A backache is one thing. But when the pain stops behaving like a normal ache and starts shooting down your buttock, into your thigh, and sometimes all the way to your foot, something else is going on. That travelling, electric quality is the hallmark of sciatica, and it catches a lot of people off guard because the problem so rarely feels like it’s coming from the back at all.
Sciatica isn’t a diagnosis in itself. It’s a description of a symptom pattern caused by irritation or compression of the sciatic nerve, the longest nerve in the body, running from the lower back through the buttock and down each leg. Understanding what’s actually pressing on that nerve is the key to treating it properly, rather than just chasing the pain wherever it happens to show up.
What’s Happening to the Nerve
The sciatic nerve is formed from several nerve roots that exit the lower spine and merge together before travelling down the back of the leg. When any part of that pathway gets compressed or inflamed, the nerve doesn’t just hurt at the site of the problem. It sends pain, numbness, tingling, or a burning sensation anywhere along its route, which is why sciatica can feel like it’s coming from the hip, the hamstring, or even the calf, even though the root cause sits much higher up, closer to the back pain most people are more familiar with.
This is what makes sciatica tricky to self-diagnose. The location of the pain doesn’t always point to the location of the problem.
Why It Happens: The Real Causes
Most cases of sciatica come down to something narrowing the space around the nerve or irritating it directly. A few causes account for the vast majority of what physiotherapists see.
Disc Herniation
By far the most common cause. When the soft cushioning between spinal vertebrae bulges or ruptures, it can press directly on a nearby nerve root. This often happens gradually through repeated bending and lifting, though it can also follow a single awkward movement.
Spinal Stenosis
A narrowing of the spaces within the spine, usually linked to age-related changes, bone spurs, or degenerative disc disease. This narrowing leaves less room for the nerve roots, and less room means more pressure.
Piriformis Syndrome
The piriformis, a small muscle deep in the buttock, sits right next to the sciatic nerve. Spasm or tightness in this muscle, often from prolonged sitting, trauma, or overuse, can irritate the nerve without any involvement from the spine at all.
Spondylolisthesis
A condition where one vertebra slips forward over the one beneath it, which can pinch the nerve roots as they exit the spine.
Pregnancy and Prolonged Sitting
Both increase pressure on the lower spine and surrounding structures, and both are common, underappreciated contributors.
Age, a sedentary lifestyle, physically demanding work involving heavy lifting or twisting, and previous back injuries all raise the likelihood of developing sciatica at some point.
Recovering Properly: What the Evidence Supports
The reassuring reality is that most sciatica settles well without surgery. Structured, evidence-based physiotherapy is genuinely effective, and comparisons show that conservative treatment and surgery tend to arrive at similar outcomes over the long term, even though surgery can offer faster relief in the short term. For the small number of cases where surgery is unavoidable, the same principles of structured post-operative rehabilitation still apply.
- Get the source identified. Because disc-related sciatica and stenosis-related sciatica often respond to different types of movement, a proper assessment matters more than guesswork. What helps one cause can aggravate another.
- Stay moving within comfortable limits. Prolonged bed rest tends to slow recovery rather than speed it up. Gentle, guided movement keeps the nerve gliding properly and prevents the surrounding muscles from stiffening further.
- Follow a structured exercise programme. Core stability and targeted strengthening exercises, typically over an eight to twelve week programme, have strong evidence behind them for reducing sciatic pain and preventing recurrence.
- Address the specific mechanical cause. Extension-based movements tend to help centralise pain from a disc issue, while flexion-based movements often suit stenosis better. Getting this distinction right, rather than following generic advice, speeds up progress considerably.
- Manage the early, acute pain sensibly. In the first few weeks, techniques such as manual therapy and other physiotherapy pain relief techniques can help take the edge off enough to keep you moving and engaged with your rehab programme.
- Give it realistic time. Most mild to moderate cases improve substantially within four to six weeks of consistent, appropriate treatment. More stubborn cases take longer, and that’s normal, not a sign that something has gone wrong.
The Physiocare Approach to Sciatica
Sciatica walks through our door in all kinds of forms: the office worker who’s been sitting through the pain for months, the tradesperson whose back finally caught up with years of lifting, and, every so often, someone convinced they have a knee problem when the pain is really being referred from the nerve higher up.
What ties these cases together at Physiocare is a proper assessment before anything else. Pinpointing what’s actually irritating the nerve, rather than reaching for a generic exercise sheet, is what turns a temporary improvement into lasting relief. It also means we can push back on the common misconceptions about physiotherapy that lead a lot of people to sit with sciatica far longer than they ever needed to. Where it’s genuinely needed, that assessment can also lead to physiotherapeutic modalities such as manual therapy, acupuncture, or different forms of electrotherapy, always decided after we’ve assessed the patient rather than applied as a default.
If pain is travelling down your leg and it isn’t settling on its own, don’t wait for it to become chronic. Get in touch with our team and let’s find out exactly what’s causing it.