Sciatica

Sciatica is the name given to pain, numbness or weakness in the areas supplied by the sciatic nerve — the hip, buttock, thigh, calf and foot. The sciatic nerve is the longest and thickest nerve in the body, running from the lower back, through the buttock, and down the back of the leg, and when it’s compressed, irritated or inflamed, the resulting pain can be genuinely debilitating, often more limiting than the back pain that frequently comes before it.

It’s worth understanding that “sciatica” describes a pattern of symptoms rather than a single diagnosis — a few different underlying problems can produce it, which is why getting an accurate assessment of the actual cause matters more than simply treating the leg pain in isolation.

What causes sciatica

Sciatica is most often brought on by restrictions or irritation within the lower spine that affect the nerve roots feeding into the sciatic nerve, causing pain to refer down the leg along the nerve’s path. A disc that’s bulging or irritated can press directly on a nerve root, producing this same pattern. Restrictions or tightness in the pelvis and gluteal muscles can also compress the sciatic nerve directly as it passes beneath them, a presentation sometimes called piriformis-related sciatica, which behaves a little differently to a disc-related cause and responds to a different emphasis in treatment.

Sciatica is commonly preceded by a few weeks of ordinary back pain before leg pain develops and, in many cases, becomes more troublesome than the back pain itself. Because sciatica can arise from more than one structure — and because it can occasionally stem from something more significant than a mechanical disc or joint problem — a thorough assessment is important to identify which cause applies to you, since the right treatment depends on getting this right.

When to see a physiotherapist

Most sciatica responds well to conservative physiotherapy, and seeing Andrew as soon as leg pain starts — rather than waiting until it becomes unbearable — gives you the best chance of a faster, more complete recovery. Sciatica left untreated for a long period tends to take longer to resolve and carries more potential for lasting nerve irritation, including reduced reflexes and muscle wasting in the lower leg, most noticeably in the calf, in more severe or prolonged cases.

A small number of sciatica presentations need urgent medical attention rather than routine physiotherapy. See a doctor or emergency department immediately if you notice numbness around the saddle area (inner thighs, groin or genitals), new difficulty controlling your bladder or bowel, or rapidly worsening leg weakness — these can indicate cauda equina syndrome, a rare but serious condition caused by significant compression of the nerves at the base of the spine, which requires emergency assessment. Progressive weakness, numbness that’s spreading, or a foot that drags when you walk also warrant a prompt physiotherapy assessment rather than a wait-and-see approach, even outside these emergency red flags.

Physiotherapy treatment for sciatica

Because sciatica can arise from a number of different sources, treatment is tailored to what your assessment identifies rather than following a fixed formula. Andrew’s approach typically draws on:

• Manual therapy, including techniques to restore movement in restricted spinal joints and ease the muscular guarding that develops around an irritated nerve
• Dry needling for tight, overactive muscles — particularly through the buttock and lower back — that can be contributing to nerve compression or guarding around the painful area
• Exercise rehabilitation, including core and lumbar strengthening work and specific nerve mobility exercises (sometimes called nerve gliding or flossing), aimed at reducing irritation at the source rather than simply easing pain temporarily

Consulting Andrew involves a review of your complete medical history and a thorough physical examination to determine what’s actually driving your sciatica. You may need imaging such as x-rays or an MRI in some cases, which Andrew will discuss with you if your presentation warrants it — x-rays are usually bulk-billed, so this doesn’t typically involve an additional out-of-pocket cost. Once this information is gathered, your treatment options are discussed together before starting.

What to expect from treatment

Gentle movement, including walking, is usually more helpful for sciatica than prolonged bed rest, since extended rest tends to stiffen the spine further and can slow recovery. That said, if walking or other movement clearly worsens your leg pain, it’s worth having Andrew reassess rather than pushing through, since this can be a sign that the current approach needs adjusting. Most people notice a reduction in leg pain within the first few sessions, though the underlying spinal mobility and core strength that reduce how likely sciatica is to recur take longer to build, and are usually the focus once the acute nerve irritation has settled.

Preventing recurrence

Because the back pain that often precedes sciatica shares many of the same underlying drivers — restricted spinal movement, muscle guarding and core weakness — the strategies for preventing recurring low back pain are closely related to preventing sciatica returning. Andrew’s home exercise programme is built with this connection in mind, targeting the spinal mobility and core strength that make a repeat episode less likely.