physical therapy

What to Do for Sciatica Pain: A Physiotherapist’s Guide

That shooting pain down your leg that makes you catch your breath, the tingling that won't go away, or the ache that's keeping you awake at night - if this sounds familiar, you're likely dealing with sciatica. As physiotherapists, we see patients with sciatica regularly, and one of the first things they ask is: "What can I actually do about this pain?"

The good news is that most sciatica responds very well to the right approach. While it can feel overwhelming when you're in pain, understanding what sciatica is, what triggers it, and most importantly, what you can do to help yourself can make a significant difference to your recovery.

What Does Sciatic Pain Feel Like?

Sciatica isn't just "back pain that goes down your leg." Patients describe sciatica pain in very specific ways that help us understand what's happening:

  • "Like an electric current running down my leg"

  • "A hot wire from my back to my foot"

  • "Sharp shooting pain that takes my breath away"

  • "Burning sensation that travels down my thigh"

  • "Tingling and numbness, like my leg's gone to sleep"

The pain typically follows the path of your sciatic nerve - from your lower back, through your buttock, down the back or side of your thigh, and sometimes all the way to your foot. It's usually worse on one side, though it can affect both legs.

Not everyone experiences sciatica as sharp or burning pain — for some, it presents as a persistent mild ache in the buttock, thigh, or calf.

Understanding the Confusion: Is a Slipped Disc the Same as a Herniated Disc?

Before we dive into treatment, let's clear up a common confusion that causes unnecessary worry for many sciatica patients.

The simple answer: Yes, they're the same thing. Whether you've been told you have a "slipped disc," "herniated disc," "prolapsed disc," or "ruptured disc," these terms all describe different severities of the same issue.

Your spinal discs haven't actually "slipped" anywhere - think of them more like jam donuts. The tough outer ring can develop a weakness, allowing some of the soft inner material to bulge out or leak through. When this presses on the sciatic nerve, it can cause the pain that travels down your leg.

“I reassure patients that regardless of which term their previous doctor used, what matters is how we can help them recover. The treatment approach is the same whether you call it slipped, herniated, or prolapsed.”
— Paul Martin, Spinal Specialist

What Triggers Sciatica Pain?

Understanding your triggers helps you manage symptoms and prevent flare-ups:

Common Triggers Include:

  • Sitting for long periods - especially in poor posture

  • Bending forward - particularly first thing in the morning

  • Coughing or sneezing - increases pressure in your spine

  • Lifting or twisting - especially when combined

  • Getting out of bed - after lying still for hours

Why Sciatica Is Often Worse at Night

Many patients find their sciatica pain intensifies during the night or early morning. This happens because:

  • Lying flat can sometimes increase pressure on the affected nerve

  • Reduced movement during sleep can cause stiffness

  • Inflammation tends to build up overnight

  • Muscle tension accumulates from the day

Immediate Steps You Can Take for Sciatica Relief

When sciatica strikes, here's what our physiotherapists recommend you do right away:

1. Keep Moving (Gently)

Contrary to what many people think, complete bed rest usually makes sciatica worse. Gentle movement helps reduce inflammation and prevents stiffness.

Try these movements:

  • Walking - even just 5-10 minutes if that's all you can manage

  • Gentle marching on the spot - when walking is too painful

  • Supported standing - holding onto a chair or wall

2. Find Your Comfortable Positions & Personal Preferences

Different positions work for different people, but these often provide relief:

For sitting:

  • Use a small rolled up towel behind your lower back

  • Keep your feet flat on the floor

  • Avoid low, soft chairs that make you slouch

For lying down:

  • Lie on your back with a pillow under your knees

  • Or lie on your side with a pillow between your knees and a small rolled towel rolled up and place between the ribs and the top of the pelvis.

