Low Back & Pelvis

What It Is

Sciatica is nerve pain that travels down the back of the leg. It is less commonly known as sciatic neuritis, lumbar radiculopathy or sciatic neuralgia. Symptoms can include pain in the lower back and/or buttock, as well as pain, weakness and/or numbness in parts of the leg and foot. Some people feel tingling or pins and needles in the foot or leg, or a sharp, burning pain down the back of the leg (NHS, 2024). It usually affects one side and may or may not spread below the knee.

Sciatica can sometimes occur without much back pain, and simply show up as pain or pins and needles in the leg (NHS, 2024).

Sciatica Anatomy

The sciatic nerve is the longest and largest nerve in the body. At its widest it is about 2cm across, roughly the width of a thumb (Adibatti and Sangeetha, 2014).

The sciatic nerve begins in the lower back, as nerve roots leave the spinal cord through the gaps between the bones of the lower (lumbar) spine and the sacrum. The nerve then extends the entire length of the leg and into the foot.

The sciatic nerve is made up of five nerve roots: L4 and L5 from the lower back, and S1, S2 and S3 from the sacrum (Adibatti and Sangeetha, 2014).

The sciatic nerve travels down the back of the leg and branches out to different parts of the leg, providing feeling and muscle control all the way down to the foot.

Common Causes of Sciatica

Disc prolapse – a "slipped disc" is the most common cause of sciatica (NHS, 2024), accounting for up to 85% of cases (Bharadwaj et al., 2023). As the disc bulges or prolapses backwards, it can press on a nerve root, sending pain down the back of the leg.
Spinal stenosis – narrowing of the part of the spine where the nerves pass through (NHS, 2024).
Spondylolisthesis – a slippage of one of the bones of the spine (usually forwards), which can pinch the nerve or narrow the spinal canal (NHS, 2024).
Piriformis syndrome – less commonly (around 6 to 8% of cases), the sciatic nerve can become compressed near the piriformis (buttock) muscle (Bharadwaj et al., 2023).
Space occupying lesion – rarely, something taking up space around the nerve, such as a tumour or cyst, can cause sciatica (Bharadwaj et al., 2023).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Sciatica

There are ways to manage sciatica at home. However, because these symptoms could also be caused by a different medical condition, you should always get them checked out. Sciatica usually gets better in a few weeks to a few months (NHS, 2024), and most people improve without surgery (AAOS, n.d.).

Medicines: ask a pharmacist about painkillers. The NHS notes that paracetamol is unlikely to help, and it is not clear how much anti-inflammatory medicines such as ibuprofen help with sciatica (NHS, 2024). (This medicine information comes from the NHS website, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)
Heat or ice: holding heat packs to the painful area can help (NHS, 2024), and some people find gentle cold soothing (AAOS, n.d.). Always wrap ice or heat in a towel to prevent a burn. I can show you how long to use them.
If your pain is severe, you may need to take things a little easier for a short time, but try to carry on with your normal activities as much as possible, and avoid sitting or lying down for long periods (NHS, 2024).
Take care with heavy lifting, and use a safe lifting technique (NHS, 2024).
Some people find that bending forwards aggravates their sciatica. If this is the case for you, I can help you work out whether limiting bending might help (AAOS, n.d.).
Start gentle exercise as soon as you can; regular exercises and stretches for sciatica can help your recovery (NHS, 2024).
Physiotherapy, including exercise advice and hands-on (manual) therapy, can help (NHS, 2024). UK guidance recommends manual therapy only as part of a treatment package that includes exercise (NICE, 2016). I combine hands-on treatment with exercise in the same way, and can add gentle nerve glides. See the My Approach tab for how I work.
If your pain has not improved after a few weeks of home treatment, is getting worse or is stopping you doing normal activities, see your family doctor or nurse practitioner (NHS, 2024). Scans such as MRI are only needed in some cases, when the result would change your treatment (NICE, 2016).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope:

If your pain is severe and other treatments have not helped, you may be referred to a hospital specialist for (NHS, 2024):

A painkilling injection, such as an epidural, into the spine.
Radiofrequency denervation, a procedure to seal off some of the nerves in the back so they stop sending pain signals.
Decompression surgery, an operation to relieve pressure on the nerve.

