Sciatica Nerve Pain: Causes, Symptoms & Physiotherapy Treatment

Understanding & Treating Sciatica

Sciatica isn't a diagnosis — it's a symptom. It describes pain radiating along the sciatic nerve pathway from lower back through hips/buttocks and down each leg. Usually affects only one side.

What Causes Sciatica?

Lumbar Herniated Disc (90% of cases): The gel-like center of a disc pushes through a tear, pressing on nerve roots. Most common at L4-L5 or L5-S1 levels.

Piriformis Syndrome: The piriformis muscle in the buttock spasms and compresses the sciatic nerve. Often misdiagnosed as disc herniation.

Spinal Stenosis: Narrowing of the spinal canal, typically in adults over 60. Causes neurogenic claudication — pain worsens with walking, improves with sitting/leaning forward.

Spondylolisthesis: One vertebra slips forward over another, narrowing the nerve exit pathway.

Physiotherapy Treatment Approach

Phase 1 (Weeks 1-2): Pain Reduction

• Nerve gliding exercises (neural flossing)
• McKenzie extension exercises (if disc-related)
• TENS for pain modulation
• Positional relief strategies

Phase 2 (Weeks 3-6): Mobility Restoration

• Hamstring and hip flexor stretching
• Core stabilization (dead bug, bird-dog)
• Graduated walking program
• Posture correction

Phase 3 (Weeks 6-12): Strength & Prevention

• Progressive resistance training
• Functional movement retraining
• Ergonomic modifications
• Home exercise program for maintenance

5 Exercises for Immediate Sciatica Relief

1. Nerve Gliding: Sit tall, straighten leg, flex ankle up/down. 10 reps. Flosses the nerve through tissues.
2. McKenzie Press-Up: Lie face down, press upper body up keeping hips down. 10 reps. Centralizes pain.
3. Piriformis Stretch: Figure-4 stretch, hold 30 seconds. Releases muscle compression.
4. Cat-Cow: Mobilizes lumbar spine. 10 slow reps.
5. Walking: 10-15 minutes, multiple times daily. Pumps inflammation away from nerve.

Red Flags — See a Doctor Immediately

Loss of bowel/bladder control, saddle anesthesia (numbness in groin area), progressive leg weakness, or pain following major trauma. These indicate cauda equina syndrome or fracture — surgical emergencies.