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Sciatica: Causes, Symptoms, Treatment & When to See a Physiotherapist

Sciatica is a common condition that can cause pain travelling from the lower back or buttock into the leg. Depending on the affected nerve root, symptoms may also include tingling, numbness or weakness.

However, not every type of leg pain is sciatica, and not every person with a herniated disc has symptoms.

Understanding the difference is important because effective treatment should begin with an accurate clinical assessment rather than simply treating the location where the pain is felt.

What Is Sciatica?

Sciatica describes symptoms associated with irritation or compression of one or more of the nerve roots that contribute to the sciatic nerve.

The pain may travel from the lower back or buttock down the leg and, in some cases, may be accompanied by:

• Numbness
• Tingling
• Burning or electric-like pain
• Muscle weakness
• Changes in movement or function

The exact pattern depends on which nerve root is affected and how significantly it is involved.

This is why a proper assessment is important before deciding what treatment is appropriate.

What Causes Sciatica?

Several conditions can contribute to sciatica.

One of the most common is a herniated disc, where disc material can irritate or compress a nerve root.

Other possible contributors include:

• Age-related changes in the spine
• Spinal stenosis
• Degenerative changes
• Conditions affecting the lumbar nerve roots

But there is an important point to remember:

An abnormal MRI does not automatically mean that it is the cause of your pain.

Disc bulges and other spinal changes can be present in people who have no symptoms.

For this reason, imaging findings should be interpreted alongside the person’s symptoms and clinical examination.

NICE does not recommend routine imaging for people with low back pain or sciatica in non-specialist settings. Imaging may be considered when the result is likely to change management. 

What Are the Symptoms of Sciatica?

Sciatica can present differently from one person to another.

Common symptoms include:

1. Radiating leg pain

Pain may travel from the lower back or buttock into the thigh, calf or foot.

2. Numbness or tingling

Some people experience altered sensation along part of the leg or foot.

3. Muscle weakness

Some nerve-root problems can affect the strength of specific muscle groups.

4. Symptoms affected by movement or position

Symptoms may change with:

• Sitting
• Bending
• Walking
• Coughing or sneezing
• Certain spinal or hip movements

The pattern of symptoms is important, but it should not be used alone to determine the diagnosis.

Is Every Leg Pain Sciatica?

No.

This is an important distinction.

Some people experience pain in the leg that is referred from the lower back or other musculoskeletal structures without having true nerve-root involvement.

This is why physiotherapists assess more than just the location of pain.

A clinical assessment may consider:

• Symptom distribution
• Sensation
• Muscle strength
• Reflexes when appropriate
• Movement
• Functional limitations
• Response to different movements and positions

The goal is to understand the patient’s presentation rather than simply attach a label to the pain.

When Should You See a Physiotherapist for Sciatica?

You may benefit from a physiotherapy assessment if your symptoms are affecting:

• Walking
• Sitting
• Sleeping
• Working
• Exercise
• Sports
• Daily activities

A physiotherapist can assess your symptoms and determine whether they are consistent with a musculoskeletal presentation that can be managed through rehabilitation or whether further medical assessment is appropriate.

At PhysioTech, our approach starts with a comprehensive assessment followed by an individualized rehabilitation plan based on the patient’s condition, functional limitations and goals. 

PhysioTech Catalogue.pdf

How Is Sciatica Treated?

Treatment should not simply focus on temporarily reducing pain.

The broader goal is to help the patient understand the condition, remain appropriately active, restore movement and gradually return to normal function.

NICE recommends providing information and advice that supports self-management and encourages people to continue normal activities as much as possible. 

1. Exercise Therapy

Exercise can be an important component of rehabilitation for people with low back pain and sciatica.

However, there is no single exercise that is best for every person with sciatica.

The programme should be selected according to factors such as:

• Current symptoms
• Irritability
• Strength
• Mobility
• Functional limitations
• Activity level
• Individual goals
• Response to exercise

The aim is usually to gradually improve movement, strength, confidence and functional capacity.

NICE recommends considering exercise programmes according to the person’s needs, capabilities and preferences. 

2. Manual Therapy

Manual therapy can sometimes be included as part of a rehabilitation programme.

Depending on the clinical presentation, this may include techniques such as:

• Mobilisation
• Manipulation
• Soft-tissue techniques

However, manual therapy should not be presented as a standalone cure for sciatica.

NICE recommends considering manual therapy for low back pain with or without sciatica only as part of a treatment package that includes exercise. 

This fits the PhysioTech approach of combining appropriate hands-on treatment with active rehabilitation rather than relying exclusively on passive treatment. 

PhysioTech Catalogue.pdf

3. Education and Self-Management

Understanding your condition can be an important part of recovery.

