Sciatica: Symptoms, Causes, and Physiotherapy Treatment
Sciatica affects approximately 40% of people at some point in their lives, causing radiating leg pain from sciatic nerve irritation or compression. Whether you're experiencing sharp shooting pain down your leg, numbness in your foot, or persistent buttock discomfort, physiotherapy offers effective evidence-based treatment. London has over 150 physiotherapists experienced in treating sciatica through targeted exercises, manual therapy, and neurodynamic techniques that address nerve mobility and reduce symptoms.
What is sciatica?
Sciatica is pain radiating along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. True sciatica involves nerve compression or irritation causing pain, numbness, tingling, or weakness in the leg. The condition typically affects only one side of the body. Sciatica is a symptom rather than a diagnosis - the underlying cause may be disc herniation, spinal stenosis, piriformis syndrome, or other nerve compression.
The sciatic nerve is the longest and widest nerve in the body, formed by nerve roots L4, L5, S1, S2, and S3 in the lower spine. When compressed or irritated, these nerves produce characteristic symptoms following the nerve distribution pattern down the back of the thigh, sometimes into the calf and foot.
Sciatica differs from general back pain through its radiating nature. While back pain remains localised in the spine, sciatica travels down the leg following specific nerve pathways. This distinction is important for accurate diagnosis and treatment selection.
What are the symptoms of sciatica?
The main symptoms of sciatica include sharp, shooting pain travelling from the lower back or buttock down the back of the leg, numbness or tingling in the leg or foot, muscle weakness in the affected leg, and pain that worsens with sitting, coughing, or sneezing. Symptoms typically affect one leg only. Severity ranges from mild ache to severe, debilitating pain preventing normal activities.
Common symptoms:
Radiating Pain - Sharp, shooting, or burning pain travelling from the lower back or buttock down the back of the thigh, sometimes continuing into the calf and foot. Pain follows the sciatic nerve distribution.
Numbness and Tingling - Altered sensation including pins and needles, numbness, or reduced feeling anywhere along the sciatic nerve path. Some people describe "dead leg" feeling.
Muscle Weakness - Difficulty performing specific movements such as standing on tiptoes, lifting the foot, or rising from a chair. Weakness indicates significant nerve compression requiring prompt assessment.
Pain Patterns - Symptoms typically worsen with prolonged sitting, bending forward, coughing, sneezing, or straining. Standing and walking often provide relief, though severe cases hurt constantly.
One-Sided Symptoms - Sciatica usually affects one leg. Bilateral (both legs) symptoms may indicate serious spinal pathology requiring urgent medical attention.
Buttock Pain - Deep ache in the buttock is common, sometimes the predominant symptom. Piriformis syndrome causes sciatica-like symptoms from muscle compression of the nerve in the buttock.
When to seek urgent medical attention:
Seek immediate medical help if experiencing:
Inability to control bladder or bowels (cauda equina syndrome - medical emergency)
Progressive leg weakness or numbness in both legs
Severe pain unrelieved by any position or medication
Symptoms following significant trauma
Saddle anaesthesia (numbness around the groin and inner thighs)
These red flags suggest serious nerve compression requiring emergency investigation.
What causes sciatica?
Sciatica is caused by compression or irritation of the sciatic nerve from disc herniation (90% of cases), spinal stenosis, piriformis syndrome, spondylolisthesis, or degenerative disc disease. Risk factors include age (most common 40-50 years), obesity, prolonged sitting, heavy lifting, and diabetes affecting nerve health. In many cases, no specific injury triggers symptoms - gradual degenerative changes in spinal discs create vulnerability to nerve compression.
Primary causes:
Disc Herniation - The most common cause of sciatica. The soft inner disc material (nucleus pulposus) bulges through the outer layer (annulus fibrosus), pressing on adjacent nerve roots. L4/L5 and L5/S1 discs most frequently herniate, compressing the sciatic nerve.
Spinal Stenosis - Narrowing of the spinal canal compresses nerve roots. Usually age-related from bone spurs, ligament thickening, and disc bulging. More common in people over 60.
Piriformis Syndrome - The piriformis muscle in the buttock compresses the sciatic nerve passing beneath it. Caused by muscle tightness, spasm, or anatomical variations. Accounts for 6-8% of sciatica cases.
Spondylolisthesis - Forward slippage of one vertebra over another pinches nerve roots. May be degenerative (age-related) or from stress fractures in young athletes.
Degenerative Disc Disease - Age-related disc changes including dehydration and height loss alter spinal biomechanics, potentially compressing nerves.
Spinal Tumours or Infections - Rare causes requiring medical investigation if suspected.
