Sciatica: Symptoms, causes & treatment

What is sciatica? 

The sciatic nerve is the largest nerve in the human body. It runs down your lower back and through the back of the leg, right down to your toes. 

The most important thing to know about sciatica is that it is not a diagnosis. Sciatica is the term used to describe the symptoms of radiating pain down the lower back, hips and legs, which can be the result of different conditions or underlying causes. 

Sciatica is a common complaint that can be extremely painful, but it responds very well to the correct treatment with a skilled physiotherapist. 

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Do I have sciatica?

Sciatica is when your sciatic nerve becomes irritated, causing discomfort and painful symptoms which can include:

• Pain that radiates down through your buttocks, hips and legs typically – you might experience this as a mild ache, burning sensation or shooting pains (the pain can vary from person to person).
• The feeling of irritation, pins and needles or a painful tingling down your buttocks, hips and legs.
• Very occasionally weakness in your legs or feet. 

What are the causes of sciatica?

Irritation of the sciatic nerve can be due to a wide range of different conditions and issues, usually relating to your back. For example, osteoarthritis, disc bulges, muscle tightness, poor posture or reduced flexibility. 

The most common causes of sciatica are:

• Age – If you are over 40 you are more likely to experience sciatica because normal age-related changes can impact on your spine and sciatic nerve.
• Pregnancy – Back pain and sciatica are common during pregnancy because your body undergoes huge changes that can impact on your sciatic nerve - read more about sciatica in pregnancy.
• Weight – Being overweight or obese puts more strain on your spine and back, which can lead to conditions that may put pressure on your sciatic nerve.  
• Lifestyle – People who live a sedentary lifestyle and spend long periods sitting down are more likely to experience sciatica than those who are more active. Sustained pressure or strain on the sciatic nerve or spine, for example from heavy lifting at work or driving, may also trigger sciatica. 

Treatment

How can I stop the pain of sciatica?

If you are experiencing the sudden onset of sciatica symptoms or what some may refer to as a ‘flare up’ it can be extremely painful. 

Taking painkillers with the advice of your pharmacist or GP can help you to relax and get comfortable, which can be important for recovery given that sciatica is a condition affecting your nervous system. 

Ice and heat can also be an effective way to relieve pain and discomfort quickly. Most patients with sciatica find heat more relieving, but some people also benefit from using ice. It’s really down to personal preference. 

If you can, try to relax. Reducing stress and anxiety can have a big impact on conditions like sciatica because it affects your nervous system, and your mental and physical health is closely connected. Read our top ten tips for managing pain for more guidance. 

If you have already seen an Ascenti physiotherapist they will have discussed a treatment plan with you and a way to manage the pain. For example, they may have given you stretches to do during a flare up or advice about using massage balls. 

If you haven’t spoken to a physiotherapist yet, then make sure that you book an appointment with one. Sciatica is not something that you have to put up with or live with. 

An Ascenti physiotherapist can help you to rehabilitate and to put a stop to the pain. 

Should I see a physio or chiropractor for sciatica? 

Chiropractic treatment is predominantly focused on the mechanics of the spine and skeletal system, and typically involves manipulation of the spine and other joints. 

Physiotherapists may use some of the same evidence-based treatment techniques as chiropractors (such as joint mobilisation), but the main difference is that they will take into account your soft-tissues, muscles, ligaments, posture and a range of other factors relating to your overall health – not just your back and your spine. This is important because sciatica can have a wide range of root causes that are not always related to the spine in every individual. 

Sciatica can be very painful to live with and many people seek out a quick ‘cure’ to stop pain. The reality is that sciatica can be complex, so my advice would be to consider your treatment choices carefully and to see a qualified physiotherapist first. 

If you book an appointment with Ascenti you can rest assured that you are in good hands. We are a trusted partner to the NHS and all Ascenti physiotherapists are registered with the Health and Care Professions Council (HCPC). 

Ascenti is also registered with the Care Quality Commission (CQC), the same organisation that regulates hospitals and primary care services. Learn more about our quality and safety standards. 

How does physiotherapy help sciatica?

Your physiotherapist will conduct a thorough assessment to identify the underlying cause of your sciatica. 

Identifying the root cause is important because it will enable them to create an appropriate treatment plan that will cure your sciatica. 

There is no point in treating the symptoms alone and not the underlying cause, because you will not fully rehabilitate and feel better long term. 

The causes of sciatica can vary enormously from patient to patient, which means that physiotherapy treatment must be carefully tailored to the individual.  

Physiotherapy treatment for sciatica with an Ascenti physio may include:

• Soft-tissue massage – Your physio may use a range of different soft-tissue massage techniques, typically applied to your lumbar spine and gluteal muscles to reduce muscle spasms and any tightness around the sciatic nerve. This is not the same as a holistic massage or a sports massage; this is targeted physiotherapy treatment that will form one part of a wider treatment plan.
• Joint mobilisation – Your physiotherapist may manually apply pressure to your joints or certain parts of your lower spine to encourage movement. If this increases the mobility in your spine then it may reduce the impingement on your sciatic nerve and help your sciatica.
• Stretches – Flexibility work and stretching within pain limits can help to reduce tension and improve mobility, which again can reduce irritation to the sciatic nerve. Stretching has the potential to improve the pain of sciatica for some people but can make it worse for others, depending on the root cause of sciatica, so it’s important to seek exercise advice from a physiotherapist.
• Exercise therapy – Sciatica can often be improved by building up the strength and stability of the lower back, glutes and hamstrings. If needed, your physiotherapist will prescribe exercises for you to follow at home. They will use our patient app to provide you with exercise instructions and a treatment plan, where you will be able to access demo videos, track your progress and send messages to your physio after your appointment. This is a great tool as it gives you 24/7 access to guidance at the touch of a button and the confidence to know that you are doing your exercises correctly.
• Lifestyle advice – Your physiotherapist will also talk to you about your lifestyle and discuss adjustments that could improve your sciatica. For example: posture advice, considering orthotics or improving the way you complete every-day tasks such as lifting. 

Is massage good for sciatica?

Massage can help a little bit, but massage alone is not the answer. 

To treat sciatica properly you need a complete rehabilitation plan and to identify the root cause with a physiotherapist. There is no point in just treating the symptoms with massage which can provide some relief, but not addressing the underlying cause. 

Depending on what’s causing your sciatica, massage could form one aspect of your physio treatment plan with us, but this will not be the same as a holistic or sports massage. 

Physiotherapists will use targeted soft-tissue massage techniques to reduce muscle spasms and any tightness around the sciatic nerve, and this will always be combined with other treatments approaches.  

For example, if sciatica is caused by muscular tension or back pain, some soft-tissue massage can alleviate that alongside other lifestyle advice, but if your sciatica is caused by disc issues then massage may not be as effective. 

How many physio sessions will I need for sciatica?

At Ascenti we typically treat sciatica in 4-6 physiotherapy sessions.

Because sciatica is not a diagnosis, recovery can vary from person to person depending on the root cause of your sciatica and underlying condition. 

To rehabilitate fully and as quickly as possible, it’s important that you follow the advice of your physiotherapist, stick to your exercise plan and make any lifestyle adjustments that have been recommended.  

What physio exercises can help sciatica?

Often the best exercises for sciatica involve strengthening your glutes, hamstrings and lower back. 

You should take advice from your physiotherapist, but these exercises are a great way to start building up strength in the lower back, glutes and areas that affect sciatica. 

Remember, you shouldn’t push yourself too far and must always stay within your own pain limits. 

Postural adjustments and sitting correctly can also have a big impact on sciatica.