Your rehabilitation may include advice about:

• Staying appropriately active
• Managing activities that aggravate symptoms
• Gradually increasing physical activity
• Understanding symptom behaviour
• Returning to normal activities

The goal is not to make patients afraid of movement.

Instead, rehabilitation should help patients gradually regain confidence in movement and physical activity.

Should You Stay in Bed With Sciatica?

Usually, prolonged bed rest is not the goal of treatment.

For most people, remaining appropriately active is preferable to avoiding movement completely.

You may need to temporarily modify activities that significantly aggravate your symptoms, but this is different from prolonged inactivity.

NICE recommends encouraging people with low back pain or sciatica to continue normal activities as much as possible. 

Do You Need an MRI for Sciatica?

Not necessarily.

Having symptoms of sciatica does not automatically mean that you need an MRI.

Imaging may be appropriate in selected situations, particularly when:

• The diagnosis is unclear
• There are concerning clinical findings
• Symptoms are not improving as expected
• Imaging is likely to change management
• Specialist or surgical assessment is being considered

The important point is that MRI findings should be interpreted in the context of the clinical presentation.

A disc bulge on an MRI does not automatically mean that surgery or aggressive treatment is required.

Does Traction Treat Sciatica?

Traction is sometimes promoted as a treatment for disc problems and sciatica.

However, NICE does not recommend traction for managing low back pain with or without sciatica. 

This is an important example of why treatment should be selected based on clinical reasoning and evidence rather than simply choosing a technique because it is available.

What About Electrotherapy and Other Devices?

Modern physiotherapy clinics may use a variety of therapeutic technologies.

However, the presence of advanced equipment does not mean that every device is appropriate for every patient.

For low back pain and sciatica, NICE does not recommend routine use of treatments such as TENS, interferential therapy or ultrasound. 

At PhysioTech, the treatment plan should therefore start with:

Assessment → Clinical Reasoning → Individualized Plan → Rehabilitation → Reassessment

rather than starting with a specific machine or treatment modality.

This reflects the clinic’s stated philosophy of assessment-based, individualized treatment and continuous follow-up. 

PhysioTech Catalogue.pdf

When Is Sciatica an Emergency?

Most cases of sciatica are not medical emergencies.

However, certain symptoms require urgent medical assessment.

Seek urgent medical attention if you develop symptoms such as:

• New problems controlling your bladder or bowel
• Numbness around the genital or saddle area
• Significant or rapidly worsening weakness
• Severe neurological symptoms
• Symptoms affecting both legs
• Other signs suggesting a serious underlying condition

These symptoms can indicate a more serious neurological problem and should not be managed simply by continuing routine physiotherapy.

Does Sciatica Always Require Surgery?

No.

Many people with sciatica improve without surgery.

Surgical treatment may be considered in selected patients when non-surgical treatment has not improved pain or function and imaging findings are consistent with the person’s sciatic symptoms. 

The presence of a herniated disc on an MRI alone is therefore not an automatic indication for surgery.

The PhysioTech Approach to Sciatica

At PhysioTech, we believe that effective physiotherapy begins with understanding the patient rather than simply treating the painful area.

Our approach includes:

Clinical Assessment

Understanding the patient’s symptoms, movement and functional limitations.

Clinical Reasoning

Identifying the factors that may be contributing to the patient’s presentation.

Individualized Rehabilitation

Developing a treatment plan based on the patient’s condition and goals.

Active Recovery

Using exercise and progressive rehabilitation to restore function.

Continuous Reassessment

Monitoring the patient’s response and modifying the plan when necessary.

This reflects the broader PhysioTech philosophy described in the clinic catalogue: precise assessment, individualized treatment and continuous follow-up. 

PhysioTech Catalogue.pdf

Frequently Asked Questions

Can sciatica go away on its own?

Many cases improve over time, particularly when there are no serious neurological findings. The appropriate management depends on symptom severity, function and how symptoms change over time.

Is a herniated disc always the cause of sciatica?

No. A herniated disc is one possible cause, but other conditions can affect the lumbar nerve roots.

Is physiotherapy effective for sciatica?

Physiotherapy can be an important part of rehabilitation, particularly when it includes appropriate assessment, education, exercise and progressive return to activity. Manual therapy may be used as part of a broader exercise-based programme. 

Do I need an MRI if I have sciatica?

Not necessarily. Routine imaging is not recommended for everyone with low back pain or sciatica. Imaging is considered when it is likely to change management or when specialist assessment is required. 

Is traction good for sciatica?

NICE does not recommend traction for low back pain with or without sciatica. 

When should I seek urgent medical help?

Seek urgent medical assessment if you develop new bladder or bowel problems, saddle-area numbness, significant or worsening weakness, or other severe neurological symptoms.