Risk factors:
Age 40-50 years (peak incidence)
Obesity increasing spinal load
Sedentary occupation with prolonged sitting
Jobs requiring heavy lifting or vibration (lorry drivers)
Diabetes affecting nerve health
Previous back injury
Smoking reducing disc nutrition
Pregnancy (temporary sciatic nerve compression)
How does physiotherapy help sciatica?
Physiotherapy treats sciatica through comprehensive assessment identifying the pain source, specific exercises reducing nerve compression, manual therapy addressing muscle tension and joint mobility, neurodynamic techniques improving nerve mobility, and education about positions and movements to avoid. Research shows physiotherapy significantly reduces sciatic pain and improves function, with 60-80% of patients experiencing major improvement within 6-8 weeks.
Assessment:
Sciatica physiotherapy begins with detailed assessment differentiating true nerve compression from referred pain patterns. Your physiotherapist performs specific tests including straight leg raise, slump test, and neurological examination checking reflexes, sensation, and muscle strength. These tests identify which nerve roots are affected and whether symptoms arise from disc herniation, spinal stenosis, or piriformis syndrome.
Movement assessment reveals positions and activities exacerbating symptoms, guiding treatment selection. Some sciatica improves with extension (backward bending) while others respond better to flexion (forward bending). This directional preference is crucial for effective treatment.
Treatment techniques:
McKenzie Method - Specific repeated movements and sustained positions reduce disc pressure and centralize symptoms (pain moving from the leg towards the spine). This technique is highly effective for disc-related sciatica, often providing rapid relief.
Neurodynamic Techniques - Gentle nerve mobilization exercises improve nerve mobility and reduce sensitivity. The sciatic nerve must slide and glide during leg movements; restrictions cause pain. Neurodynamic treatment restores this mobility.
Manual Therapy - Soft tissue massage releases tight muscles compressing the nerve, particularly the piriformis. Joint mobilization improves spinal mobility, reducing nerve irritation. These hands-on techniques complement exercise.
Core Strengthening - Specific exercises strengthen deep abdominal and back muscles supporting the spine, reducing disc pressure and preventing recurrence. Progression from basic activation to functional strengthening.
Flexibility Training - Stretching tight hip flexors, hamstrings, and piriformis muscle relieves nerve tension. However, aggressive stretching can aggravate acute sciatica - physiotherapists guide appropriate intensity.
Postural Correction - Sitting and standing posture significantly affects sciatic nerve tension. Ergonomic modifications and postural muscle training reduce daily irritation.
Pain Education - Understanding pain mechanisms reduces fear and anxiety. Modern pain science shows nervous system sensitivity contributes to chronic sciatica. Education empowers self-management.
Additional treatments include dry needling for piriformis trigger points and taping techniques for acute symptom relief.
What is the recovery timeline for sciatica?
Recovery from sciatica typically takes 6-12 weeks with appropriate physiotherapy, though individual timelines vary considerably. Acute sciatica from disc herniation often improves significantly within 6 weeks. Chronic sciatica (lasting over 3 months) requires 10-16 weeks of consistent treatment. Individual factors including severity of nerve compression, duration before treatment, age, and exercise compliance influence recovery speed.
Typical recovery phases:
Acute Phase (Week 1-3)
Focus: Pain reduction and avoiding aggravating movements
Symptoms: Severe leg pain, possible numbness
Treatment: McKenzie exercises, gentle mobilization, pain education
Goals: Reduce leg pain intensity, improve sitting tolerance
Subacute Phase (Week 4-8)
Focus: Increasing activity and strengthening
Symptoms: Decreasing leg pain, improving function
Treatment: Progressive exercises, increased mobilization, postural training
Goals: Pain-free daily activities, return to light work
Rehabilitation Phase (Week 9-16)
Focus: Full recovery and preventing recurrence
Symptoms: Minimal or no leg pain, occasional back discomfort
Treatment: Advanced strengthening, return to full activity
Goals: Return to all activities including sport, prevent future episodes
Factors affecting recovery:
Severity of compression - Mild irritation recovers faster than significant herniation with muscle weakness
Duration before treatment - Early intervention (within 4 weeks) produces better outcomes
Nerve root involved - L5 and S1 compressions often take longer than L4
Age - Younger patients typically recover faster
Exercise compliance - Consistent home exercises dramatically improve outcomes
Work demands - Sedentary jobs allow easier modification than heavy manual work
Psychological factors - Fear avoidance and catastrophizing delay recovery
Most sciatica resolves with physiotherapy. Surgery becomes necessary only for severe cases with progressive weakness, cauda equina syndrome, or symptoms failing to improve after 12 weeks of appropriate conservative treatment.
