Sciatica is a term commonly used to describe pain that travels from the lower back or buttock into the leg.
For some people, the symptoms are relatively mild. For others, sciatica can cause significant leg pain, altered sensation or weakness and make sitting, walking, sleeping, working or exercising difficult.
Although sciatica is often associated with lower back pain, the leg symptoms are usually related to irritation or compression of one or more nerve roots in the lower spine (Jensen et al., 2019).
At Trilogy Physiotherapy in Sinnamon Park, we assess people experiencing lower back and leg symptoms to determine whether their presentation is consistent with sciatica and develop an appropriate treatment and rehabilitation plan.
What Is Sciatica?
The sciatic nerve is the largest nerve in the body and is formed by nerve roots originating from the lower back.
These nerve roots eventually combine to form the sciatic nerve, which travels through the buttock and down the back of the leg.
Sciatica usually refers to symptoms resulting from irritation or compression of a lumbar or sacral nerve root rather than a problem with the sciatic nerve becoming physically “stuck” somewhere in the leg (Jensen et al., 2019).
Symptoms most commonly affect one leg and may travel from the lower back or buttock into the thigh, calf or foot.
What Does Sciatica Feel Like?
Sciatica can feel different from person to person.
Symptoms may include:
• Pain travelling from the lower back or buttock into the leg
• Burning or sharp leg pain
• Electric or shooting pain
• Tingling or pins and needles
• Numbness or altered sensation
• Weakness in certain muscles of the leg or foot
• Symptoms that increase with certain movements or positions
Some people experience significant leg pain with very little lower back pain.
Others may have a combination of back pain and symptoms extending into the leg.
The location of the symptoms can also vary depending on which nerve root is affected.
What Causes Sciatica?
A lumbar disc herniation is one of the most common causes of sciatica.
A disc herniation can irritate or compress a nerve root as it exits the lower spine, producing pain and neurological symptoms into the leg (Jensen et al., 2019).
However, not every case of sciatica is caused by a disc herniation.
Other possible causes can include:
• Lumbar spinal stenosis
• Degenerative changes affecting the space around a nerve root
• Spondylolisthesis
• Less commonly, other conditions affecting the spine or nervous system
It is also important to distinguish true sciatica from other conditions that can produce pain through the buttock or leg.
Muscle, joint, hip and other nerve related problems can sometimes mimic sciatica.
This is why the behaviour of your symptoms and findings from the physical examination are important when determining what may be contributing to your pain.
Is Piriformis Syndrome the Same as Sciatica?
Not exactly.
The sciatic nerve travels through the buttock near the piriformis muscle, and irritation of the nerve in this region can occasionally produce symptoms that resemble sciatica.
However, this is different from the more common presentation where symptoms originate from a nerve root in the lower spine.
Buttock or leg pain should therefore not automatically be attributed to a “tight piriformis” or a nerve becoming trapped underneath a muscle.
A physiotherapy assessment can help determine whether symptoms appear to originate from the lower back, hip, peripheral nerves or another structure.
How Is Sciatica Diagnosed?
Sciatica is primarily a clinical diagnosis.
Your physiotherapist or doctor will first ask about your symptoms, including:
• Where the pain travels
• Whether you have numbness or tingling
• Whether you have noticed weakness
• Which movements or positions aggravate symptoms
• How long the symptoms have been present
• Whether you have experienced any changes to bladder or bowel function
A physical assessment may then include:
• Lower back movement
• Muscle strength
• Sensation
• Reflexes
• Walking
• Functional movements
• Neurological testing
• Tests such as the straight leg raise or slump test where appropriate
These findings help determine whether the symptoms are consistent with nerve root involvement and whether further investigation may be required (Jensen et al., 2019).
Do You Need an MRI for Sciatica?
Not usually in the early stages.
Imaging such as MRI is not routinely recommended for uncomplicated lower back pain or sciatica when there are no signs suggesting serious pathology (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2022).
This is partly because scans frequently identify changes such as disc bulges or degeneration in people who have no symptoms at all.
A scan therefore needs to be interpreted alongside the person’s symptoms and clinical examination.
Imaging may be considered when:
• There are concerning neurological or other red flag symptoms
• Significant or progressive weakness is present
• Symptoms are not improving as expected
• Surgery or another specialist procedure is being considered
• The result of the scan is likely to change management
Your physiotherapist can recommend medical review where imaging or further investigation appears appropriate.
What Are the Red Flags With Sciatica?
Most cases of sciatica are not medical emergencies.
However, certain symptoms require urgent medical assessment.
Seek urgent medical care if you develop symptoms such as:
• New difficulty starting or controlling urination
• New loss of bladder or bowel control
• Numbness or altered sensation around the saddle or genital region
• Significant or rapidly progressing weakness in the legs
• Severe symptoms affecting both legs, particularly when accompanied by neurological changes
These symptoms can indicate significant compression of the nerves at the bottom of the spinal canal, known as cauda equina syndrome, and require urgent medical assessment (Jensen et al., 2019).
Other concerning features including significant trauma, unexplained fever or illness, a history of cancer or other unusual symptoms should also be discussed with an appropriate health professional.
How Long Does Sciatica Last?
Recovery varies considerably between people.
Many people with acute sciatica improve over time with non surgical management, but it is not accurate to say that almost everybody will be pain free within two weeks.
Symptoms may improve over several weeks or months depending on the cause, severity of nerve irritation, neurological findings and individual circumstances.
A proportion of people continue to experience symptoms at 12 months, which highlights the fact that recovery can vary substantially (Liu et al., 2023).
