAUSES OF SCIATIC NERVE ENTRAPMENTEXAMPLES
Masses compressing the sciaticSpinal disc herniation (aka disc bulge) Masses arising in the back and pelvis (e.g., fluid collections, soft tissue)
Cysts
Prolonged compression of the sciatic nerveSedentary lifestyle Excessive sitting e.g., driving Poor workplace set up
As the sciatic nerve passes through muscle groupsLower back muscles (erector spinae, psoas), Gluteal, Piriformis, Pelvic floor, Hamstring
As the sciatic nerve passes through other structuresExiting foramen (holes) in the spinal column Spondylolisthesis (slipping of spinal vertebrae)

4. Disc bulge compressing on the sciatic nerve

What is spinal disc bulge?

The most common structure that compresses the sciatic nerve are spinal discs. Spinal discs provide the key functions of stability, movement and protection for the vertebral column and spinal cord. Each spinal disc lies between two spinal vertebrae. Each disc has a soft gelatinous centre (the nucleus pulposus) with a firmer harder casing (the annulus fibrosus), analogous to a Jam Donut. Just behind the disc lies the spinal cord, with spinal nerve roots exiting on both sides.

spinal disc bulge

Spinal discs are dynamic and mobile structures. They move in harmony with the rest of spine. When discs are forced into positions where there may be overstressed (e.g., forward, sidewards or backward bends) a disc bulge can occur. Discs may also become injured with less extreme movements, especially when muscles of the back are not primed and ready to support the discs (e.g., picking up an object incorrectly). Poor standing and seated postures as well as sedentary behaviours also increase the disc of getting disc bulges.

This picture shows a side view of the spine through an MRI scan. The orange blocks are the vertebral bodies with the purple ovals the discs in between them.

sciatica

The green lines outline the spinal canal and cord. It is very normal for the discs in the lower part of the spine (especially the discs between the L4 and L5 vertebrae, and the L5 and S1 vertebrae) to be subjected to wear and tear, as this part of the spine has large amounts of force and load going through it.
The “jam” tends to become thicker and more viscous and is sometimes labelled as disc dehydration. Disc dehydration is a completely normal phenomena and occurs in almost everyone as we get old.

“KEEPING OUR BACK AND CORE MUSCLES STRONG AND ACTIVE PRIMES THEM FOR MOVEMENT, THUS HELPING PROTECT OUR SPINE FROM INJURIES SUCH AS DISC BULGES”

“Disc Bulge” is a generic term and refers to one of the following three types of mechanism of injury.

disc bulge

1. THE ANNULUS FIBROSUS TEARS BUT THE NUCLEUS REMAINS INTACT.

This can cause acute pain in the back at the level of the disc, but as the “jam does not leave the donut” there is often no surrounding nerve irritation or sciatica symptoms. This type of disc injury is called an Annular Tear.

2. THE DISC AS AN ENTIRETY BULGES OUT.

There is still no spillage of jam out of the donut, but this time the annulus itself may contact and irritate the surrounding nerves roots. This type of disc bulge is called a Prolapsed disc and can often occur and recovery over a period of months to years.

3. THE ANNULUS TEARS AND THE NUCLEUS PULPOSUS EXITS THE DISC.

Disc injuries that cause the “jam” to spill out of the donut are often acute and very painful and are called a Sequestrated disc. The nucleus, or “jam”, is highly irritative and can cause lots of inflammation around the nerve and its sheath. Fortunately, the body is very good at absorbing the “jam” so symptoms tend to settle fairly quickly, often with complete resolution.

In reality, it does not really matter which type of disc bulge you are suffering with as the treatments and rehabilitation strategies will be largely the same.

In some cases, understanding the nature of the disc bulge may give some insight around the length and duration of symptoms as well as influencing further treatment decisions.

new figure sciatica

THE BODY HAS A REMARKABLE CAPACITY TO HEAL ANY DISC INJURY, BUT THIS IS A PROCESS THAT OFTEN REQUIRES WEEKS TO MONTHS. A GOOD REHABILITATION PLAN CAN VASTLY EXPEDITE RECOVERY.

