Sciatica: What's Going On and What Helps

6 hours ago

4 min read

It starts as an ache in your back or buttock, and a day later a sharp, electric line is running down the back of your leg. Everyone you know has a story about a cousin who needed surgery. Here is the more common story: sciatica usually gets better over a few weeks to a few months, even though it can be miserable along the way [1].

What is sciatica?

Sciatica is pain along the path of the sciatic nerve, which runs from the low back through the buttock and down the leg. It happens when the nerve is irritated or compressed [1]. A slipped disc is the most common cause, and it is more likely as we get older. Other causes include narrowing of the spinal canal (stenosis), a vertebra slipping out of position, or a back injury [1]. When a nerve root in the low back is the source, you may hear it called lumbar radiculopathy.

What does it feel like?

The symptoms usually affect the buttock and the back of one leg, and often the foot and toes. People describe a sharp or burning pain, tingling like pins and needles, numbness, or weakness. It can come on suddenly or slowly, and it may be worse when you move, sneeze, or cough [1]. The leg pain is often worse than any back pain. If you only have back pain, it is probably not sciatica [1]. Because sciatica so often starts in the low back, our post on low back pain is worth a read too.

Physical therapist performing a straight leg raise on a male patient lying on a treatment table

Red flags that need urgent care

Sciatica is rarely an emergency, but a few signs mean you should not wait for an appointment. Go to the emergency room or call 911 if you have [1]:

Sciatica on both sides
Weakness or numbness in both legs that is severe or getting worse
Numbness around or under your genitals, or around your bottom
Trouble starting to pee, being unable to pee, or being unable to control it, if this is not normal for you
Not noticing when you need to poop, or being unable to control it, if this is not normal for you

These can be signs of a serious back problem that needs hospital care as soon as possible [1]. Do not drive yourself.

Call your doctor if your pain is getting worse or is stopping you from doing your normal activities [1].

What can you do at home?

Carry on with normal activities as much as you can, and start gentle exercise as soon as you can. Anything that gets you moving can help [1].
Avoid sitting or lying down for long stretches. The NHS notes that moving, even when it hurts, is not harmful [1].
You do not need to rest in bed. A Cochrane review found that for people with sciatica there was little or no difference in pain or function between advice to rest in bed and advice to stay active [3].
Ask a pharmacist before you buy a pain reliever. The NHS says paracetamol is unlikely to help sciatica and it is not clear how much anti-inflammatories help [1].

Man walking a golden retriever on a leash along a neighborhood sidewalk

How does physical therapy help?

At the first visit I screen for the red flags above, figure out whether your symptoms fit sciatica, and find which positions and movements calm your leg and which stir it up. The NHS lists exercise advice and hands-on techniques as the physiotherapy approach for sciatica [1].

Here is the honest part. The research on physical therapy for sciatica is mixed. A 2023 review of 18 trials and 2,699 people found no clear difference in pain or disability between physiotherapy and comparison treatments overall. Physiotherapy looked better than minimal care for long-term pain, but the trials had a high or unclear risk of bias, and the authors concluded there is not yet enough evidence for firm recommendations [4]. So I will not promise that physical therapy shortens an episode. What we can do is help you keep moving safely, calm things down while the nerve settles, and notice early if you are not trending the right way.

You may also be wondering about surgery. In a Dutch trial of 283 people with severe sciatica for 6 to 12 weeks, those assigned to early surgery had faster relief. But about 95% of people in both groups felt recovered at one year, and 39% of those who started with conservative care ended up having surgery [2]. If your pain is severe and other treatments have not helped, your doctor may discuss injections or surgery [1].

Physical therapist leaning over a woman who is lying on her side on a treatment table, with his hands on her low back and hip

When should you get seen?

Book an evaluation if your leg pain has not improved after a few weeks of home care, if it is getting worse, or if it is getting in the way of work, sleep, or training [1].

How can Hybrid Physical Therapy help?

We spend the first visit working out what is driving your pain, not just where it hurts. You work one-on-one with a Doctor of Physical Therapy every session, and we build the plan around what you want to get back to.

This post is general education and does not replace an exam. If leg pain has been hanging around for more than a couple of weeks, come in and let us take a look.

Let Hybrid Physical Therapy be the ones to optimize your performance.

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References:

NHS. Sciatica. Source page
Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-56. doi:10.1056/NEJMoa064039. PubMed (PMID 17538084)
Dahm KT, Brurberg KG, Jamtvedt G, et al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010;2010(6):CD007612. doi:10.1002/14651858.CD007612.pub2. PubMed (PMID 20556780)
Dove L, Jones G, Kelsey LA, et al. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J. 2023;32(2):517-533. doi:10.1007/s00586-022-07356-y. PubMed (PMID 36580149)