The sciatic nerve is the largest and longest nerve in your body, starting in your lower back and running down the back of each leg to your feet. It forms from several smaller nerves that come together in the lower spine, specifically in the lumbar (lower back) and sacral (pelvic) regions. This nerve is responsible for a significant part of your leg’s motor and sensory functions.

After forming in the lower spine, the sciatic nerve exits the pelvis and passes through the buttock area. It then travels down the back of the thigh, staying deep within the muscles. As it reaches the knee, the nerve typically splits into two major branches: the tibial nerve, which continues down the back of the leg, and the common peroneal nerve, which wraps around the outer knee and goes down the front and side of the leg.

The sciatic nerve plays a crucial role in both movement and sensation. It controls muscles in the back of your thigh, like the hamstrings, as well as muscles in your lower leg and foot, allowing you to move these parts of your body. Additionally, it carries sensory information from your lower leg and foot to your brain, enabling you to feel things like pain, temperature, and touch.

Diagnosing sciatica involves a combination of clinical evaluation, patient history, and diagnostic tests. The goal is to identify the underlying cause of the sciatic nerve irritation/ compression and to determine the most appropriate treatment plan.

The first step in diagnosing sciatica is a thorough physical examination. During this exam, we will assess your spine and legs, looking for signs of muscle weakness, loss of spinal range of movement, increased muscle tone, reflex changes, or sensory deficits.

Key aspects of the physical examination include:

• Observation: We will observe your posture, gait, and any visible deformities or asymmetries.
• Palpation: We will palpate (feel) your spine and muscles to identify areas of tenderness or muscle spasms.
• Range of Motion Tests: We may ask you to perform certain movements and special tests, such as bending, lifting your leg and nerve stretches, to see if they trigger sciatica symptoms.
• Neurological Tests: Reflexes, muscle strength, and sensation in your legs and feet will be tested to assess the functioning of the sciatic nerve.

Imaging studies are often used to confirm the diagnosis of sciatica and to identify the specific cause of nerve compression or irritation. An MRI is the most common imaging test used to diagnose sciatica. It provides detailed images of the soft tissues, including discs, muscles, and nerves, allowing us to identify conditions like herniated discs, spinal stenosis, or facet joint degeneration.

Physiotherapy is the cornerstone of treating sciatica, focusing primarily on pain relief and restoring full range of movement. Most individuals with sciatica can achieve significant improvement through a combination of hands-on manual therapy and targeted home exercises.

Beyond initial recovery, a structured rehabilitation program is essential for preventing future issues and improving spinal robustness. Physiotherapists also play a crucial role in identifying the root cause of the problem, ensuring long-term relief and prevention of recurrence.

The first and most immediate goal of physiotherapy for sciatica is to alleviate pain and restore normal movement patterns. This is achieved through:

Manual Therapy Techniques

Soft Tissue Mobilisation: Physiotherapists use hands-on techniques such as massage, myofascial release, and trigger point therapy to relieve muscle tension, improve blood flow, and reduce pressure on the sciatic nerve. These methods are highly effective in providing immediate pain relief and enhancing mobility.

Joint Mobilisation: Mobilisation of the spine and pelvis helps to improve alignment, reduce nerve irritation, and restore normal joint function. This can significantly alleviate pain and restore the range of motion that may have been lost due to muscle guarding or joint stiffness.

Targeted Home Exercises

Stretching: Patients are given specific stretching exercises to perform at home. These exercises focus on improving flexibility in the lower back, hips and hamstrings.

Strengthening: Early-stage exercises often include gentle strengthening of the core muscles and lower back/ hip strengthening.

Once pain relief and movement restoration are underway, the focus shifts to a structured rehabilitation program. This phase is critical for preventing future sciatica episodes and building resilience in the spine.

Most people with sciatica find relief through non-surgical methods such as physiotherapy. However, surgery may be considered when non-surgical methods fail, or if sciatica is caused by a more severe condition like a large herniated disc or spinal stenosis. The goal of surgery is to remove the source of nerve compression, providing quicker and more lasting relief.

While surgery can be effective, it carries risks and typically requires a longer recovery period. Ultimately, the choice between surgery and non-surgery should be made in consultation with a spinal specialist, considering factors like the intensity of pain, the underlying cause of sciatica, and the patient’s overall health.

For individuals with more advanced degenerative conditions, such as significant spinal stenosis, severe osteoarthritis, or chronic disc degeneration, ongoing maintenance treatments may be necessary to manage symptoms and maintain quality of life.

Continued manual therapy sessions can help manage pain and stiffness associated with degenerative conditions and these are often on a 4-8 week basis. One of the most critical aspects of long-term maintenance is the consistent adherence to home management strategies. Patients who diligently follow their prescribed home exercise routines and lifestyle modifications are more likely to experience sustained relief and prevent future sciatica episodes.

The Sharp Physio Team