Typical symptoms of sciatica
- Pain starting in the buttock and running down the back or side of the leg
- Leg pain that is often worse than the back pain
- Numbness, tingling or electric-shock sensations in the leg or foot
- Symptoms that increase with long sitting, bending forward, coughing or sneezing
- Usually affects one leg only
- In some people, weakness in the foot or difficulty walking on tiptoe
Causes and risk factors
The most common cause of sciatica is a herniated disc pressing on or chemically irritating a nerve root. In older adults, narrowing of the spinal canal (spinal stenosis) can cause similar symptoms. Because muscle and joint problems around the hip can also send pain down the leg, the first step in treatment is working out whether the pain really comes from the nerve. Nerve pain usually travels below the knee and comes with changes in sensation such as numbness or tingling, whereas pain referred from the hip often stays at thigh level.
- A herniated disc
- Age-related narrowing of the spinal canal or the openings where nerves exit
- Long hours of sitting and an inactive lifestyle
- Jobs involving heavy lifting
- Changes in load and posture during pregnancy
How I work with sciatica
First I pin down where the pain is coming from, because pain from a nerve root and pain referred from the hip are treated differently.
Assessment
I check how your back and hips move, along with nerve tension tests, your reflexes, sensation and muscle strength. This shows how much the nerve is affected and which positions change the pain. If I find any warning signs, I refer you to a doctor first.
Manual therapy
I use joint mobilisation and soft tissue techniques around the lower back and hips. Gentle neural mobilisation, which aims to help the sciatic nerve glide freely through the surrounding tissues, is also something I use often.
Exercise therapy
We start with movements that ease the leg pain or draw it back towards the lower back. As the pain calms down, we move on to a programme that strengthens your trunk, hip and leg muscles.
Education
We talk about why nerve pain tends to come and go, which activities to cut back on for a while and which to keep doing. I also give you practical tips for how you sit and sleep.
How many sessions will I need?
Nerve pain usually settles more slowly than muscle pain. We start with 2–3 sessions a week and space them out as you improve; for many people 6–12 sessions is a realistic range. The exact plan depends on the nerve findings in your assessment and how long you've had the pain.
What you can do at home
- Rather than lying down all day, take short walks at regular intervals.
- Avoid sitting in low, soft chairs for long periods, and break up your sitting often.
- If you sleep on your side, a pillow between your knees can make nights more comfortable.
- Don't force stretches that make your leg pain worse — stretching the nerve doesn't always help.
When to see a doctor first
If you notice any of the following, don't wait — see a doctor or go to the emergency department:
- Loss of bladder or bowel control, or being unable to pass urine
- Numbness around the groin and buttocks
- Pain or numbness starting in both legs at once
- Rapidly increasing weakness in the leg, or your foot catching or dragging on the ground
- Pain that started after a fall or accident
- Pain together with fever, unexplained weight loss or a history of cancer
Frequently asked questions
Are sciatica and a herniated disc the same thing?
How long does sciatica last?
Should I use heat or ice for sciatica?
Do I need a doctor's referral for sciatica?
This page is for general information only and does not replace a medical diagnosis or examination. If your symptoms are severe or getting worse quickly, see a doctor first.