5. How do we treat disc bulges that cause Sciatica?

Once a disc bulge has been diagnosed there are several treatment options.

  • NATURAL HEALING AND LIFESTYLE MODIFICATION. Most disc bulges will resolve themselves within 4-6 months if we manage them correctly. It is important to change various aspects of our lifestyles and improve the health of our spine. We can modify our activities, exercise, workplace set up and sleep patterns to create the optimum environment for healing.
  • REHABILITATION. The role of rehabilitation is outlined below and is a vital step when recovering from a disc bulge.
  • REDUCING THE INFLAMMATION AROUND THE NERVE. In acute disc injuries where there is lots of inflammation around the sciatic nerve roots, this treatment option can be very effective for reducing pain symptoms and aiding normal function. This can be achieved by anti-inflammatory medication or spinal injection therapy for short courses. These treatments are best given in conjunction with the steps outlined above.
  • REMOVING THE PART OR ALL THE DISC TO DECOMPRESS THE SCIATIC NERVE. – As mentioned above, the body has a great capability to self-correct disc bulges. However, sometimes removing the disc material and “creating more space” within the spine for nerves to transit is required. This may be the case when symptoms are severe (sensory and/or motor) and all other treatments have failed.

Other masses compressing on the sciatic nerve

Much less commonly, it is possible to have other masses in the back, pelvis and thigh that press on the sciatic nerve. In this case, symptoms can be much more sinister in nature (e. G. , weight loss, bloating, temperatures, change in bowel habit) and this usually prompts further medical investigation. Examples of such masses include collections of fluid, infections, soft tissue masses and cysts. Investigations such as an mri scan can rule this type of pathology out. If there is a mass compressing on the sciatic nerve, removing it medically or surgically usually improves symptoms.

Prolonged functional compression of the sciatic nerve

We may have experienced the sensation of sciatic nerve compression after slouching or sitting down for too long, particularly on a hard surface. This can cause pins and needles and weakness down the leg as well as buttock and lower back pain. Prolonged compression can eventually cause the sciatic nerve to become inflamed. Activities that leave us exposed to this included driving, poor workplace set up and sedentary lifestyle. If we can mobilise often, and keep the core, gluteal and thigh muscles active, we greatly reduce the risk of compressing the sciatic nerve.

Sciatic nerve entrapment from muscle groups

tension and weakness through certain muscle groups including the lower back muscles, gluteal, pelvic floor and hamstrings can trap the sciatic nerve and irritate it. These symptoms can often be misinterpreted as a muscle strain or injury (e. G. , pulled hamstring). By keeping these muscle groups active, strong and flexible, we can reduce the tension put on the nerve and improve any sciatica symptoms. Incorporating regular exercise and appropriate rehabilitation routines into our lifestyle is key.

Sciatic nerve entrapment from other structures

It is normal to have wear and tear in the bones and joints of spine. This can sometimes cause compression or irritation of the nerves as they leave the spine through there bony tunnels (foraminal stenosis). Examples of this may include arthritis of the spine, or slipping of the vertebrae (spondylolithesis). The joints that connect the vertebrae together (facet joints) can also be inflamed and cause sciatic nerve irritation.

6. How do we diagnose sciatic nerve injury?

Most of the time, sciatica is diagnosed clinically after discussing your symptoms and a thorough examination. Sometimes further investigation may be needed to confirm the diagnoses. These can be divided into investigations that (1) look at the spine, the sciatic nerve, its surrounding structures and its course (2) test the conduction and speed of the sciatic. Both these investigations may help to confirm the diagnosis and plan ongoing rehabilitation.

