Understanding Sciatica: 2 Causes, Symptoms, and Treatments

Pain can be frustrating—especially when it gets in the way of your daily life. One of the most common and misunderstood types is sciatica. It might start as a dull ache, but can quickly become sharp, shooting pain that runs down your leg and makes even simple tasks difficult.

Sciatica isn’t a disease; it’s a symptom, often caused by a herniated disc pressing on the sciatic nerve. This pressure triggers pain, numbness, or tingling that travels from your lower back through your leg.

Nearly 40% of people will experience sciatica in their lifetime¹. The good news? Understanding the cause is the first step to finding relief.

At Daniel da Cruz Physiotherapy, sciatica is one of the most common problems I treat. With the right care, you can ease the pain and get back to doing what you love.

What is Sciatica?

Sciatica is the name for pain that travels along the sciatic nerve, which runs from your lower back, through your hips, and down each leg. But sciatica isn’t really a condition on its own—it’s a symptom of something else going on in your back, like a slipped disc or narrowing of the spine.

The pain can feel different for everyone; it might be a dull ache, a sharp, burning sensation, or even severe pain that makes it hard to move.

Who Gets Sciatica?

Sciatica is pretty common. Around 5-10% of people with lower back pain have sciatica, and nearly 40% of people will deal with sciatica at some point in their lives¹.

It usually happens to people between 30 and 50 years old, when they’re most active. Men tend to get sciatica a bit more than women, possibly because of different physical activities or work that puts more stress on the lower back.²

Why Does Sciatica Happen?

There are a number of things that make sciatica more likely. As we get older, our spines naturally wear down, which can lead to problems like slipped discs. Jobs that involve heavy lifting, twisting, or sitting for long periods can also put strain on the spine, increasing the chances of sciatica.

Being overweight adds extra pressure on the spine, which can make things worse¹. Even things like bad posture or how you sleep can play a role in whether you develop sciatica.

What are Common Symptoms in Sciatica?

• Sharp, Shooting Pain: A sudden, sharp pain that shoots down one leg, often starting in the lower back or buttock and traveling down the back of the thigh and calf.
• Numbness or Tingling: You will feel a “pins and needles” sensation or numbness in your leg or foot, often in the same areas where you feel pain.
• Weakness: Your leg will feel weak, making it difficult to stand up, walk, or even move your foot.
• Worsening Pain with Movement: The pain often gets worse when you stand up, sit down, or twist your body. Even something as simple as coughing or sneezing can make the pain flare up.
• Pain in One Side: Sciatica usually affects just one side of your body, so the pain, tingling, or numbness is typically felt in one leg.
• Lower Back Pain: While the pain in your leg will be the most noticeable, you would also have a constant ache in your lower back.
• Difficulty Sitting for Long Periods: Sitting, especially on hard surfaces, will increase the pain in your leg and lower back, making it hard to sit comfortably for long periods.
• Burning Sensation: Some people describe the pain as a burning or searing sensation that’s hard to ignore.
• Pain that Radiates: The pain will start in your lower back or buttock and radiate down the leg, sometimes reaching the foot or toes.

How Does Sciatica Happen?

Sciatica happens when something irritates or puts pressure on the sciatic nerve, which is the longest nerve in your body. This nerve starts in your lower back, runs through your hips, and down each leg.

When it’s irritated, it can cause pain, tingling, or weakness anywhere along its path. But why does this happen in the first place? Let’s break it down.

The Role of the Sciatic Nerve

The sciatic nerve is like a highway that carries signals from your brain to your legs and feet. It controls the muscles in your lower legs and gives you sensation in your thighs, legs, and feet.

When this nerve is working well, you probably don’t even think about it. But when it gets irritated or pinched, you’ll definitely notice. The pain can start in your lower back and travel all the way down your leg, sometimes even reaching your toes.

Why Does the Nerve Get Irritated?

There are a few common reasons why the sciatic nerve might become irritated or pinched:

Pressure on the Nerve Roots

The nerve roots that form the sciatic nerve exit the spinal column through small openings between the bones in your spine. If one of these openings gets smaller, the nerve root can get pinched. This is a common reason for sciatic pain.

Inflammation

Sometimes, the tissues around the sciatic nerve become inflamed, which can irritate the nerve itself. When the nerve gets irritated, it can send pain signals to your brain, even if there’s no real damage being done.

Muscle Spasms

The muscles in your lower back or buttocks can sometimes spasm, or tighten up suddenly. When these muscles spasm, they can put pressure on the sciatic nerve, causing pain to radiate down your leg.

How Does It All Start?

Often, sciatica begins with something as simple as lifting a heavy object the wrong way or twisting your back suddenly. These actions can cause the discs in your spine to shift slightly, which might press on the nerve roots.

Even just sitting for too long in one position can trigger sciatic pain because it puts constant pressure on your lower back.

