Sciatica.
What is sciatica?
Sciatica is a term used to describe pain felt along the sciatic nerve, which runs from the lumbar spine down through the buttock, hamstrings and into the lower leg. This can happen on one side or both sides simultaneously. The main nerve roots that contribute to the sciatic nerve travel from the lower back — L4, L5 and S1 — and irritation or compression of these roots causes the severe leg pain characteristic of the condition. The sciatic nerve is the longest nerve in the body.
An important clinical point: sciatica is a symptom, not a diagnosis. It describes the pattern of pain rather than its cause, and identifying the underlying cause is the most important step in management — because the treatment for a lumbar disc herniation compressing the L5 nerve root differs meaningfully from that for piriformis syndrome irritating the sciatic nerve in the buttock, which differs again from spinal stenosis producing neurogenic claudication in an older adult.
What causes sciatica?
Issues such as a herniated disc, spinal stenosis, degenerative disc disease, arthritis, and spondylolisthesis can all cause sciatica — and the course of action to treat each one will vary.
The most common cause is lumbar disc herniation — where the nucleus pulposus of an intervertebral disc pushes through the annular fibres and directly compresses a lumbar nerve root. The L4-5 and L5-S1 levels are most frequently affected, producing symptoms corresponding to the L4, L5 or S1 nerve root distributions respectively. L4 radiculopathy produces symptoms into the anterior thigh and medial shin. L5 produces symptoms into the lateral shin and dorsum of the foot. S1 produces symptoms into the posterior calf, heel and lateral foot.
Lumbar spinal stenosis — narrowing of the spinal canal from degenerative changes — produces a characteristic pattern of bilateral leg pain and heaviness with walking that relieves with sitting and forward bending (neurogenic claudication), most commonly in adults over 60.
Piriformis syndrome — where the piriformis muscle in the buttock compresses the sciatic nerve as it exits the pelvis — produces deep buttock pain with radiation down the posterior thigh, often worse with sitting and hip rotation. It is a peripheral rather than spinal cause of sciatic nerve irritation and is frequently missed when the lumbar spine is assumed to be the culprit.
Spondylolisthesis — forward slippage of one vertebra on the one below — can compress nerve roots at the affected level. Sacroiliac joint dysfunction can refer pain into the posterior thigh and mimic sciatic distribution. Degenerative disc disease and facet joint syndrome are additional spinal contributors.
What are the symptoms?
Sciatica typically produces a combination of lower back and leg symptoms — though the leg symptoms are often more prominent and more distressing. Sharp, shooting, burning or electric pain radiating from the lower back or buttock down the posterior or lateral thigh, calf and into the foot is the classic description. Numbness, tingling and altered sensation in the foot and toes is common. Weakness of the foot and lower leg — particularly foot drop from L4-5 involvement — indicates significant nerve root compromise.
Symptoms are typically worse with sustained sitting, forward bending, coughing and sneezing — activities that increase intradiscal pressure and tension on the nerve root. Lying down typically eases symptoms. The pattern of aggravating and easing positions is highly diagnostically informative.
Red flags to be aware of
Most sciatica is benign in the sense that it does not represent serious underlying pathology. However, certain presentations require urgent medical assessment: bilateral leg symptoms with saddle anaesthesia (numbness in the inner thighs and perineum), bladder or bowel dysfunction, rapidly progressive leg weakness, and sciatica in the context of fever, unexplained weight loss or a history of cancer are all red flags that require prompt medical evaluation rather than physiotherapy as the first step.
How is it diagnosed?
A physiotherapist will perform a thorough physical examination to diagnose sciatica, including evaluation of the patient's medical history, symptoms, and lifestyle factors. The straight leg raise test — raising the leg with the knee extended to reproduce the patient's leg pain — is the most sensitive clinical test for lumbar nerve root irritation. The slump test assesses neural tension through the entire posterior neurological chain. Dermatomal and myotomal assessment identifies which nerve root level is most affected from the distribution of sensory and motor changes.
Imaging tests such as X-ray, MRI or CT scan may be ordered to identify the underlying cause. MRI is the most informative investigation for lumbar nerve root compression and should be considered when symptoms are severe, progressive or not responding to appropriate conservative management.
How can physiotherapy help?
Sciatica and its symptoms often respond well to a tailored personal exercise plan with a focus on reducing pain and improving tolerance to daily activities and function. No one form of exercise is the answer — the severity and intensity of sciatic symptoms can vary from presentation to presentation, resulting in a need to be flexible with the exercise and rehabilitation plan.
In the acute phase, activity modification, positioning advice — typically extension-biased positions for disc herniation, flexion-biased positions for spinal stenosis — and gentle movement within comfortable limits are the priorities. Neural mobilisation techniques — gentle nerve gliding exercises that promote movement of the sciatic nerve through the lumbar spine and down the leg — reduce neural mechanosensitivity and are a distinctive and highly effective physiotherapy intervention for sciatic nerve irritation.
Manual therapy to the lumbar spine reduces mechanical factors contributing to nerve root irritation and improves mobility. Deep core muscle retraining — multifidus and transversus abdominis — and gluteal strengthening rebuild the active support system that protects the lumbar discs and neural structures from mechanical overload.
Real time ultrasound guides retraining of the deep lumbar stabilisers. Clinical Pilates provides a controlled environment for progressive core and hip strengthening as the acute phase settles. Dry needling assists with pain management and muscle guarding in the lumbar and gluteal region.
For patients whose sciatica arose from a workplace or motor vehicle injury, WorkCover and CTP funded physiotherapy is available.