  1. An MRI scan is a key investigation which allows us to look at the spine, the sciatic nerve, its surrounding structures, and its course down the leg. This can help us identify anything that may be compressing the nerve or causes inflammation (e.g., disc bulge, pelvic mass). It may be possible to tell if the sciatic nerve is thickened or swollen, indicating injury.
  2. Nerve Conduction and EMG studies can measure how well the sciatic nerve is firing, conducting signal and whether there are any changes in muscle activation.

7. The role of rehabilitation in sciatica

Along with lifestyle modification, rehabilitation is the cornerstone in treatment for spinal disc injury and sciatica. The picture below shows a cross-sectional view of the lumbar spine taken from an MRI scan.

The yellow lines highlight the huge core and back muscles that envelope the spine to support and protect it. They have an intimate relationship with the vertebral column itself highlighted in orange (the vertebral body, spinous processes and facet joints).

In the centre of this complex is the spinal cord and the nerve roots leaving from either side.

sciatica
sciatica

A REHABILITATION PROGRAMME SHOULD BE WELL CONSIDERED AND COVER THE FOLLOWING AIMS:

  • REDUCE BACK MUSCLE SPASM. With any injury of the spine, the muscles of the back go into spasm to protect the spine. Although a completely natural response, this can be very painful and debilitating. The first step in the treatment of sciatica should be to improve the mobility and flexibility of the back muscles as quickly as possible, releasing them from spasm and getting them to function normally.
  • REDUCING SCIATIC NERVE TENSION AND TIGHTNESS. Exercises such as neural glides can improve the tension in the sciatic nerve and release the nerve from inflamed surrounding tissue and tight muscles
  • IMPROVING CORE, BACK, GLUTEAL AND HAMSTRING STRENGTH AND FLEXIBILITY. The longer-term goal in the rehabilitation of sciatica should be focused around improving the strength of the muscles that the sciatic nerve supplies, as well as the core and back muscle that support the spine.
  • MODIFY AGGRAVATING FACTORS. By being aware of factors that may put our spine and sciatic nerve into compromising positions, will help us avoid repeat flares.

It is important to discuss any potential signs and symptoms of sciatica with your doctor to get a clear diagnosis and treatment plan.

Download the LBSM Sciatica Guide

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Picture of Author: Dr. Ajai Seth
Author: Dr. Ajai Seth

Dr. Ajai Seth is a Consultant in Sport, Exercise & Rehabilitation Medicine based in London. He has dedicated his career to helping people with sport and exercise related injury and illness; specialising in musculoskeletal injuries, running mechanics, racket sport injuries, football and rugby injury, chronic fatigue syndrome, and groin pain.
He works with everyone from the elite athlete to weekend recreational sportspeople and is skilled in musculoskeletal ultrasound diagnostics and therapeutic joint injections, including cortisone injections and PRP.

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Dr. Richard Antbring
MBBS, MSc, MRCP, FFSEM
Consultant Partner, LBSM
Consultant in Sport and Exercise Medicine

About

Dr. Richard Antbring is a dedicated Sport and Exercise Medicine consultant with extensive experience in diagnosing and treating a wide range of both acute and chronic musculoskeletal conditions and injuries. 

Within his private practice he provides comprehensive care for individuals, young and old, from all walks of life, across all levels of physical activity, from elite and recreational athletes to those who lead a slower pace of life; helping them recover from injuries sustained from sports, daily activity, and work-related incidents.

He has a vast experience addressing a full spectrum of conditions such as ligament sprains, muscle strains, dislocations, and more complex, long-term overuse issues like tendonitis and stress fractures. 

His work also extends to treating people with medical problems related to physical activity e.g. concussion, overtraining syndrome, and nutritional deficiencies.

Having worked extensively within professional football, Dr. Antbring has a special interest in lower limb injuries, especially groin pain, and ankle and knee injuries.

Clinical Expertise and Holistic Care

Dr. Antbring is committed to providing individual and personalised care that is specific to the needs of each of his patients. 

