SCIATICA

Sciatica is nerve pain down the leg from irritation of the sciatic nerve or its roots in the lower back. Physio treatment is about calming the nerve, finding what’s compressing it, and fixing that so it doesn’t keep coming back.

1. *Figure out what’s causing it*

Not all leg pain is true sciatica. Physios check:

- *Disc involvement*: Pain worse with sitting, forward bending, coughing/sneezing. Often centralizing with extension.

- *Spinal stenosis*: Pain worse with standing/walking, better with sitting/forward flexion.

- *Piriformis/glute tightness*: Deep butt pain, worse with sitting. Can mimic disc sciatica.

- *Nerve root vs nerve trunk*: Straight leg raise test, reflexes, sensation check for nerve root irritation.

Red flags like loss of bowel/bladder control, saddle numbness, progressive leg weakness need urgent medical review.

2. *Acute phase: calm the nerve and pain*

Goal is to reduce irritation so you can move without guarding.

- *Position of relief*: Most disc-related sciatica eases with extension-based positions. Standing, walking, lying prone. Flexion-based positions help stenosis.

- *Neural glides*: Gentle nerve flossing to restore nerve mobility without aggressive stretching.

- *Manual therapy*: Joint mobilizations for stiff lumbar segments, soft tissue work on glutes, hamstrings, piriformis.

- *Education*: How to sit, stand, lift without aggravating. Avoid prolonged sitting and slouched posture early on.

3. *Movement correction phase*

Sciatica rarely fixes itself just with passive treatment. You need to change the mechanics loading the nerve.

- *Core stability*: Dead bug, bird dog, side planks. Not crunches - you want control without spinal flexion.

- *Hip mobility*: Tight hip flexors and hamstrings increase lumbar load. Glute strength to take load off the back.

- *McKenzie approach*: Repeated extension movements if you’re “extension responder”. Centralizes pain from leg back to low back.

- *For stenosis*: Flexion-based exercises, core bracing in flexed postures, walking with poles.

4. *Strength and loading phase*

Once pain is manageable, rebuild tolerance.

- *Glute & hamstring strength*: Hip hinges, Romanian deadlifts with light load. Strong posterior chain protects the spine.

- *Progressive loading*: Start with partial range, slow tempo. Build to full squats, deadlifts, walking/running if that’s your goal.

- *Walking program*: Often the best medicine for disc-related sciatica. Start short, frequent walks.

5. *What to avoid early on*

- Aggressive hamstring stretching - it tensions the nerve.

- Repeated flexion if you have disc pain and flexion aggravates it.

- Complete bed rest. Studies show it delays recovery vs staying active within tolerance.

What works according to evidence

*Exercise + education* beats passive modalities. Manual therapy helps short-term for stiffness, but long-term outcomes depend on strength, mobility, and movement habits. Surgery is usually only for severe nerve compression with weakness or cauda equina symptoms.

Typical timeline

- Mild disc irritation: 2-6 weeks with consistent rehab

- More significant disc/nerve root irritation: 6-12 weeks

- Stenosis: Often chronic, but manageable with ongoing exercise

Sciatica can feel scary because of the nerve pain, but most cases improve a lot with the right movement. 

Is your pain worse with sitting, standing, or bending forward? That tells me whether we’re likely dealing with disc, stenosis, or muscular causes and changes the exercise choice.

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