Sciatica Treatment

What Is Sciatica?

Sciatica refers to pain that radiates along the path of the sciatic nerve — from the lower back, through the buttock, and down the back of the leg. It's not a diagnosis in itself but a symptom, most commonly caused by a disc bulge, spinal stenosis, or piriformis muscle irritation pressing on or irritating the sciatic nerve as it exits the spine.

Because sciatica can stem from several different underlying causes, effective treatment depends entirely on correctly identifying which structure is actually irritating the nerve. Treating the symptom without addressing the source often leads to temporary relief that doesn't last.

Symptoms & Causes

Common symptoms include:

• Sharp, burning, or shooting pain from the lower back down one leg
• Numbness, tingling, or a "pins and needles" sensation along the leg
• Pain that worsens with prolonged sitting, standing, or specific movements
• Occasional muscle weakness in the affected leg
• Pain typically affecting one side of the body
• Symptoms that may worsen with coughing, sneezing, or straining

Common underlying causes:

• Disc bulge or herniation pressing on the nerve root
• Spinal stenosis (narrowing of the space around the nerve)
• Piriformis syndrome (a deep hip muscle irritating the nerve)
• Spondylolisthesis (a vertebra slipping out of alignment)
• Prolonged sitting or sedentary posture aggravating existing nerve sensitivity

How We Assess It

Assessment focuses on identifying exactly where and why the sciatic nerve is being irritated:

• Neural tension testing — including the straight leg raise test, to reproduce and localize nerve symptoms
• Neurological screening — reflexes, sensation, and muscle strength testing in the affected leg
• Movement assessment — identifying which positions or movements ease or worsen symptoms, which helps distinguish discogenic pain from piriformis-related or stenosis-related pain
• Postural and lifestyle review — since prolonged sitting is a major aggravating factor for many patients

This structured approach matters because discogenic sciatica, piriformis syndrome, and stenosis-related sciatica each respond to different treatment emphases.

Our Treatment Approach

Treatment is tailored to the underlying cause identified during assessment, and may include:

• Nerve gliding/flossing exercises — gentle, specific movements that help the nerve move freely within its surrounding tissue
• Manual therapy — including piriformis release and soft tissue work to reduce muscular compression on the nerve
• Core stabilization exercises — to reduce mechanical stress on the lower spine
• Postural correction — particularly for sitting posture, since this is one of the most common aggravating factors
• Dry Needling — frequently used alongside physiotherapy to address secondary muscle guarding around the irritated nerve

Most patients are also given a home exercise routine to manage symptoms between sessions and prevent flare-ups.

Benefits of Treatment

• Reduces radiating leg pain and nerve irritation
• Improves nerve mobility and reduces tingling/numbness
• Addresses the underlying mechanical cause, not just the symptom
• Restores ability to sit, stand, and walk without pain
• Reduces likelihood of recurrence with long-term movement strategies
• Avoids or delays the need for injections or surgery in many cases

Who Should Consider This / Contraindications

Physiotherapy is highly effective for most sciatica cases, particularly when started early rather than after symptoms have become chronic. As with disc-related back pain, certain red-flag symptoms require urgent medical evaluation rather than physiotherapy:

• Progressive weakness in the leg or foot
• Saddle anesthesia (numbness in the groin/inner thigh area)
• New bladder or bowel control changes

These may indicate a rare but serious condition called cauda equina syndrome, which is a medical emergency. Our therapists screen for these signs at your first visit and will refer you for urgent medical care if present.