He is a highly skilled diagnostician, combining advanced clinical reasoning with evidence-based assessment tools, to ensure an accurate diagnosis. He often utilises ultrasound scans during consultations for real-time diagnostic imaging, allowing him to provide immediate and detailed insight into his patients’ conditions. 

When required, Dr. Antbring is able to access and arranges advanced imaging such as X-rays, MRI or CT scans to further investigate or confirm a diagnosis.

He is an excellent communicator, with a strong belief in empowering patients through education and collaboration. Dr. Antbring takes time to ensure his patients understand their diagnosis and treatment options and are fully committed and engaged in their treatment.

His focus on structured and individualised rehabilitation plans, together with using advanced non-surgical techniques, such as ultrasound-guided injections and shockwave therapy helps patients recover efficiently and return to their daily and physical activities as soon as possible. 

Dr. Antbring strongly believes that the key to recovery is by treating the person as a whole, rather than just focusing on the specific area of injury. He works closely with other healthcare professionals such as physiotherapists, strength and conditioning coaches, Pilates specialists, podiatrists and dieticians, to ensure your path to recovery is smooth, and focuses on longer term prevention as well as immediate treatment. 

Experience in Elite Sports

Dr. Antbring has gained extensive experience working in elite sports environments. His background includes providing medical care for Fulham FC Academy team where he focused on the unique challenges of managing the health and development of young athletes; treating conditions such as back pain, Apophysitis (overuse injury of the hip) and growth plate injuries like Osgood-Schlatter disease; ensuring that they received the highest standard of medical care during their progression toward professional football careers.

He currently works at West Ham United FC and Leyton Orient, where he supports the performance of the 1st team players, managing conditions such as ACL injuries, Achilles tears and tendinopathy, groin and hamstring injuries.

In addition to his work in football, Dr. Antbring has also worked as a doctor for the Lawn Tennis Association (LTA), offering his expertise in musculoskeletal care to wheelchair tennis players. 

His involvement in sports like football and tennis has helped him develop a keen understanding of the specific needs of athletes, enabling him to deliver expert care tailored to the demands of their respective sports and helping them safely return to peak performance following injuries.

Special Interests in High-Intensity Sports

Dr. Antbring has had a strong interest in sport and exercise since childhood, and in later years has developed a personal passion for high-intensity sports and fitness activities, including HYROX, HIIT, CrossFit, and weightlifting. 

His personal enthusiasm for these challenging disciplines has had a significant influence on his practice and makes him uniquely positioned to understand the physical demands placed on these athletes and allows him to provide specialised care for fitness enthusiasts engaged in similar pursuits. 

Training and Qualifications

Dr. Antbring graduated from the prestigious Queen Mary’s University of London in 2015.

During this time, he developed a strong foundation in musculoskeletal medicine and sports injuries, equipping him with the knowledge and skills to treat a broad spectrum of conditions.

In addition to his medical degree, Dr. Antbring has completed a Master’s in Sport and Exercise Medicine, which he achieved with distinction. He also holds a Postgraduate Certificate in Musculoskeletal Ultrasound imaging, further enhancing his diagnostic capabilities and enabling him to perform ultrasound-guided injections and other procedures with precision.

Life Outside Medicine

Outside his clinical work, Dr. Antbring is passionate about maintaining his own fitness through high-intensity workouts like HYROX and HIIT sessions. A typical day for Dr. Antbring starts with his own fitness routine, whether it’s a gym session or an early morning run.

He is devoted Arsenal supporter and Formula 1 enthusiast, and proudly backs McLaren on race days. When he’s not cheering on his sports teams, Dr. Antbring loves to travel, ski, and spend quality time with his family, embracing life to the fullest both in and out of the clinic.