Our physiotherapists Emma Cameron and Bethany Kippen both have experience in lumbar spine conditions and sciatica management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Sciatica is a term used to describe pain felt along the sciatic nerve, which runs from the lumbar spine down through the buttock, hamstrings and into the lower leg. This can happen on one side or both sides simultaneously. The main nerve roots that contribute to the sciatic nerve travel from the lower back — L4, L5 and S1 — and irritation or compression of these roots causes the severe leg pain characteristic of the condition. The sciatic nerve is the longest nerve in the body.
An important clinical point: sciatica is a symptom, not a diagnosis. It describes the pattern of pain rather than its cause, and identifying the underlying cause is the most important step in management — because the treatment for a lumbar disc herniation compressing the L5 nerve root differs meaningfully from that for piriformis syndrome irritating the sciatic nerve in the buttock, which differs again from spinal stenosis producing neurogenic claudication in an older adult.
What causes sciatica?
Issues such as a herniated disc, spinal stenosis, degenerative disc disease, arthritis, and spondylolisthesis can all cause sciatica — and the course of action to treat each one will vary.
The most common cause is lumbar disc herniation — where the nucleus pulposus of an intervertebral disc pushes through the annular fibres and directly compresses a lumbar nerve root. The L4-5 and L5-S1 levels are most frequently affected, producing symptoms corresponding to the L4, L5 or S1 nerve root distributions respectively. L4 radiculopathy produces symptoms into the anterior thigh and medial shin. L5 produces symptoms into the lateral shin and dorsum of the foot. S1 produces symptoms into the posterior calf, heel and lateral foot.
Lumbar spinal stenosis — narrowing of the spinal canal from degenerative changes — produces a characteristic pattern of bilateral leg pain and heaviness with walking that relieves with sitting and forward bending (neurogenic claudication), most commonly in adults over 60.
Piriformis syndrome — where the piriformis muscle in the buttock compresses the sciatic nerve as it exits the pelvis — produces deep buttock pain with radiation down the posterior thigh, often worse with sitting and hip rotation. It is a peripheral rather than spinal cause of sciatic nerve irritation and is frequently missed when the lumbar spine is assumed to be the culprit.
Spondylolisthesis — forward slippage of one vertebra on the one below — can compress nerve roots at the affected level. Sacroiliac joint dysfunction can refer pain into the posterior thigh and mimic sciatic distribution. Degenerative disc disease and facet joint syndrome are additional spinal contributors.
What are the symptoms?
Sciatica typically produces a combination of lower back and leg symptoms — though the leg symptoms are often more prominent and more distressing. Sharp, shooting, burning or electric pain radiating from the lower back or buttock down the posterior or lateral thigh, calf and into the foot is the classic description. Numbness, tingling and altered sensation in the foot and toes is common. Weakness of the foot and lower leg — particularly foot drop from L4-5 involvement — indicates significant nerve root compromise.
Symptoms are typically worse with sustained sitting, forward bending, coughing and sneezing — activities that increase intradiscal pressure and tension on the nerve root. Lying down typically eases symptoms. The pattern of aggravating and easing positions is highly diagnostically informative.
Red flags to be aware of
Most sciatica is benign in the sense that it does not represent serious underlying pathology. However, certain presentations require urgent medical assessment: bilateral leg symptoms with saddle anaesthesia (numbness in the inner thighs and perineum), bladder or bowel dysfunction, rapidly progressive leg weakness, and sciatica in the context of fever, unexplained weight loss or a history of cancer are all red flags that require prompt medical evaluation rather than physiotherapy as the first step.
How is it diagnosed?
A physiotherapist will perform a thorough physical examination to diagnose sciatica, including evaluation of the patient's medical history, symptoms, and lifestyle factors. The straight leg raise test — raising the leg with the knee extended to reproduce the patient's leg pain — is the most sensitive clinical test for lumbar nerve root irritation. The slump test assesses neural tension through the entire posterior neurological chain. Dermatomal and myotomal assessment identifies which nerve root level is most affected from the distribution of sensory and motor changes.
Imaging tests such as X-ray, MRI or CT scan may be ordered to identify the underlying cause. MRI is the most informative investigation for lumbar nerve root compression and should be considered when symptoms are severe, progressive or not responding to appropriate conservative management.
How can physiotherapy help?
Sciatica and its symptoms often respond well to a tailored personal exercise plan with a focus on reducing pain and improving tolerance to daily activities and function. No one form of exercise is the answer — the severity and intensity of sciatic symptoms can vary from presentation to presentation, resulting in a need to be flexible with the exercise and rehabilitation plan.
In the acute phase, activity modification, positioning advice — typically extension-biased positions for disc herniation, flexion-biased positions for spinal stenosis — and gentle movement within comfortable limits are the priorities. Neural mobilisation techniques — gentle nerve gliding exercises that promote movement of the sciatic nerve through the lumbar spine and down the leg — reduce neural mechanosensitivity and are a distinctive and highly effective physiotherapy intervention for sciatic nerve irritation.
Manual therapy to the lumbar spine reduces mechanical factors contributing to nerve root irritation and improves mobility. Deep core muscle retraining — multifidus and transversus abdominis — and gluteal strengthening rebuild the active support system that protects the lumbar discs and neural structures from mechanical overload.
Real time ultrasound guides retraining of the deep lumbar stabilisers. Clinical Pilates provides a controlled environment for progressive core and hip strengthening as the acute phase settles. Dry needling assists with pain management and muscle guarding in the lumbar and gluteal region.
For patients whose sciatica arose from a workplace or motor vehicle injury, WorkCover and CTP funded physiotherapy is available.
Our physiotherapists Emma Cameron and Bethany Kippen both have experience in lumbar spine conditions and sciatica management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
