Pain that starts in the low back or buttock and shoots down the leg has a way of changing how you move through the day. Standing up from a chair, driving, even lying in bed can turn into something you brace for. Sciatica is common, and for most people it settles well with the right physiotherapy, especially when it's picked up and treated early rather than pushed through for weeks.
Sciatica isn't a diagnosis on its own — it's a pattern of symptoms that shows up when the sciatic nerve gets irritated or squeezed where it leaves the spine. The nerve roots involved usually sit low in the back, between L4 and S1, and the sciatic nerve itself runs from there through the buttock and down the back of the leg.
Most of the time, a disc that's bulging or slipped is pressing against one of these nerve roots. Less often, a tight or spasming piriformis muscle deep in the buttock irritates the nerve as it passes underneath or through it. Either way, the pain typically travels down just one leg, following the path of the nerve rather than staying put in the back.
A herniated or bulging disc pressing on a nerve root is the most frequent cause, especially in the lower lumbar spine. Spinal stenosis — a narrowing of the space the nerve passes through — can produce the same pattern and tends to show up more in older adults.
Piriformis syndrome is another common driver: in some people, the muscle sits right over the sciatic nerve, and when it tightens or spasms, it presses directly on it. Degenerative changes in the discs as they lose height and flexibility with age, and spondylolisthesis, where one vertebra slips forward over the one below it, can also narrow the space around a nerve root enough to set sciatica off.
If pain is travelling below the knee and has lasted more than a week or two, it's worth getting assessed rather than waiting it out. The same goes for numbness or weakness in the leg or foot, or pain that simply isn't easing with rest. Struggling to stand up from sitting, or noticing it's become a real effort rather than routine, is another sign not to leave it.
One thing worth flagging separately: if you ever lose control of your bladder or bowel alongside leg symptoms, that needs emergency medical attention straightaway, not physiotherapy. It's rare, but it's not something to sit on.
Sciatica responds differently depending on what's actually driving it and how irritated the nerve is right now, so treatment is built around your specific presentation rather than a fixed routine. Here's the general shape it takes.
We use movement and positional testing to work out which nerve root is likely involved and whether a disc or the piriformis muscle is the more likely driver behind your symptoms. That distinction changes what the rest of your treatment looks like.
Early on, the focus is calming the irritation down. That means finding positions that ease your symptoms, gentle nerve gliding exercises, and steering clear of postures that aggravate things while the acute stage settles.
Once the sharp pain has settled, we build up core and lower back strength gradually to take load off the disc and nerve. This stage matters most for keeping sciatica from coming back once it's resolved.
We choose from these depending on what's driving your symptoms and how acute the nerve irritation currently is — not every technique suits every stage.
Hands-on techniques to ease muscle tension and joint restriction around the lower back that may be adding to nerve pressure.
Nerve gliding movements and McKenzie-style extension exercises that encourage the disc away from the nerve root and ease leg symptoms.
Targeted stretches for the piriformis and hamstrings, both of which can tighten up around an irritated sciatic nerve.
Correcting the sitting and standing habits that load the lower back unevenly and keep aggravating the nerve.
Practical changes to your desk setup, chair, or driving position so daily routines stop feeding the problem.
Heat or TENS-based pain relief used to settle acute nerve irritation, particularly in the early, more painful stage.
Recovery varies a fair bit depending on what's causing your sciatica, how severe it is, and how consistent you are with your exercises. Milder cases, often driven by muscle or postural factors, tend to improve within four to six weeks of starting physiotherapy. Disc-related sciatica usually takes longer — six to twelve weeks is typical before symptoms settle meaningfully. If your sciatica is chronic or keeps recurring, ongoing core and lumbar management becomes part of normal maintenance rather than a short course of treatment. Your physiotherapist will give you a clearer estimate once they've worked out what's driving your particular case.
Not quite. General back pain usually stays around the lower back and doesn't travel further. Sciatica specifically involves the sciatic nerve, so the pain radiates down one leg, often past the knee, and can come with numbness or tingling that ordinary back pain doesn't cause. The treatment approach differs too, since sciatica means addressing the nerve root itself, not just the local muscles.
Not usually. Most cases of sciatica can be assessed clinically through movement testing and a good history, and physiotherapy can start straight away. An MRI becomes useful if symptoms aren't improving as expected, if there are signs of significant nerve involvement, or if surgery is being considered — it isn't a routine first step for most people.
Many people notice their leg pain easing within the first couple of weeks of starting the right treatment, though full recovery takes a bit longer. It depends on what's causing your sciatica and how irritated the nerve is when you start — your physiotherapist can give you a more specific idea after the first assessment.
No — bed rest generally slows recovery rather than helping it. Staying completely still can make the surrounding muscles stiffer and doesn't do anything to address the nerve compression itself. Gentle movement and positions of ease, guided by a physiotherapist, tend to work far better than lying flat for days.
In most cases, yes, with some adjustments. Prolonged sitting is one of the things that aggravates sciatica, so we'll usually suggest changes to your chair setup, more frequent standing breaks, and a few simple movements you can do between calls or meetings. Very few people need to stop working altogether.
It can, particularly if the underlying cause — like a weak core or poor lifting habits — hasn't been addressed. That's exactly why we don't stop treatment once the pain settles; building up strength and correcting the habits that led to it in the first place is what keeps it from returning.
Surgery is only considered for a small minority of cases — usually when there's significant, worsening leg weakness, when bladder or bowel function is affected, or when symptoms simply haven't responded to a proper course of physiotherapy over several months. For most people, physiotherapy resolves sciatica well before surgery ever becomes a conversation.
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The sooner sciatica gets assessed, the sooner you can sit, stand, and walk without bracing for it. Come in and let's find out exactly what's driving your pain and get you moving properly again.
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