Sciatica Physio
Causes, Symptoms & Treatment
Sciatica refers to pain that travels along the path of the sciatic nerve — the longest nerve in the body, running from your lower back, through the buttock, and down the back of the leg. Rather than being a diagnosis in itself, sciatica is a symptom of an underlying issue affecting the nerve roots in your lumbar spine.
At Thrive Physiotherapy, we see sciatica regularly across a wide range of ages and activity levels, from office workers with prolonged sitting postures to weekend sports players and older adults with degenerative spinal changes. The good news is that the majority of sciatica cases improve significantly with the right physiotherapy management, without the need for injections or surgery.
What Causes Sciatica?
Sciatica occurs when a structure in the lower spine irritates or compresses one of the nerve roots that form the sciatic nerve. Common causes include:
Disc bulge or herniation — where the soft inner material of a spinal disc pushes outward and presses on a nearby nerve root
Spinal stenosis — a narrowing of the spinal canal that reduces space around the nerves, more common in older adults
Piriformis syndrome — tightness or spasm in the piriformis muscle in the buttock, which sits close to the sciatic nerve
Degenerative disc disease — age-related wear of the spinal discs that can reduce space around nerve roots
Spondylolisthesis — where one vertebra slips forward over the one below it, potentially narrowing the space nerves pass through
Referred pain associated with lower back pain, often referred to as “sciatica”, can be due to either somatic referred pain or radicular referred pain, both of which are described below. Our physiotherapists are trained to use specific tests to determine the cause of leg symptoms and treat them appropriately.
Somatic referred pain is the most common cause of leg symptoms in patients with lower back pain and is often the cause of pain in the buttock or back of the hamstring. The symptoms are due to referred pain, where the pain sensations from the lower back are mixed with the sensations from the leg. Unlike radicular referred pain, there is no direct compression or irritation of the nerve roots that exit the spine, it is simply due to crossed signals between the sensory nerves coming from the muscles/joints of the back and those coming from the muscles/skin of the legs. This type of cross talk is similar to the cause of neck based headaches.
Radicular referred pain is the term used to describe symptoms in the leg that are due to compression or irritation of a nerve root in the lower back. The nerve root may be physically impinged by a disc or bone, or may be irritated by the inflammatory chemicals that are associated with an surrounding injury. Pain in the leg will often follow a dermatomal pattern, where the symptoms travel in a line from the lower back down to the foot. There may also be numbness/pin and needles/weakness in the leg . It is vital that radicular referral pain is assessed thoroughly by a physiotherapist or other professional therapist, as these nerve injuries can lead to weakness that can be longstanding.
Symptoms of Sciatica
Sciatica typically presents as pain radiating from the lower back or buttock down the back or side of one leg, sometimes reaching as far as the foot. It's often described as sharp, burning, or shooting, and can be accompanied by:
Numbness or pins-and-needles along the nerve path
Muscle weakness in the leg or foot
Pain that worsens with sitting, coughing, or sneezing
Symptoms usually affecting one side of the body
When to Seek Urgent Care
While most sciatica is manageable with conservative treatment, certain symptoms warrant immediate medical attention. Seek urgent care if you experience loss of bladder or bowel control, numbness in the groin or inner thigh (saddle anaesthesia), or progressive weakness in both legs — these can indicate a serious condition called cauda equina syndrome.
How Physiotherapy Can Help
Physiotherapy is considered a first-line, evidence-based treatment for sciatica. Your physiotherapist will begin with a thorough assessment to identify the likely source of nerve irritation and rule out any red flags, before developing a tailored treatment plan. This may include:
Manual therapy — hands-on techniques to reduce stiffness in the lumbar spine and surrounding joints
Nerve gliding exercises — gentle movements designed to help the sciatic nerve move more freely within its surrounding tissue
Targeted strengthening — building strength in the core, glutes, and lower back to support the spine and reduce recurrence
Postural and ergonomic advice — practical adjustments to sitting, standing, and lifting habits that may be contributing to symptoms
Education on activity modification — guidance on which movements to modify short-term and which to keep doing, since prolonged rest is not recommended
Treatment is progressed gradually based on how your symptoms respond, with the goal of restoring pain-free movement and preventing future flare-ups.
What to Expect at Your First Appointment
Your initial consultation will include a detailed history of your symptoms, a physical examination of your lumbar spine and neurological function (reflexes, strength, and sensation testing), and a discussion of your treatment options. Most people begin to notice improvement within a few weeks of starting a structured physiotherapy program, though timelines vary depending on the underlying cause and severity.
Don't Let Sciatica Limit Your Life
Sciatica can be frustrating and disruptive, but with the right guidance, most people return to their normal activities without lasting issues. Early intervention often leads to faster, more complete recovery.
If you're experiencing lower back or leg pain, book an appointment with one of our physiotherapists today to get an accurate diagnosis and a treatment plan tailored to you.
