Sciatica: What It Actually Is and How Physiotherapy Helps

Sciatica is one of the most commonly misused terms in musculoskeletal medicine. Strictly speaking, sciatica refers to pain that travels along the path of the sciatic nerve, from the lower back through the buttock and down the leg, sometimes as far as the foot. But not all leg pain is sciatica, and not all sciatica is the same.

What actually causes sciatica?

The sciatic nerve is the largest nerve in the body, formed from the lower lumbar and sacral nerve roots. It can be irritated or compressed at several points along its path. The most common cause is a lumbar disc bulge or herniation pressing on a nerve root as it exits the spine, usually at L4-L5 or L5-S1. Other causes include spinal stenosis (narrowing of the spinal canal), piriformis syndrome (compression in the buttock), and, less commonly, referred pain from the sacroiliac joint or hip.

How is it different from regular back pain?

The distinguishing feature of true sciatica is that the pain, tingling, or numbness radiates below the knee, often into the calf, ankle, or foot. It's often described as electric, burning, or shooting, and coughing, sneezing, and prolonged sitting tend to provoke it. Pure back pain that doesn't go below the knee is rarely nerve-related. If you have significant weakness in the foot or leg, or any changes to bladder or bowel function, seek same-day medical care, as these are signs of a more serious neurological problem.

Is it sciatica or a hamstring strain?

Back-of-thigh pain is often misdiagnosed. Patients are told they have a hamstring strain when the source is the sciatic nerve, or the other way round. The distinction matters because the treatments are different and doing the wrong one can make things worse. A hamstring strain comes on suddenly during a sprint or sudden eccentric load, the pain sits in the muscle belly (mid-thigh) or near the sitting bone, and there is no radiation below the knee and no pins and needles.

• Slump test or straight leg raise: reproduces leg pain in sciatica, negative in hamstring strain
• Palpation: a hamstring strain is tender on direct pressure; sciatica is not reproduced by pressing the thigh
• Resisted strength: a hamstring strain produces pain and weakness on resisted knee flexion; sciatica may show weakness but not localised pain
• Location: mid-thigh pain points to the hamstring; pain at the sitting bone may be high hamstring tendinopathy or nerve involvement

Sometimes it's both. At the top of the hamstring the sciatic nerve and the hamstring tendon sit close together, and high hamstring tendinopathy can sensitise the nerve next to it. A thorough assessment is needed to tease these apart.

Why physiotherapy works

The research on sciatica is clear: for the vast majority of cases, active physiotherapy-based management produces better long-term outcomes than rest, pain medication, or surgery. Treatment typically involves neural mobilisation (nerve flossing techniques to reduce sensitisation), targeted lumbar and hip exercises to reduce compression on the nerve root, and load management advice to keep you moving without aggravating symptoms.

How long does sciatica take to resolve?

Most acute sciatica episodes improve significantly within 6–12 weeks with appropriate management. Chronic or recurrent sciatica, often driven by poor movement patterns, sitting habits, or deconditioning, requires a longer-term approach focused on building resilience. The single worst thing you can do for sciatica is rest completely. Graded movement, started early, consistently produces faster recovery.

Mobile physio for sciatica in the Eastern Suburbs

Sciatica can make getting to a clinic genuinely painful, particularly if sitting aggravates your symptoms. A home visit from Seth means you can be assessed and begin treatment in a comfortable position, without the stress of travel. Treatment can begin at your first appointment.