  • Some people find lying on their stomach helpful

For standing:

  • Avoid standing in one position for too long

  • Shift your weight from foot to foot

  • Use a small footstool to rest one foot if standing for a while

3. Simple Stretch & Pain Relief Techniques

Heat or Cold:

  • Ice for the first 48-72 hours if there's acute inflammation

  • Heat after the initial phase to relax muscles

  • Alternating heat and cold can sometimes work well

Gentle Stretches (only if comfortable):

  • Knee to chest - lying on your back, gently pull one knee toward your chest

  •  Gentle hip stretches can help if muscle tension is contributing

  • Cat-cow movements on hands and knees if you can get into this position

Some patients also find gentle massage helpful, particularly when muscle tension is contributing to their discomfort. While it won’t fix the underlying nerve irritation, it can provide short-term relief and relaxation.

"The key with sciatica is listening to your body. If a movement or position makes your leg pain worse, avoid it. If it reduces the leg pain, even if it slightly increases back pain, that's usually a good sign." – Phil Harris - spinal physio.

When to Seek Professional Help for Sciatica

While many cases of sciatica improve with self-care, certain situations require prompt professional assessment:

Seek Help Within a Few Days If:

  • Pain isn't improving with basic self-care measures

  • You're unable to find any comfortable positions

  • The pain is preventing you from sleeping

  • You're struggling with daily activities

Seek Urgent Help If You Experience:

  • Loss of bladder or bowel control

  • Severe weakness in your leg or foot

  • Numbness around your genital area

  • Progressive neurological symptoms

  • Severe pain following an accident

These "red flag" symptoms are rare but need immediate medical attention.

How Physiotherapy Can Help Fix Sciatica

Professional physiotherapy treatment for sciatica focuses on several key areas:

Reducing Nerve Irritation

  • Manual therapy techniques to improve spinal movement

  • Nerve mobilisation exercises to reduce sensitivity

  • Postural correction to reduce ongoing pressure

Addressing Root Causes

  • Strengthening weak muscles that may be contributing

  • Improving flexibility in tight areas

  • Correcting movement patterns that might be aggravating the problem

Education and Self-Management

  • Understanding your condition and what to expect

  • Learning which activities to modify and which are safe

  • Developing a long-term prevention strategy

Having clear, accurate information about your condition helps reduce fear and gives you the confidence to keep moving and recover more effectively.

“Sciatica often responds really well to physiotherapy because we can address both the symptoms and the underlying factors that led to the problem. Most patients see significant improvement within 4-6 weeks with the right approach.”
— Sarah Lawson - Spinal physio.

What Exercise Is Good for Sciatica Pain?

Exercise is crucial for sciatica recovery, but the right exercises depend on your specific situation:

Early Phase (When Pain Is Severe):

  • Gentle walking as tolerated

  • Basic postural awareness exercises

  • Simple breathing exercises to help manage pain

As Pain Improves:

  • Core strengthening exercises

  • Hip flexibility work

  • Nerve gliding exercises (under professional guidance)

Prevention Phase:

  • Comprehensive strengthening program

  • Movement retraining for daily activities

  • Sport or activity-specific preparation if needed

How Long Does Sciatica Pain Last?

This varies significantly, but here's what research tells us:

Typical Timeline:

  • Acute phase: 1-2 weeks of severe symptoms

  • Improvement phase: 4-6 weeks of gradual improvement

  • Recovery phase: 8-12 weeks to near-normal function

Factors That Affect Recovery Time:

  • How quickly you start appropriate treatment

  • Whether you stay active within your limits

  • Your overall fitness and health

  • The specific cause of your sciatica

  • How well you follow professional advice


Case Study: Emma's Sciatica Recovery

Emma, a 38-year-old office worker, developed severe sciatica after lifting boxes during a house move. The pain shot from her lower back down to her ankle, making sitting at work almost impossible.

Week 1-2: Emma tried complete bed rest, which made her symptoms worse. She contacted our clinic when the pain wasn't improving.

Initial treatment focus:

  • Pain relief techniques and positioning advice

  • Gentle movement exercises

  • Workplace modifications for immediate relief

Week 3-6: As Emma's acute symptoms settled, treatment progressed to:

  • Specific strengthening exercises

  • Manual therapy to improve spinal movement

  • Gradual return to normal activities

Week 8-12: Emma focused on:

  • Comprehensive prevention program

  • Return to all normal activities including exercise

  • Long-term maintenance strategies

Outcome: Emma returned to full function and remained symptom-free at 6-month follow-up by maintaining her exercise programme and using proper lifting techniques.