How I can help (see the My Approach tab)

Hands-on work for the back, buttock and leg muscles

Gentle nerve glides and symptom-guided movement

An exercise programme and a graded return to activity

Tips

Avoid sitting for long periods – get up and move around regularly (NHS, 2024).
Check with me whether forward bending is OK for you – you may need to be cautious leaning over a sink to wash your face, bending to pick objects up from the floor, reaching across a table, or making the bed.
Do move. Exercise usually helps (NHS, 2024).
Do go to work. Returning to normal day-to-day activities and routine can help (NICE, 2016).
Do cycle and swim as part of your rehabilitation, under guidance from your doctor or from me.
Minimise heavy lifting.
Be careful running – some people find it makes their symptoms worse.
Don't smoke – smoking can increase your risk of getting sciatica (NHS, 2024).

Treatment

My Approach

Sciatica usually comes from an irritated nerve root in the low back, and less often from tight muscles deep in the buttock. My aim is to ease the pain, keep you moving and help the nerve settle, while watching for any sign that you need medical care first.

I start by assessing how your back and hips move and screening the nerve: sensation, reflexes and strength in your legs, and how your symptoms respond to movement. That tells us which path you're on.

If It's Mild

Leg pain, tingling or pins and needles without weakness or worsening numbness is something I can treat directly.

Hands-on work for tight or guarding muscles in the low back, buttock and leg, keeping pressure off the nerve
Warm or cool applications in the clinic, and I'll show you how to use heat or ice at home
Finding positions and movements that ease your symptoms: if leg pain moves back toward your spine, we're heading the right way
Gentle nerve glides within comfort, with a home version
Walking, trunk and hip strength, and a graded return to lifting, running and sport

If It's More Severe

Weakness in the leg or foot, or numbness or other nerve symptoms that are getting worse, need to be checked by your family doctor or nurse practitioner first. Then I can support their plan with gentle hands-on work for the back and hips, comfortable positions and gentle movement, building up as your care team allows. After back surgery, I need your surgeon's okay before any hands-on treatment.

Any work on the buttock and hip needs your informed consent and a signed consent form. Tell me straight away if treatment brings on numbness or tingling below the knee. Numbness around your genitals or bottom, or bladder or bowel changes, mean calling 911 (see When to Get Urgent Help).

What to Expect

Typical Course

Typical course: For mild sciatica, most people come once or twice a week at first, then weekly, then every few weeks as you manage more on your own, with a reassessment at about 4 to 6 weeks; it usually gets better within a few weeks to a few months. For more severe sciatica, visits and timeline follow your medical team's plan, and recovery can take longer.

What I Focus On

Nerve Screening

Symptom-Guided Movement

Gentle Nerve Glides

Back & Hip Release

Return to Activity

Please read

When to See a Doctor First

When to Get Urgent Help

Call 911 or go to the emergency room at your nearest hospital if you have sciatica on both sides; weakness or numbness in both legs that is severe or getting worse; numbness around or under your genitals, or around your bottom (anus); difficulty starting to pee, being unable to pee or control when you pee; or not noticing when you need to poo or being unable to control it (NHS, 2024). These can be signs of a serious back problem that needs hospital treatment as soon as possible.

Sources

References

Adibatti, M. and Sangeetha, V. (2014) 'Study on variant anatomy of sciatic nerve', Journal of Clinical and Diagnostic Research, 8(8), pp. AC07–AC09. doi: 10.7860/JCDR/2014/9116.4725
American Academy of Orthopaedic Surgeons (n.d.) Sciatica. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/sciatica/ (Accessed: 7 October 2026).
Bharadwaj, U.U. et al. (2023) 'Variant sciatic nerve anatomy in relation to the piriformis muscle on magnetic resonance neurography: a potential etiology for extraspinal sciatica', Tomography, 9(2), pp. 475–484. doi: 10.3390/tomography9020039
NHS (2024) Sciatica. Available at: https://www.nhs.uk/conditions/sciatica/ (Accessed: 7 October 2026).
National Institute for Health and Care Excellence (2016, updated 2026) Low back pain and sciatica in over 16s: assessment and management (NICE guideline NG59). Available at: https://www.nice.org.uk/guidance/ng59/chapter/Recommendations (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooSciatica

What It Is

Sciatica Anatomy

Common Causes of Sciatica

Self-Care & Treatment

How to Treat Sciatica

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's Mild

If It's More Severe

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooSciatica

What It Is

Sciatica Anatomy

Common Causes of Sciatica

Self-Care & Treatment

How to Treat Sciatica

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's Mild

If It's More Severe

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Cervical Disc Herniation

Degenerative Disc Disease (DDD)

Disc Herniation

Leg Length Discrepancy

Book a session