Sciatica affects millions of people every year, causing debilitating pain that radiates from the lower back down through the leg. The good news? Most cases of sciatica respond well to conservative treatment, and you can significantly improve your symptoms with the right approach.
Understanding Sciatica
What is Sciatica?
Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.
The Sciatic Nerve
- Largest nerve in the body
- Formed from spinal nerves L4-S3
- Travels through the pelvis and down the leg
- Controls muscles in the back of knee and lower leg
- Provides sensation to much of the lower limb
Common Causes
Herniated Disc (Most Common)
- Disc material presses on nerve root
- Usually L4-L5 or L5-S1 levels
- Can occur suddenly or gradually
- Often from lifting, twisting, or aging
Spinal Stenosis
- Narrowing of spinal canal
- More common in people over 60
- Gradual onset
- May involve multiple nerve roots
Piriformis Syndrome
- Piriformis muscle irritates sciatic nerve
- Deep buttock pain
- Often mistaken for true sciatica
- Responds well to treatment
Spondylolisthesis
- Vertebra slips forward on another
- Can compress nerve root
- May be degenerative or from injury
- Sometimes requires surgical intervention
Other Causes
- Spinal tumors (rare)
- Nerve root compression from bone spurs
- Trauma or injury
- Degenerative disc disease
- Pregnancy-related compression
Symptoms and Diagnosis
Typical Symptoms
Pain Characteristics:
- Radiating from lower back to buttock and down leg
- Sharp, burning, or shooting pain
- Can be constant or intermittent
- Worse with sitting, coughing, or sneezing
- Often only one leg affected
Associated Symptoms:
- Numbness or tingling in leg or foot
- Muscle weakness in affected leg
- Foot drop (severe cases)
- Reduced reflexes
- Difficulty moving leg or foot
Red Flags - Seek Immediate Medical Attention
- Sudden, severe weakness in leg
- Loss of bowel or bladder control
- Numbness in groin area (saddle anesthesia)
- Progressive neurological symptoms
- Severe pain following trauma
- Unexplained weight loss or fever
Diagnostic Tests
Physical Examination:
- Straight leg raise test
- Slump test
- Neurological examination (strength, sensation, reflexes)
- Palpation of muscles and spine
- Range of motion assessment
Imaging:
- X-rays: Show bone structures, alignment, arthritis
- MRI: Best for visualizing discs and nerves
- CT scan: Shows bony detail
- EMG/NCS: Assesses nerve function (if needed)
Treatment Approaches That Work
Phase 1: Acute Pain Management (Days 1-7)
Goals:
- Reduce pain and inflammation
- Protect healing tissues
- Maintain some mobility
Strategies:
Activity Modification:
- Short rest periods (avoid prolonged bed rest)
- Avoid aggravating movements
- Use proper posture
- Frequent position changes
Ice or Heat:
- Ice for first 48 hours if acute injury
- Heat after 48 hours for muscle relaxation
- Alternate as needed for comfort
- 15-20 minutes at a time
Medication:
- Over-the-counter NSAIDs (if approved by doctor)
- Acetaminophen for pain
- Muscle relaxants if prescribed
- Short-term use only
Phase 2: Progressive Exercise (Weeks 1-4)
The McKenzie Method
Assess your directional preference:
Extension-Based Exercises (if pain decreases):
- Prone on elbows
- Prone press-ups
- Standing back extensions
Flexion-Based Exercises (if pain decreases):
- Knee to chest stretches
- Cat-cow stretches
- Pelvic tilts
Important: Only do exercises that centralize or reduce symptoms. If pain moves further down your leg, stop and consult a professional.