How to prevent sciatica
Prevent sciatica by maintaining strong core muscles through regular exercise, practising good posture during sitting and lifting, managing healthy body weight, taking regular breaks from prolonged sitting, and avoiding activities requiring repetitive twisting or heavy lifting. Those with previous sciatica episodes should continue core strengthening exercises indefinitely and remain vigilant about ergonomic positioning.
Prevention strategies:
Core Strengthening - Regular exercises targeting deep abdominal and back muscles protect the spine from excessive movement and disc stress. Planks, bird dogs, and dead bugs build protective muscle endurance.
Proper Lifting Technique - Lift with legs not back, keep loads close to body, avoid twisting while lifting. Heavy lifting with poor technique is a major sciatica trigger.
Sitting Posture - Maintain lumbar lordosis (natural lower back curve) when sitting. Use lumbar support, keep feet flat, take standing breaks every 30 minutes. Prolonged slouched sitting increases disc pressure.
Regular Movement - Break up sedentary periods with walking or stretching. The spine benefits from regular position changes distributing loads across different tissues.
Weight Management - Maintain healthy body weight reducing spinal load. Every kilogram of excess weight multiplies forces through the lower back.
Hip and Hamstring Flexibility - Tight hip flexors and hamstrings increase lower back stress. Regular stretching maintains optimal biomechanics.
Workplace Ergonomics - Optimize desk setup with appropriate chair height, screen position, and footrest. Drivers should adjust seat position minimizing back strain.
Avoid Prolonged Sitting - Extended sitting increases disc pressure and nerve compression risk. Stand, walk, or change position frequently.
When should I see a physiotherapist for sciatica?
See a physiotherapist for sciatica when symptoms persist beyond 2 weeks, significantly limit daily activities, cause leg weakness or numbness, recur frequently, or cause concern about underlying problems. Early physiotherapy intervention (within 4 weeks of symptom onset) produces better outcomes than delayed treatment. You do not need a GP referral to book private physiotherapy for sciatica assessment and treatment.
Seek physiotherapy when:
Leg pain persists beyond 2 weeks despite rest and over-the-counter medication
Symptoms significantly limit walking, sitting, or work activities
You experience numbness, tingling, or weakness in your leg or foot
Previous sciatica episodes have recurred
You want to avoid potential surgery through conservative treatment
GP has diagnosed sciatica but NHS waiting times are long
You're concerned about what's causing your symptoms
Early intervention prevents acute sciatica becoming chronic. Research shows physiotherapy within 4 weeks of symptom onset reduces chronic pain development by 60% compared to delayed treatment beyond 8 weeks.
Most London physiotherapists experienced in treating sciatica can see you within 3-5 days. Areas including City of London, Canary Wharf, Westminster, and Islington have numerous clinics with same-day availability.
Find a Sciatica Specialist in London
Ready to start treatment? Find physiotherapists in London experienced in treating sciatica and sciatic nerve pain.
Specialist clinics:
Back Pain Physiotherapy London - Sciatica and spinal specialists
Central London Physiotherapists - Convenient city locations
Sports Physiotherapy - Active individuals with sciatica
Related conditions:
Back Pain Guide - Lower back pain information
Lower Back Pain - Specific lumbar pain guidance
Neck Pain - Upper spine problems
Frequently Asked Questions
Can sciatica be cured?
Most sciatica resolves completely with appropriate treatment. Acute episodes typically resolve within 6-12 weeks. However, some people experience recurrent episodes requiring ongoing preventive exercise and postural awareness. Physiotherapy addresses both current symptoms and prevention strategies.
Should I use heat or ice for sciatica?
Ice may help during acute flare-ups (first 48-72 hours) if applied to the lower back, not directly over the sciatic nerve path. Heat often provides better relief for chronic sciatica by relaxing tight muscles. However, neither ice nor heat addresses underlying nerve compression. Physiotherapy treatment is essential.
Will I need surgery for sciatica?
Most sciatica (80-90%) resolves with physiotherapy and doesn't require surgery. Surgery becomes necessary only for severe cases with progressive muscle weakness, cauda equina syndrome, or symptoms failing to improve after 12 weeks of appropriate conservative treatment. Always try physiotherapy first.
Can I exercise with sciatica?
Yes, specific exercises are crucial for sciatica recovery. However, avoid activities aggravating symptoms. Your physiotherapist prescribes exercises matched to your presentation. Some sciatica improves with walking while other types worsen. Professional guidance ensures appropriate exercise selection.
Is walking good for sciatica?
Walking helps most sciatica by promoting blood flow and maintaining mobility. However, walking tolerance varies - some people manage 30 minutes comfortably while others tolerate only 5 minutes before symptoms increase. Listen to your body and gradually increase as pain allows.