The Body’s Response

When the sciatic nerve is irritated, your body reacts by tightening up the surrounding muscles to protect the area. While this might sound like a good thing, it can actually make the pain worse because those tight muscles can add even more pressure on the nerve. This creates a cycle of pain and muscle tension that’s hard to break.

What Other Conditions Could Be The Cause of Your Symptoms?

Piriformis Syndrome

Piriformis syndrome occurs when the piriformis muscle, located deep in your buttock, tightens or spasms, pressing on the sciatic nerve. While both conditions can cause pain that radiates down the leg, piriformis syndrome typically starts with pain in the buttock rather than the lower back.

The pain might also be more localized to the buttock and upper leg, rather than running all the way down to the foot.³

Lumbar Spinal Stenosis

Lumbar spinal stenosis happens when the spaces within your spine narrow, squeezing the nerves. This condition often causes pain in both legs, especially when standing or walking, which can be relieved by sitting down or bending forward. This is different from sciatica, which usually affects just one leg and might not be relieved by sitting⁴.

Hip Arthritis

Hip arthritis can cause pain that’s felt deep in the groin, the front of the thigh, or the buttock. Unlike sciatica, which often sends pain down the back of the leg, hip arthritis usually doesn’t cause pain below the knee.

The pain from hip arthritis also tends to get worse with movement, particularly when getting up from a seated position or walking.

Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction is another condition that can mimic sciatica. It causes pain in the lower back and buttock, similar to sciatica, but the pain is usually localized to the buttock and doesn’t radiate below the knee.

Movement that stresses the sacroiliac joint, such as standing up from a chair, often makes the pain worse.

Peripheral Neuropathy

Peripheral neuropathy results from nerve damage and often causes tingling, numbness, and pain in the hands and feet. Unlike sciatica, which typically affects one leg, peripheral neuropathy often affects both sides of the body symmetrically, and the pain doesn’t usually follow the path of the sciatic nerve.

What Are Common Mistakes People Make When It Comes to Sciatica?

Ignoring the Pain

A big mistake people make is ignoring the pain and hoping it will go away on its own. While mild sciatica might get better with rest, constant or severe pain usually means something more serious is going on, like a slipped disc.

If you don’t address it, the pressure on your sciatic nerve can build up, leading to chronic pain that’s harder to treat later. Ignoring it could also cause more damage to the nerve, which might lead to permanent numbness or weakness in your leg.

Pushing Through the Pain

Another mistake is trying to tough it out and keep doing your usual activities or workouts. Staying active is good, but doing too much too soon can irritate the nerve even more and make things worse.

This could delay your recovery. It’s important to strike a balance—gentle movement and stretching can help, but pushing too hard can set you back.

Being Too Inactive

On the flip side, not moving enough can also be a problem. Resting too much might seem like the best way to heal, but it can lead to muscle weakness and stiffness.

When your muscles weaken, they don’t support your spine as well, which can actually make your pain worse and slow down your recovery. The key is to stay as active as you can without overdoing it.

Delaying Treatment

Putting off treatment is another common issue. Whether it’s fear of surgery, doubt about physiotherapy, or just being too busy, delaying care can have serious consequences.

The longer you wait, the more damage might occur, making it harder to get better later. Getting treatment early on is often crucial to avoiding long-term problems.

What Happens If Sciatica is Left Untreated?

If sciatica is ignored, it can lead to long-term problems. Ongoing pressure on the nerve can cause lasting damage, leading to continuous pain, numbness, or weakness in your leg.

In severe cases, sciatica can even affect your bladder or bowel control, a condition called cauda equina syndrome, which is a medical emergency.

What Can You Expect From Sciatica?

The good news is that most people with sciatica can fully recover if they get the right treatment. Research shows that the outlook is generally positive, especially if you start treatment early.⁵

What Scans Will Be Used to Assess Sciatica?

MRI (Magnetic Resonance Imaging)

An MRI is one of the most detailed scans available. It uses strong magnets and radio waves to create images of your spine, nerves, and surrounding tissues. With an MRI, we can look closely at your discs to see if any of them are bulging or herniated, which could be pressing on your sciatic nerve. We also check for other issues like spinal stenosis (narrowing of the spinal canal) or any inflammation that might be causing your symptoms.

CT Scan (Computed Tomography)

A CT scan is like a more detailed X-ray. It takes multiple images from different angles and combines them to create a cross-sectional picture of your spine. While it’s not as detailed as an MRI, a CT scan is useful for seeing the bones of your spine and can help identify issues like bone spurs or fractures that might be affecting the nerve roots.

X-ray

An X-ray is the most basic scan and shows the bones of your spine. It’s not as detailed as an MRI or CT scan, but it’s a good starting point. We use X-rays to check for bone alignment, fractures, or any other obvious issues with the vertebrae that could be contributing to your sciatica. While X-rays can’t show soft tissues like discs and nerves, they can help rule out certain conditions or point us in the right direction for further testing.