How to Sit with Sciatica Pain

Since sitting often aggravates sciatica, here are specific strategies:

Chair Setup:

  • Lumbar support: Use a rolled towel

  • Feet flat: On the floor or on a footrest

  • Knees level: With or slightly below your hips

  • Avoid: Deep, soft sofas that make you slouch

Regular Movement:

  • Stand every 20- 30 minutes if possible

  • Gentle back extensions when you stand

  • Shift positions regularly while sitting

  • Consider a standing desk option if feasible

Alternative Positions:

  • Perching on a high stool

  • Kneeling chairs work well for some people if you have no knee issues.

  • Exercise ball for short periods (if comfortable)

How to Relieve Sciatica Pain in Pregnancy

Pregnancy-related sciatica requires special considerations:

Safe Relief Methods:

  • Prenatal yoga poses (with instructor guidance)

  • Swimming or water exercises

  • Pregnancy support belts

  • Heat therapy (avoiding overheating)

Positioning Help:

  • Pregnancy pillows for better sleep positioning

  • Avoid sleeping on your back after the first trimester

  • Side-lying with pillow support between knees

"Pregnancy sciatica often improves significantly after delivery, but we can still provide safe, effective treatment during pregnancy to help mothers stay comfortable and active." –Sarah Lawson - Spinal Physio 

“Pregnancy sciatica often improves significantly after delivery, but we can still provide safe, effective treatment during pregnancy to help mothers stay comfortable and active.”
— Sarah Lawson - Spinal Physio 

Red Flags: When Sciatica Needs Urgent Attention

While most sciatica isn't dangerous, certain symptoms require immediate medical assessment:

Emergency Symptoms:

  • Cauda equina syndrome signs: Loss of bladder/bowel control, saddle numbness

  • Severe progressive weakness: Inability to lift your foot or difficulty walking

  • Bilateral symptoms: Sciatica affecting both legs severely

Concerning Changes:

  • Rapidly worsening symptoms despite appropriate treatment

  • New neurological symptoms like significant numbness or weakness

  • Signs of infection like fever with back pain

The Best Treatment Approach for Sciatica

Research shows that the most effective treatment for sciatica combines:

  1. Early, appropriate movement rather than bed rest

  2. Professional assessment to identify specific contributing factors

  3. Graduated exercise program tailored to your recovery stage

  4. Education about the condition and self-management strategies

  5. Manual therapy when appropriate

  6. Pain management techniques to help you stay active

What Makes Treatment Successful:

  • Starting treatment early rather than waiting for it to "go away"

  • Staying active within your pain limits

  • Following professional guidance consistently

  • Addressing underlying factors like posture or fitness

  • Having realistic expectations about recovery timeline

Is Sciatica Curable?

The encouraging news is that most sciatica has an excellent prognosis:

Complete Recovery: 80-90% of people with sciatica recover completely within 6-12 weeks with appropriate treatment.

Good Improvement: Most others experience significant improvement that allows them to return to normal activities.

Chronic Cases: Only a small percentage develop long-term problems, usually when treatment is delayed or inappropriate.

Prevention: Learning proper movement patterns and maintaining fitness significantly reduces the risk of recurrence.

Taking Action on Sciatica & Back Pain: Your Next Steps

If you're dealing with sciatica pain:

  1. Don't panic - most sciatica resolves well with appropriate care

  2. Stay gently active - complete rest usually makes it worse

  3. Try the positioning and movement advice outlined above

  4. Seek professional help if symptoms aren't improving within a few days

  5. Be patient - recovery takes time but is usually very successful

Remember, sciatica is common, treatable, and in most cases, completely recoverable. The key is taking the right steps early and getting professional guidance when needed.

“The most important thing I tell patients with sciatica is that this condition responds really well to treatment. Yes, it can be painful and concerning, but with the right approach, the vast majority of people make a full recovery.”
— Charles Brahmbhatt - Spinal physio.,