Areas of Interest

Dr. Antbring’s key areas of interest include:

  • Acute and Chronic musculoskeletal injuries
  • Overuse injuries
  • Groin pain
  • Hip, knee, and foot injuries
  • Diagnostic ultrasound
  • Shockwave therapy and 
  • Ultrasound-guided injections
  • Paediatric sports injuries and rehabilitation
  • Tendon, muscle, and joint pain
  • Sports trauma and injury prevention

Consultations and Referrals

Dr. Antbring offers private consultations at the London Independent Hospital. He provides both in-person and virtual appointments.

His calm and patient-centred approach has given him an excellent reputation within the musculoskeletal medical world, and he is highly trusted and respected by his patients and peers. 

He welcomes referrals from other healthcare professionals, as well as direct, self-referrals. He is covered by all the main insurance companies and also accepts self-pay patients.

Dr. Lewis Raiman
MBBS, MRCGP, FFSEM
Consultant in Sport and Exercise Medicine

Consultant Partner, LBSM

About

Dr. Lewis Raiman is a highly experienced Sport and Exercise Medicine consultant specialising in the diagnosis, treatment, and prevention of sports-related and musculoskeletal injuries. 

He works privately at Highgate Hospital – Nuffield Health, where he runs regular weekly clinics.

While he frequently works with athletes recovering from acute injuries such as sprains, fractures, and ligament tears, Dr. Raiman also focuses on managing chronic conditions like tendinopathies, bone stress injuries and other overuse injuries. 

With extensive experience working with elite sports organisations, including West Ham United FC as the Academy Doctor, and The FA as a Performance Doctor, Dr. Raiman is highly regarded for his expertise in treating professional athletes and high performance, active individuals. 

He has also served as a Wheelchair Tennis Doctor for the Lawn Tennis Association (LTA) and worked as a Track Cycling Field Doctor at the Commonwealth Games.

These roles, especially within football and tennis, have shaped his areas of clinical interest, and he is particularly skilled in treating conditions and injuries of the knee, ankle, shoulder and wrist, including ACL injuries, Achilles tendinopathy, calf tears, shoulder impingement, rotator cuff tears, tennis and golfer’s elbow.

His expertise extends far beyond the world of sports, as he provides care to individuals of all ages and activity levels, from young athletes to older adults. In his clinics he often sees individuals who have sustained work related injuries, or injuries from everyday activities.

For patients facing joint issues like osteoarthritis, Dr. Raiman employs non-surgical treatments such as targeted therapies, joint injections, exercise plans, and lifestyle modifications, to relieve pain and improve mobility, often helping delay or even prevent the need for joint replacement surgery. 

Dr. Raiman is also based at Imperial College NHS Trust. He is deeply passionate about bringing the knowledge and expertise he has gained from working with elite athletes and professional sports organisations to the wider population, both within his NHS and Private practice. He believes that everyone deserves access to advanced sports medicine treatment techniques and is committed to delivering the same high level of care used in professional sports to the broader community regardless of their athletic background. 

Expertise and Approach

Dr. Raiman is dedicated to providing a comprehensive and holistic package of care to his patients. He is compassionate and caring, and works hard to build up a strong rapport with his patients, empowering them through education and collaborative decision-making. 

He provides extensive and thorough assessments of sports injuries and musculoskeletal conditions, utilising imaging tools such as ultrasound scans for real-time diagnosis. 

Within the private hospital at Highgate, he has access to state-of-the-art diagnostic equipment; when necessary, he arranges additional imaging, such as MRI or CT scans, then thoroughly reviews the results with his patients to ensure they understand their condition. 

His main aim is to provide his patients with an accurate diagnosis, and timely, tailored treatment and rehabilitation plans that focus on restoring movement and function, to ensure optimal recovery and to prevent future injury.

Collaborative Care

Dr. Raiman works closely with a multidisciplinary team of specialists and has good links with local physiotherapists, strength and conditioning coaches, podiatrists, dieticians, and soft tissue therapists. 

