Sciatica - The Physiotherapy Management
An overview of Sciatica
Common Symptoms of Sciatica
Common symptoms described by patients with sciatica. MSK Physiotherapists can diagnose neurogenic leg pain (sciatica) to the specific nerve root(s) by listening to patient symptoms and performing a thorough assessment.
Sciatica can be extremely painful and debilitating, our specialist home visit physiotherapists can provide you with a personalised treatment plan aimed at improving your symptoms.
Most symptoms of sciatica resolve with conservative management and do not require scanning or surgical intervention.
What is Sciatica?
Sciatica is a symptom, not a diagnosis itself. It refers to pain that radiates along the path of the sciatic nerve—typically from the lower back, through the buttock, and down the back of one leg. It’s often accompanied by numbness, tingling, or muscle weakness in the affected leg.
What Causes Sciatica?
Sciatica is usually caused by irritation, inflammation, compression, or pinching of a nerve in the lower back. Common causes include:
Herniated or slipped disc (most common cause)
Spinal stenosis (narrowing of the spinal canal)
Degenerative disc disease
Spondylolisthesis (a vertebra slipping out of place)
Piriformis syndrome (tight piriformis muscle compressing the sciatic nerve)
Injury or trauma
How is Sciatica Diagnosed by a Physiotherapist?
Physiotherapists are trained to assess and diagnose musculoskeletal and nerve-related conditions like sciatica without the need for scans in most cases. Here’s how they go about it:
🗣️ 1. Detailed Subjective Assessment (Patient Interview)
The physio will start by asking about:
Pain location and pattern (e.g., radiating down the leg, buttock pain)
Type of pain (sharp, burning, shooting, tingling, numbness)
Onset and history (sudden vs gradual, any injuries or triggers)
Aggravating and easing factors (e.g., sitting, bending, coughing)
Impact on daily function (e.g., walking, sleeping, dressing)
This helps identify if the symptoms follow a sciatic nerve distribution, which is key to diagnosis.
🧠 2. Physical Examination
Physios use specific tests to confirm if the sciatic nerve is involved:
Observation & posture check – Looks for muscle imbalances, pelvic tilt, or protective postures.
Neurological tests – To assess:
Strength of key leg muscles
Reflexes (e.g., knee or ankle jerk)
Sensation (touch or pinprick testing along nerve pathways)
Range of motion testing – Checking flexibility of the spine and hips.
Neural tension tests:
Straight Leg Raise (SLR) – A classic test for sciatica.
Slump Test – Another test to check if nerve tension reproduces your symptoms.
These tests help pinpoint the source of nerve irritation or compression.
🧾 3. Functional & Movement Analysis
The physio may assess how you:
Walk
Sit and stand
Bend or lift
Perform day-to-day tasks
This gives insight into how sciatica is affecting your function and biomechanics, and helps guide your treatment plan.
📸 4. Referral for Imaging (if needed)
Physiotherapists can work alongside your GP or specialist to recommend further investigations like an MRI, but only if:
Symptoms are severe or not improving
There are signs of serious nerve involvement (e.g., significant weakness)
There's concern about an underlying condition
Treatment Options for Sciatica
Treatment depends on the severity and underlying cause. Options include:
1. Conservative (Non-surgical) Treatment
Rest and activity modification (avoiding activities that worsen symptoms)
Pain relief medications (NSAIDs, paracetamol, neuropathic medication)
Muscle relaxants (if needed)
Heat or ice therapy (if this improves symptoms)
Physiotherapy (more on this below)
Manual therapy (physiotherapy led)
Steroid injections (for inflammation)
2. Surgical Treatment
Reserved for severe cases not responding to conservative treatment, especially if there’s:
Persistent pain
Significant weakness or numbness
Loss of bowel or bladder control (medical emergency)
Common surgeries include discectomy or laminectomy.
How Can Physiotherapy Help Sciatica?
Physiotherapy is often central to recovery and long-term management. It can help by:
Reducing pain and inflammation
Improving mobility and flexibility
Strengthening core and back muscles
Correcting posture and biomechanics
Providing education to prevent recurrence
Onwards Referral to Orthopaedics when Physiotherapy is not improving symptoms, when scanning would be beneficial or invasive treatments are recommended.
Common physiotherapy techniques:
Manual therapy
Targeted stretching and strengthening exercises
Postural re-education
Nerve gliding (neural mobilisation) techniques
Electrotherapy (e.g., TENS)
NICE Guidelines for Treatment of Sciatica (UK)
The National Institute for Health and Care Excellence (NICE) provides evidence-based guidance. Key recommendations:
Initial management: Encourage self-management, stay active, and use simple analgesia (like NSAIDs).
Manual therapy: Consider spinal manipulation and mobilisation as part of a treatment package.
Exercise: Structured exercise programs to improve function and reduce pain.
Psychosocial support: Address fear-avoidance and mental health as needed.
Referral for specialist care if symptoms persist >6–8 weeks or worsen.
Benefits of Home Visit Physio for Sciatica
Home-based physiotherapy offers several advantages:
Convenience: Especially for those in severe pain or with limited mobility.
Personalised treatment: In your own environment, tailored to how you move and function at home.
Comfort and reduced stress: No need to travel, which can aggravate symptoms.
Faster intervention: Often leads to earlier assessment and quicker relief.
Better long-term outcomes: Home exercises are more likely to be integrated into daily life with hands-on guidance.
How Home Physio Company Can Help Improve Your Sciatica
At Home Physio Company, we bring expert care directly to your doorstep, offering personalised treatment plans to effectively manage and relieve sciatica symptoms. Here's how we can support your recovery:
✅ Pain Relief at Home
Our experienced physiotherapists use evidence-based techniques such as manual therapy, nerve mobilisations, and targeted exercises to reduce nerve irritation and ease pain—without the need to travel.
✅ Tailored Rehab Programmes
Every patient receives a custom rehabilitation plan focused on improving mobility, reducing muscle tension, strengthening the core, and correcting posture—key elements in long-term sciatica relief.
✅ Functional Support in Your Environment
We assess how you move and function at home, identifying any daily habits or setups that may worsen your symptoms. This allows us to provide practical adjustments and ergonomic advice on the spot.
✅ Faster Recovery, Greater Comfort
Avoid the stress and discomfort of clinic visits. Our convenient home appointments allow for early intervention and consistent care, promoting quicker healing in the comfort of your own surroundings.
✅ Ongoing Support & Education
We empower you with the knowledge and tools to self-manage your condition and prevent future flare-ups—guiding you through every step of your recovery.
