Sciatica is one of the most common and most misunderstood causes of leg pain. It often starts as a dull ache, and for some people it becomes a sharp, shooting pain that runs down the leg and makes everyday tasks harder.

Sciatica is not a disease in itself. It is a symptom, usually caused by irritation of a nerve root in the lower back, and it can bring pain, numbness or tingling that travels from the back into the leg.

Sciatica is common: around 40% of people experience it at some point in their lives.¹³ It is also one of the problems I see most often in the clinic. This article explains what sciatica is, why it happens, how it is assessed, what treatment involves, and when it is worth getting help.

The Short Version

Sciatica is pain that travels along the path of the sciatic nerve, usually from the lower back into the buttock and down the leg, most often because a nerve root in the lower back is irritated or compressed. Many people improve with the right diagnosis, graded exercise and sensible load management. A proper assessment helps identify the cause and rule out anything more serious. Some warning signs, like changes in bladder or bowel control or numbness around the saddle area, need urgent medical care.

If sciatica is affecting you, a proper assessment is the best place to start.

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What is Sciatica?

Sciatica usually describes pain that travels into the leg because one or more nerve roots in the lower back are irritated or affected. It may come with tingling or numbness. When there is measurable weakness, altered reflexes or sensory loss, clinicians may use the term lumbar radiculopathy.

A lumbar disc problem is a common cause, although spinal narrowing and other conditions can also affect a nerve root. Deep gluteal syndrome can produce similar symptoms but arises outside the spine and needs to be told apart during assessment.

The pain can feel different from person to person. It might be a dull ache, a sharp or burning sensation, or at times severe enough to make moving difficult.

Who Gets Sciatica?

Sciatica is common. Around 5 to 10% of people with lower back pain have sciatica, and roughly 40% of people experience it at some point in their lives.¹³

It most often affects people between 30 and 50, when they tend to be most active. It appears slightly more often in men than in women.¹³

Why Does Sciatica Happen?

Sciatica happens when a nerve root in the lower back becomes irritated or affected. Several things can contribute, and it is not always possible to pin it to a single structure.

Common contributors include changes in the discs of the spine (a disc can bulge or herniate and irritate a nearby nerve root), age-related narrowing of the spaces the nerves pass through, and periods of heavier or unaccustomed loading of the lower back. Everyday factors such as how much you are moving, how you are sleeping and your general health can also play a part.

When a nerve is sensitised, pain can make you move differently and tense the surrounding muscles, which may add discomfort and make normal activity feel harder. The aim of treatment is to restore comfortable movement and gradually rebuild your tolerance, rather than to release a trapped nerve.

Common Symptoms of Sciatica

Sharp, shooting pain: A pain that can shoot down one leg, often starting in the lower back or buttock and travelling down the back of the thigh and calf.
Numbness or tingling: A pins-and-needles feeling or numbness in the leg or foot, often in the same areas as the pain.
Weakness: The leg may feel weak, which can make standing, walking or moving the foot harder.
Worse with movement: The pain often increases when you stand, sit or twist, and coughing or sneezing can make it flare.
Usually one side: Sciatica usually affects one side, so the pain, tingling or numbness is typically felt in one leg.
Lower back pain: Leg symptoms are often the most noticeable, but there can also be an ache in the lower back.
Harder to sit for long: Sitting, especially on hard surfaces, can increase leg and back symptoms.
Burning sensation: Some people describe a burning or searing quality to the pain.
Radiating pain: Symptoms can start in the lower back or buttock and travel down the leg, sometimes reaching the foot.

When to Get Help Urgently

Most sciatica is not dangerous and settles with the right care. A small number of warning signs point to a more serious problem and need urgent attention.

Go to emergency care now if you notice:

new sciatica affecting both legs
severe or worsening weakness or numbness in both legs
numbness around the genitals or saddle area
new difficulty controlling or passing urine or stool

Arrange a prompt medical assessment for:

significant trauma, such as a fall or accident
fever or other signs of systemic illness
unexplained weight loss
a history of cancer, or another concern about serious underlying illness

These signs do not always mean something serious, but they are worth checking properly rather than guessing. When in doubt, get assessed in person.

What Else Could Be Causing Your Symptoms?

Deep Gluteal Syndrome (Piriformis-Related)

Deep gluteal syndrome involves irritation of the sciatic nerve where it passes through the buttock, sometimes related to the piriformis muscle. It can cause pain down the leg like sciatica, but the pain often starts in the buttock rather than the lower back, and may stay more focused in the buttock and upper leg.³

Lumbar Spinal Stenosis

Lumbar spinal stenosis happens when the spaces within the spine narrow and crowd the nerves. It often causes pain in both legs, especially when standing or walking, which tends to ease when sitting or bending forward. This differs from sciatica, which usually affects one leg.⁴

Hip Osteoarthritis

Hip osteoarthritis can cause pain 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 pain usually does not travel below the knee, and it tends to be worse with movement such as getting up from a chair or walking.

Sacroiliac Joint Pain

Pain from the sacroiliac joint can affect the lower back and buttock, a bit like sciatica, but it is usually focused around the buttock and does not travel below the knee. Movements that load the joint, such as standing up from a chair, can make it worse.

Peripheral Neuropathy

Peripheral neuropathy comes from nerve changes often affecting the hands and feet, and it tends to cause tingling, numbness and pain on both sides fairly symmetrically. Unlike sciatica, the symptoms do not usually follow the path of a single nerve root down one leg.