He understands that a team approach is essential for providing the best care and outcomes for his patients. He has an exceptional reputation among both his patients and peers which is a testament to his commitment and compassionate patient care.

When surgical intervention is required, he refers patients to his trusted network of top surgeons specialising in sports injuries, ensuring continuity of care and the best possible outcomes.

Training and Experience

Dr. Raiman completed his Higher Specialist Training in London and is registered with the General Medical Council (GMC) as a Consultant in Sport and Exercise Medicine. His career in elite sports medicine includes roles with leading organisations, where he applies cutting-edge diagnostic and treatment principles to both professional and amateur athletes. 

Areas of Interest

Dr. Raiman’s key areas of interest include:

  • Musculoskeletal and sports injuries
  • Overuse injuries (tendinopathy, stress fractures, bone stress injuries, shin splints)
  • Achilles tendon and ACL injuries 
  • Shoulder, hip, knee, and foot injuries
  • Back pain
  • Football and Tennis injuries
  • Shockwave therapy and ultrasound-guided joint injections (cortico-steroid and Hyaluronic acid)
  • Paediatric (children and adolescents) sports injuries and rehabilitation
  • Injury prevention

Research and Innovation

Dr. Ramia is committed to providing the best, evidence-based care to his patients. With the ever-evolving world of medicine he understands how important it is to keep up with regular training and new research. 

His own research has significantly influenced his clinical practice, particularly in the areas of injury prevention and rehabilitation. His extensive studies on musculoskeletal injuries, biomechanics, and the role of exercise in long-term recovery have shaped his patient-centred approach, enabling him to provide evidence-based treatments tailored to each individual’s needs. 

By staying at the forefront of research on conditions like osteoarthritis and tendon degeneration, Dr. Ramia incorporates the latest advancements in non-surgical interventions, including regenerative therapies and personalised rehabilitation programs. His research-driven insights not only enhance the recovery process but also focus on preventing future injuries, ensuring that his patients, whether athletes or individuals from the general population, can return to their daily activities with improved function and reduced pain. 

https://www.researchgate.net/scientific-contributions/Lewis-Raiman-2049220560

Personal Interests

Outside his clinical life, Dr. Raiman enjoys spending quality time with his young family. He is local to the North London area and enjoys the mix of cultures and makes the most of city life.

He has extended family who live far afield in Australia and New Zealand and with a strong interest in travel he uses this as an opportunity to meet in exotic locations and explore new countries and cultures. It also makes for some healthy family banter when there is international sporting event on!

Referrals and Consultations

Dr. Raiman is committed to helping all patients—from elite athletes and fitness enthusiasts to older patients and those who lead less active lives —achieve their physical best. He offers private consultations at Highgate Hospital – Nuffield Health, on Tuesdays and Wednesday mornings, and welcomes patients seeking expert care for musculoskeletal and sports injuries. 

He is happy to receive referrals from consultants, GPs and other healthcare professionals as well as self-referrals. He also welcomes second opinions and complex cases that need specific expert assessment and intervention.

Dr. Raiman is covered by all major insurance companies, and he also sees self-pay patients. 

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
    BSc, MSc
    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    MBBS, PhD, FRCS
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

    Mr Saha regularly lectures and runs workshops across the globe on the latest surgical techniques to treat vascular disease. He has also been awarded a number of research grants from the Royal College of Surgeons, the Circulation Foundation, the Wellcome Trust, the Academy of Medical Sciences, and the British Heart Foundation, which has led to over 80 publications and the development of innovative technologies to help treat patients. For this work, Prakash has received a number of prizes, including the Venous Forum prize from the Vascular Society of Great Britain and Ireland, an International Young Investigator Award, and an Early Career Investigator Award from the American Heart Association.

    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

    Dr Gajan Rajeswaran
    MBBS, FRCR
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    MBBS, BSc, MSc, MRCS, MRCGP, FFSEM
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.