Best Exercises for Sciatica Relief
1. Nerve Flossing (Neural Mobilization)
Sciatic Nerve Glide:
- Sit on edge of chair
- Extend affected leg straight
- Flex and point foot
- Gently bend and straighten knee
- 10 repetitions, 2-3 times daily
2. Piriformis Stretch
Seated Piriformis Stretch:
- Sit in chair
- Cross affected leg over opposite knee
- Gently lean forward
- Hold 30 seconds
- Repeat 3 times
3. Cat-Cow Stretch
- Start on hands and knees
- Arch back (cow pose)
- Round back (cat pose)
- Move slowly and gently
- 10 repetitions, 2-3 times daily
4. Pelvic Tilts
- Lie on back, knees bent
- Flatten back against floor
- Hold 5 seconds
- Relax and repeat
- 10-15 repetitions
5. Knee to Chest Stretch
- Lie on back
- Bring one or both knees to chest
- Hold 20-30 seconds
- Repeat 2-3 times
6. Hamstring Stretch
- Lie on back
- Raise one leg straight up
- Use towel around foot if needed
- Hold 30 seconds
- Repeat 3 times each leg
7. Child's Pose
- Kneel on floor
- Sit back on heels
- Stretch arms forward
- Hold 30-60 seconds
- Repeat as needed
8. Bridges
- Lie on back, knees bent
- Lift hips toward ceiling
- Hold 5 seconds
- Lower slowly
- 10-15 repetitions
Phase 3: Strengthening and Stabilization (Weeks 4-12)
Core Strengthening
Dead Bug:
- Lie on back
- Raise opposite arm and leg
- Maintain neutral spine
- 10 repetitions each side
Bird Dog:
- Start on hands and knees
- Extend opposite arm and leg
- Hold 10 seconds
- 10 repetitions each side
Planks:
- Hold plank position
- Start with 15-30 seconds
- Progress to 60 seconds
- Side planks for obliques
Lower Body Strengthening
Squats:
- Proper form essential
- Start shallow, progress depth
- Body weight initially
- 2-3 sets of 10-15 repetitions
Lunges:
- Forward, reverse, and lateral
- Control is key
- 2-3 sets of 10 each leg
Single-Leg Deadlifts:
- Improves balance and strength
- Start without weight
- 2-3 sets of 10 each leg
Physiotherapy Treatment
Manual Therapy
Techniques:
- Joint mobilizations (spine and pelvis)
- Soft tissue massage
- Myofascial release
- Trigger point therapy
- Neural mobilization
Modalities
- Ultrasound (promote healing)
- TENS (pain management)
- IFC (interferential current)
- Acupuncture
- Dry needling
Education
- Proper body mechanics
- Ergonomic modifications
- Activity pacing
- Self-management strategies
Lifestyle Modifications
Posture and Ergonomics
Sitting:
- Lumbar support essential
- Feet flat on floor
- Knees level with hips
- Take breaks every 30 minutes
- Consider standing desk
Sleeping:
- Side sleeping: pillow between knees
- Back sleeping: pillow under knees
- Avoid stomach sleeping
- Supportive mattress
Lifting:
- Bend at knees, not waist
- Keep object close to body
- Tighten core before lifting
- Avoid twisting while carrying
Activity Modifications
What to Avoid:
- Prolonged sitting
- Forward bending with straight legs
- Heavy lifting
- High-impact activities initially
- Twisting movements
What to Do:
- Walk regularly (as tolerated)
- Swim or water aerobics
- Stationary bike
- Gentle yoga or Pilates
- Progressive return to activities
Advanced Treatment Options
Epidural Steroid Injections
- Anti-inflammatory medication injected near nerve
- Provides temporary relief (weeks to months)
- Allows participation in physiotherapy
- 1-3 injections maximum per year
- 50-70% experience short-term improvement
Surgical Options
Considered when:
- Severe pain unresponsive to conservative treatment (6-12 months)
- Progressive neurological deficits
- Cauda equina syndrome (emergency)
- Significant functional impairment
Common Procedures:
- Microdiscectomy (most common)
- Laminectomy
- Spinal fusion (select cases)
Success Rates:
- 80-95% pain improvement
- Recovery time: 6-12 weeks
- Physical therapy essential post-surgery
Prevention Strategies
Regular Exercise
- Maintain strong core
- Keep back and leg muscles flexible
- Regular cardiovascular exercise
- Maintain healthy weight
Proper Body Mechanics
- Use good posture always
- Lift with legs, not back
- Avoid prolonged sitting
- Take frequent movement breaks
Ergonomic Setup
- Proper workstation arrangement
- Supportive chair
- Appropriate desk height
- Computer monitor at eye level
Risk Factor Management
- Maintain healthy weight
- Don't smoke (affects disc health)
- Stay active
- Manage stress
- Get adequate sleep
Treatment Timeline
Week 1-2:
- Pain management focus
- Gentle movement
- Begin directional preference exercises
- Expected: Some symptom improvement
Week 3-6:
- Progressive exercises
- Strengthening begins
- Activity gradually increases
- Expected: 50-70% improvement
Week 7-12:
- Advanced strengthening
- Return to normal activities
- Emphasis on prevention
- Expected: 80-90% resolution
Note: 90% of acute sciatica cases resolve within 6-12 weeks with proper treatment.
When to Seek Professional Help
See a healthcare provider if:
- Pain persists beyond 2 weeks
- Symptoms worsen despite home treatment
- Numbness or weakness develops
- Pain significantly impacts daily life
- Previous treatments haven't helped
What to Expect from Treatment
Realistic Goals:
- Significant pain reduction (may not be 100% pain-free)
- Improved function and mobility
- Return to normal activities
- Prevention of future episodes
Success Factors:
- Early treatment
- Consistent exercise program
- Addressing contributing factors
- Proper body mechanics
- Active participation in recovery
Don't Suffer in Silence
Sciatica can be incredibly painful and limiting, but it doesn't have to control your life. With proper treatment and rehabilitation, most people make full recoveries and return to all their activities.
Dealing with sciatica pain? Our physiotherapy team at M.O. Therapy specializes in treating sciatic nerve pain. We'll identify the root cause of your symptoms, create a personalized treatment plan, and guide you through evidence-based exercises for lasting relief.
Book your assessment today and take the first step toward a pain-free life. Don't let sciatica keep you from doing what you love.