This does not mean persistent symptoms automatically require surgery.
The important thing is to monitor pain, function and neurological symptoms and ensure rehabilitation is progressing in the right direction.
Should You Rest if You Have Sciatica?
Prolonged bed rest is generally not recommended.
Australian clinical care standards encourage people with lower back pain, including presentations with leg symptoms, to remain as active as reasonably possible and gradually return to normal activities (ACSQHC, 2022).
That does not mean ignoring severe symptoms and forcing yourself through every painful activity.
You may temporarily need to modify things such as prolonged sitting, heavy lifting, running or other movements that significantly aggravate your leg symptoms.
The goal is usually to find an appropriate level of movement and activity rather than stopping everything until the pain completely disappears.
How Can Physiotherapy Help Sciatica?
Physiotherapy management depends on your individual presentation.
There is no single exercise or treatment that is appropriate for every person experiencing sciatica.
Treatment may include a combination of:
Education and Advice
Understanding what sciatica is and what your symptoms mean can reduce uncertainty and help guide recovery.
Your physiotherapist can explain which activities are appropriate, what symptoms should be monitored and how activity can be gradually progressed.
Staying Active
Where safe and appropriate, maintaining normal daily activities is generally encouraged.
This might involve temporarily adjusting the duration or intensity of certain tasks rather than completely avoiding movement.
As symptoms improve, activities can gradually be increased.
Individual Exercise Rehabilitation
Your exercise program will depend on your symptoms and physical assessment.
This may include exercises designed to improve:
• Spinal movement
• Lower limb strength
• Trunk strength and physical capacity
• General mobility
• Walking tolerance
• Confidence with bending and lifting
• Return to gym, running or sport
There is not one specific “sciatica exercise” that works for everybody.
Exercises should be selected and progressed according to how your symptoms respond and what activities you need to return to.
Neural Mobility Exercises
Some people with nerve related leg symptoms may benefit from specific neural mobility exercises.
These exercises aim to gently move the nervous system through its available range rather than aggressively stretching the sciatic nerve.
They are not appropriate for every presentation and should be prescribed according to your assessment and symptom response.
Hands On Physiotherapy
Manual therapy or soft tissue treatment may sometimes be used to assist with pain or movement.
However, current guidelines recommend that passive treatment is not used in isolation.
At Trilogy Physiotherapy, hands on treatment may form one part of the overall program alongside education, activity and progressive exercise rehabilitation.
Returning to Work, Gym or Sport
As symptoms settle, rehabilitation should increasingly reflect what you actually need to do.
For one person this might mean sitting comfortably at work and lifting their children.
For another it may involve:
• Heavy lifting
• Running
• Gym training
• Field sport
• Manual work
• Repeated bending
The aim is to progressively rebuild your physical capacity rather than simply waiting until all symptoms have disappeared before returning to normal life.
Does Sciatica Require Surgery?
Most people with sciatica are initially managed without surgery.
Surgery may be considered when significant symptoms continue despite appropriate non surgical management, particularly when imaging findings correspond with the person’s neurological symptoms.
Surgery may also be considered more urgently when significant or progressive neurological deficits are present.
Research suggests that surgery for disc related sciatica can provide faster relief for some people who are appropriate surgical candidates, although differences compared with non surgical treatment become much smaller over longer follow up periods (Liu et al., 2023).
The decision to consider surgery is individual and should involve appropriate medical and specialist assessment.
What Do We Assess at Trilogy Physiotherapy?
At Trilogy Physiotherapy, assessment is tailored to the person rather than simply treating every case of leg pain as the same condition.
Depending on your presentation, we may assess:
• Lower back movement
• Leg symptoms
• Muscle strength
• Sensation
• Reflexes
• Neural sensitivity
• Hip and lower limb movement
• Walking
• Bending and lifting
• Work related activities
• Gym or sporting movements where appropriate
We also monitor whether symptoms are becoming more localised, spreading further into the leg or associated with changes in strength or sensation.
This information helps guide your rehabilitation and identify whether further medical assessment may be required.
Sciatica Physiotherapy in Sinnamon Park
Trilogy Physiotherapy provides one on one physiotherapy for lower back pain, sciatica and other musculoskeletal conditions from our clinic in Sinnamon Park.
Our clinic includes private treatment rooms and a dedicated rehabilitation gym, allowing treatment to progress from early symptom management through to strength, lifting, running and return to higher level activity where required.
If pain is travelling from your lower back or buttock into your leg, or you are experiencing tingling, numbness or weakness, a physiotherapy assessment can help determine whether your symptoms appear consistent with sciatica and establish an appropriate plan.
Book online or call Trilogy Physiotherapy on (07) 3148 8785 to arrange an appointment.
References
Australian Commission on Safety and Quality in Health Care. (2022). Low Back Pain Clinical Care Standard. Australian Commission on Safety and Quality in Health Care.
Jensen, R. K., Kongsted, A., Kjaer, P., & Koes, B. (2019). Diagnosis and treatment of sciatica. BMJ, 367, l6273. doi:10.1136/bmj.l6273.
Liu, C., Ferreira, G. E., Abdel Shaheed, C., Chen, Q., Harris, I. A., Bailey, C. S., Peul, W. C., Koes, B., & Lin, C. W. C. (2023). Surgical versus non surgical treatment for sciatica: Systematic review and meta analysis of randomised controlled trials. BMJ, 381, e070730. doi:10.1136/bmj-2022-070730.
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