When is Surgery Needed?

Surgery might be needed if:

• Pain Won’t Go Away: If you’ve tried other treatments like physical therapy and medications for several months and your pain is still really bad, surgery might help by taking pressure off the sciatic nerve.
• Weakness in Your Leg: If your leg or foot is getting weaker, it might mean the nerve is being squeezed too much. Surgery could be necessary to prevent permanent damage.
• Bladder or Bowel Problems: In rare cases, sciatica can cause loss of bladder or bowel control. This is serious and requires immediate surgery to relieve pressure on the nerves.

The most common surgery for sciatica is called a Discectomy. This is where the surgeon takes out the part of the disc that’s pressing on the nerve. Another surgery is a Laminectomy, where a small piece of bone or tissue is removed to make more space for the nerve.

After surgery, rehabilitation is very important. Your body needs time to heal, and your muscles need to be strengthened again. Physical therapy will help you get your strength and flexibility back, which will help you return to your normal activities. This step is key to making sure you recover fully and avoid future problems.

What Treatments Are Available For Sciatica?

As a physical therapist, there are many effective treatment options I can offer to help manage your sciatica. These treatments aim to reduce pain, improve mobility, and prevent future flare-ups.

Let’s break down some of the key therapies that can be part of your treatment plan:

Myofascial Release

Myofascial release is a hands-on technique where I apply gentle pressure to the myofascial tissues—these are the connective tissues that surround your muscles.

The goal is to relieve tension and pain caused by tight or restricted tissues, which can contribute to sciatic pain. By releasing these tight spots, we can help reduce pressure on the sciatic nerve and improve your overall mobility.⁶

Orthopedic Manual Therapy

Orthopedic manual therapy involves specific movements and manipulations of your spine and joints. These techniques are designed to restore normal movement patterns and reduce pain.

For sciatica, I might use techniques like spinal mobilization or manipulation to ease pressure on the nerve and improve your range of motion. Manual therapy can be very effective in providing immediate pain relief and improving function.⁷

Neural Mobilization

Neural mobilization is a specialized technique aimed at gently stretching the nerves, including the sciatic nerve, to relieve pain and improve mobility. This technique involves carefully moving your limbs in specific ways that help “mobilize” the nerve, reducing the pressure and irritation that causes sciatic pain. Neural mobilization can be particularly helpful for sciatica because it targets the nerve directly, helping to reduce pain and improve function.⁸

Laser Therapy

Laser therapy is a non-invasive treatment that uses focused light to reduce pain and inflammation. The laser light penetrates deep into the tissues, promoting healing at the cellular level.

For sciatica, laser therapy can help reduce inflammation around the nerve and speed up the healing process.⁹ This therapy is painless and can be used alongside other treatments to enhance your recovery.

Dry Needling

Dry needling involves inserting thin needles into specific trigger points in your muscles. These trigger points are often tight bands of muscle that can contribute to pain and discomfort.

By targeting these areas, dry needling can help release muscle tension, reduce pain, and improve mobility. It’s particularly effective for treating the muscle tightness and spasms that often accompany sciatica.¹⁰

Strapping (Taping)

Strapping, also known as taping, involves applying special tape to the skin in ways that support muscles and joints without restricting movement. For sciatica, taping can help by providing support to the lower back, improving posture, and reducing strain on the sciatic nerve.

It can also offer pain relief by altering muscle activation and providing a gentle lift to the skin, which reduces pressure on the underlying tissues.¹¹

Exercise Therapy

Exercise therapy is a crucial part of managing sciatica. This includes stretching exercises to improve flexibility, strengthening exercises to support your spine, and aerobic exercises to improve overall fitness.

The goal is to build a strong core, which helps stabilize your spine and reduces the pressure on the sciatic nerve. Regular exercise can also help prevent future episodes of sciatica by keeping your muscles and joints healthy.¹²

Advice and Education

In addition to these hands-on treatments, I can provide advice on lifestyle changes that can help manage your sciatica. This might include tips on proper lifting techniques, posture correction, and ergonomic adjustments to your work or home environment. Education on how to manage flare-ups and when to seek further treatment is also a key part of your recovery process.

Conclusion

As your physiotherapist, I want you to know that sciatica doesn’t have to control your life. With the right approach and a bit of patience, you can reduce your pain and get back to doing the things you enjoy. I’ve worked with many people who came in struggling with sciatica, but by sticking to their treatment plan, they’ve found relief and regained their confidence.

Sciatica can be tough, but it’s a challenge you can overcome. With tools like targeted exercises, manual therapy, and techniques like neural mobilization, we can help relieve your pain and strengthen your body. These treatments will support your recovery and help you regain the strength and mobility you need to live pain-free.

If you need anything along the way, don’t hesitate to reach out—I’m here to help you every step of the way.

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References

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