Common Mistakes People Make With Sciatica

A few common patterns can slow recovery down:

Doing nothing and hoping it passes. Some sciatica settles on its own, but if the pain is severe, persistent or spreading, an assessment helps work out what is driving it and the best way forward.
Pushing too hard through the pain. Staying active is helpful, but a big jump in activity can stir symptoms up. The aim is to keep moving within comfortable limits and build back up gradually.
Resting too much. Long periods of rest can leave you stiff and deconditioned, which does not help recovery. Gentle, regular movement is usually better than strict rest.¹

What Happens If Sciatica Is Not Treated?

Sciatica does not automatically get worse or cause permanent nerve damage if treatment does not begin immediately. Many cases improve over time, although symptoms can sometimes persist and interfere with walking, sleep, work or exercise.

Recovery varies. Some symptoms settle within weeks, while others take several months or stay troublesome for longer. Treatment can help manage pain, restore movement and function, and guide a safe return to normal activity.⁵

It is worth getting assessed when the pain is severe, your function is getting worse, symptoms are not settling, or you notice increasing weakness or numbness. Bladder or bowel changes, numbness around the saddle area, or rapidly worsening neurological symptoms need urgent medical assessment.

When Are Scans Needed?

Most sciatica is diagnosed from your history and a physical examination, not from a scan. In many cases a scan is not needed early on, and it is usually considered only when the result is likely to change your management, for example if symptoms are severe, not settling, or there are specific neurological findings.

Disc bulges and other age-related findings can also be seen in people without any pain. Scan results therefore need to be interpreted alongside your symptoms, neurological examination and functional findings, rather than treated as the diagnosis on their own.

When imaging is used, the main options are:

MRI: shows the discs, nerves and soft tissues in detail, and can identify a disc that is irritating a nerve root or narrowing of the spinal canal.
CT: shows the bony structures well and can be useful when an MRI is not suitable.
X-ray: shows the bones and can help rule out certain problems, though it does not show discs or nerves.

When Is Surgery Needed?

Surgery is considered only in a minority of cases. It may be discussed when severe pain has not responded to other treatment over time, when there is significant or progressing weakness, or in the rare emergency where bladder or bowel control is affected.

The most common procedure is a discectomy, where the part of the disc irritating the nerve is removed. Less often, a laminectomy is used to make more space for the nerve.² Rehabilitation afterwards helps restore strength and movement and supports your return to normal activity.

What Treatments Are Available for Sciatica?

Treatment is individualised. It is guided by your diagnosis, how irritable your symptoms are, your goals and what the examination shows. The aim is to reduce pain, restore comfortable movement, and gradually rebuild your tolerance for activity. These are some of the approaches I use, usually in combination with exercise.

Exercise and Load Management

This is the foundation of recovery. Graded exercise, including movement, strengthening and a gradual return to activity, helps you build tolerance and supports recovery. What is progressed, and how quickly, depends on your symptoms.¹²

Myofascial Release

Myofascial release is a hands-on technique that can reduce discomfort in tight or sensitive muscles and make movement and exercise easier. It is not a way to physically release a trapped nerve.⁶

Orthopaedic Manual Therapy

Orthopaedic manual therapy uses hands-on techniques that can give short-term relief of pain and stiffness and improve movement, as part of a broader rehabilitation programme. NICE says manual therapy may be considered, but only as part of a treatment package that includes exercise.⁷

Neural Mobilisation

Neural mobilisation uses controlled movements intended to make nerve-related movement feel easier and less sensitive. It does not physically release, stretch free or decompress a trapped nerve. Reviews suggest it may help pain and function for some people, though results vary.⁸

Dry Needling

Dry needling targets tight or sensitive points in the muscles and can help ease muscle-related discomfort and make movement easier for some people.¹⁰

Laser Therapy (Low-Level Laser Therapy)

Low-level laser therapy is sometimes used as a modest adjunct to support comfort during a rehabilitation programme. I use it alongside exercise and other treatment rather than as a stand-alone fix.⁹

Taping and Strapping

Taping can provide temporary sensory or movement support for some people while symptoms settle. It works by supporting movement and comfort, not by lifting the skin to decompress deeper tissues.¹¹

Advice and Education

Understanding your symptoms, how to manage flare-ups, sensible activity and load, and when to seek further help is a key part of recovery. I will also cover practical things like movement, sitting and gradually getting back to the activities you value.

Frequently Asked Questions

How long does sciatica usually take to settle?

It varies a lot depending on the cause and severity. Many people notice a meaningful improvement over a few weeks with the right plan, while some cases take longer. A proper assessment helps set realistic expectations for your situation.

Should I rest or stay active with sciatica?

In most cases, staying gently active is better than strict bed rest. Prolonged rest can lead to stiffness and deconditioning. The aim is to keep moving within comfortable limits and gradually build back up, and your physiotherapist can help you find the right level.

Can sciatica go away on its own?

Some episodes do settle over time. If your pain is persistent, recurring, or spreading, an assessment helps identify what is driving it and how best to manage it.

Is walking good for sciatica?

Gentle walking is often helpful because it keeps the spine and nerves moving without heavy loading. If walking sharply increases your leg symptoms, ease off and have it assessed rather than pushing through.

When should I see a physiotherapist about sciatica?

It is worth getting assessed if your pain is not improving, keeps coming back, travels down the leg, or affects your daily activities. Seek urgent medical care straight away if you notice bladder or bowel changes, numbness around the saddle area, or weakness in both legs.

Conclusion

Sciatica can be painful and frustrating, but for most people it improves with the right approach and a bit of patience. A clear diagnosis, graded exercise, sensible load management, and hands-on treatment where it helps can reduce your pain and help you move more comfortably.

If your symptoms are severe, not settling, or you notice any of the warning signs above, it is worth getting assessed. I am happy to help you work out the right next step.

Ready to take the next step? Book a session at Daniel da Cruz Physiotherapy in Sandton.