Sciatica

Not everything that produces leg pain is sciatica, and the distinction changes the treatment.

Lumbar disc bulge is the most common cause of true sciatica, not a separate condition ^1,2, but a bulging disc can also cause back pain with no nerve involvement at all, which needs a different plan.

Facet joint pain comes from the small joints at the back of the spine. It refers pain convincingly into the buttock and upper thigh, but typically stops above the knee and doesn't bring the pins and needles, numbness or weakness nerve-root involvement does.

Piriformis-type buttock pain (irritation where the nerve passes through the deep buttock muscles rather than at the spinal root ¹) presents similarly, but the level you'd treat is different.

And one that matters more than its rarity suggests: cauda equina syndrome can initially look like ordinary low back pain ⁶. It's why an assessment asks about bladder and bowel function when you came in about your leg.

Sciatica is diagnosed in the clinic room, from your symptoms and an examination ⁴. You'll be asked where the pain runs, when it started, and whether there's tingling, numbness or weakness in the leg ⁴. Leg pain that's worse than the back pain points towards sciatica ⁴. Back pain with nothing in the leg probably isn't it ². If your back has grabbed and locked but your leg is fine, read about back spasm instead.

The test most people remember is the straight leg raise: you lie on your back and your leg is lifted with the knee straight. Reflexes, strength and sensation are checked too ⁴. Scans aren't routine. They're considered when symptoms have gone past 12 weeks, the pain is getting worse or the weakness is progressing ⁴.

The first job is working out which nerve root is involved and whether your symptoms centralise: whether certain movements pull the pain up out of the leg towards the spine, or push it further down. That response is what turns "do some sciatica stretches" into an actual plan.

From there, here's where the evidence on exercise stands: exercise helps, and no specific exercise has been shown to be the one that helps. The most thorough review available found exercise reduces pain in the short term, but made no recommendation for any particular type, other than that it be supervised exercise therapy ⁴. That single word is the finding, and it's why our exercise prescription and conditioning programs are built around your presentation, not a template.

What the evidence is clear about is movement itself. Bed rest may be counterproductive; staying active is the preferred option ³. Carry on with normal activities as far as you can, and don't sit or lie down for long stretches. Even when moving hurts, it isn't causing harm ². Keep it low-impact: walking and swimming, not running or standing weights ¹.

For pain that has settled in and stopped responding to the usual advice, our chronic pain management approach deals with what exercise alone doesn't: sleep, load tolerance, and the avoidance that builds up.

Sciatica is an irritated nerve, not a torn tissue, so The Well Motion Recovery Path™ starts by calming the nerve and then builds up what it can tolerate. You move up a phase when your leg symptoms allow it, not when a date arrives.

• Reset: from the first visit. We find the nerve root involved, then keep you active with walking or swimming ^1,3, adding manual therapy ⁵, neural mobilisation ⁷ or dry needling where they suit. Expect the leg pain to come and go. We move you on once it is retreating up the leg and you can sit and walk for longer. New bladder or bowel changes, numbness around the genitals or bottom, or weakness in both legs mean the emergency department, not the next phase ².
• Rebuild: supervised exercise therapy ⁴, through our exercise prescription and conditioning programs. Expect the odd flare as the load goes up. We move you on when everyday tasks no longer stir up the leg.
• Return: a full day of sitting at work, driving, lifting, and sport if that is yours. We test those tasks directly. You leave with an exercise plan, because regular exercise is linked with a lower risk of sciatica ⁹.

How long it usually takes. Most cases settle in 6 weeks to 3 months ³. Some people still have symptoms after a year ¹.

Nobody has trialled prevention for sciatica itself. These come from large studies of who gets it and one Australian trial in back pain:

• Keep exercising once it settles. In seven studies following about 78,000 people, those who exercised four or more times a week were 12% less likely to develop sciatica than people who did none ⁹. Healthdirect says to keep up low-impact exercise after you've recovered ¹.
• Walk to a plan. In a trial of 701 Australian adults who'd just got over a bout of low back pain, half were given a walking program that built up over six months. They went a median of 208 days before pain next limited their activity. The untreated group went 112 ⁸. That was back pain with no specific diagnosis: close to sciatica, though not the same.
• If you smoke, quit. Across 28 studies, current smokers had 46% higher odds of sciatica than people who'd never smoked. For ex-smokers it was 15% ¹⁰.
• Rethink the commute. Smoking and obesity both raise the risk of a hospital stay for sciatica. Walking or cycling to work lowers it ⁴.