Sciatica can stop you in your tracks, but most cases get better without surgery. Here is what causes it, how physical therapy helps, and which warning signs need a doctor right away.
Sciatica is a common reason people visit a physical therapist. It often starts as a deep ache in the buttock that shoots down the back of the leg. Some people also feel burning, tingling, or numbness in the calf or foot.
The good news is that most cases of sciatica improve with time and the right kind of movement. This guide explains what sciatica is, what causes it, how a physical therapy plan works, and when you should see a doctor right away.
What Is Sciatica?
Sciatica is not a diagnosis by itself. It is a name for symptoms caused by an irritated nerve root in the low back, or the sciatic nerve along its path. The sciatic nerve is the largest nerve in the body. It forms from nerve roots in the lower spine and runs down the back of each leg.
When something presses on or inflames those nerve roots, you can feel symptoms anywhere along the nerve. Common signs include:
- Pain that travels from the low back or buttock down one leg, often past the knee
- Burning, tingling, or "pins and needles" in the leg or foot
- Numbness or a weak feeling in part of the leg
- Leg pain that is often worse than the back pain
Sciatica usually affects one leg. Symptoms in both legs need a closer look by a clinician.
Common Causes of Sciatica
Disc herniation
This is the most common cause, especially in adults under about 50. The discs between your vertebrae have a tough outer ring and a softer center. If part of a disc bulges or pushes out, it can press on a nearby nerve root and cause inflammation. Disc-related sciatica often feels worse with sitting, bending forward, coughing, or sneezing.
Spinal stenosis
Stenosis means narrowing. As we age, joint changes and thickened ligaments can narrow the spaces where nerves exit the spine. This is more common after age 60. People with stenosis often feel leg pain or heaviness when they stand or walk for a while, and relief when they sit or lean forward, such as on a shopping cart.
Piriformis-type irritation
Sometimes the sciatic nerve is irritated deep in the buttock, near the piriformis and other hip muscles. This is sometimes called deep gluteal or piriformis syndrome. Symptoms may get worse with long sitting or certain hip positions.
Less common causes include a slipped vertebra (spondylolisthesis), pregnancy-related changes, injury, and, rarely, infection or tumor. That is why red flags, covered below, are so important.
Why Most Sciatica Improves With Conservative Care
Research and clinical guidelines agree that most people with sciatica get better without surgery. Inflammation around the nerve tends to calm down over time. In many cases, the body can even reabsorb part of a herniated disc.
Conservative care means treatment without surgery. It includes staying active, physical therapy, and medicine your doctor recommends. Surgery is usually considered for people with serious or worsening nerve problems, or those who do not improve after a fair trial of conservative care.
What a Physical Therapy Evaluation Includes
Your first visit finds what is driving your symptoms. A typical evaluation includes:
- Your story: when symptoms started, where you feel them, and which positions and activities change them.
- Screening for red flags: questions to make sure you do not need urgent medical care first.
- Movement testing: how your back and hips move, and how repeated movements affect your leg symptoms.
- Nerve checks: strength, reflexes, and feeling in your legs, plus tests of how well the nerve tolerates stretch.
- Hip and core assessment: strength, flexibility, and control around the pelvis.
From there, your therapist builds a plan that fits you. If anything in the exam suggests another problem, they will refer you to a physician.
How Physical Therapy Treats Sciatica
Directional preference exercises
Many people find that moving in one direction eases their leg symptoms. For example, gentle back-bending (extension) movements help some people with disc-related sciatica. Others with stenosis feel better with forward-bending (flexion) positions. A good sign is "centralization": pain moving out of the leg toward the back. Your therapist will help you find your direction and use it at home.
Nerve mobility exercises
Nerves need to slide and glide as you move. Gentle "nerve flossing" or nerve glide exercises help the sciatic nerve move more freely and can reduce sensitivity. They should never cause sharp or lasting pain.
Core and hip strengthening
As symptoms calm, strengthening becomes the focus. Work on the deep core, glutes, and hip muscles helps support your spine and spread out load. This may help reduce future flare-ups.
Activity modification
You do not have to stop everything. Your therapist will help you adjust how long you sit, how you lift, how you sleep, and how you return to walking, work, and exercise. The goal is to stay as active as possible without stirring up symptoms.
Manual therapy
Hands-on techniques such as joint mobilization and soft tissue work can ease pain and stiffness in the short term. They work best alongside exercise, not as a replacement for it. At our Fair Lawn, Lyndhurst, and Caldwell clinics, dry needling may also be an option for tight, sensitive muscles when your therapist thinks it fits your plan.
What to Avoid With Sciatica
- Long bed rest. Staying in bed for days can slow recovery. Short rests are fine.
- Sitting for long stretches. Get up and move every 20 to 30 minutes if sitting makes symptoms worse.
- Pushing through hard stretches. Aggressive hamstring stretching can irritate the nerve more.
- Heavy lifting and twisting during a flare. Keep loads light and close to your body.
Home Tips for Sciatica Relief
- Take short, easy walks several times a day if walking feels okay.
- Try heat or ice for 15 to 20 minutes, whichever feels better.
- Sleep on your side with a pillow between your knees, or on your back with a pillow under your knees.
- Use a small rolled towel behind your low back when you sit.
- Do the exercises your therapist gives you, a little at a time, every day.
For more on easing back pain at home and in the clinic, read our guide to lower back pain relief.
When to see a doctor right away
Go to the emergency room or call 911 if you have:
- Numbness in the groin, inner thighs, or buttocks ("saddle" numbness)
- New trouble controlling or emptying your bladder or bowels
- Leg weakness that is getting worse, or foot drop
- Sciatica symptoms in both legs that come on suddenly
See your doctor promptly if back or leg pain comes with fever or chills, unexplained weight loss, a history of cancer, a weakened immune system, or follows a major fall or accident.
Getting Started
You can schedule physical therapy, occupational therapy and speech therapy directly. Some insurance plans require a referral for coverage; our staff will verify your benefits. Learn more on our insurance page.
Holsman Physical Therapy & Wellness has 17 clinics across New Jersey and New York, including Newark, Fair Lawn, and Lyndhurst. If getting to a clinic is hard during a flare, ask about in-home therapy. Call 1-855-465-7626 or contact us to book an evaluation.
Frequently Asked Questions
How long does sciatica usually last?
Many people feel clearly better within a few weeks to a few months. How fast you improve depends on the cause, how irritated the nerve is, and how active you can stay. A physical therapist can track your progress and adjust your plan if you stall.
Should I rest in bed when I have sciatica?
Short rest during a bad flare is fine, but long bed rest is not recommended. Gentle movement and staying as active as you comfortably can usually lead to a faster recovery than lying down for days.
Can physical therapy help sciatica from a herniated disc?
Yes. Most disc-related sciatica is first treated with conservative care, and physical therapy is a core part of that. Treatment often includes movements that ease leg symptoms, nerve mobility work, and strengthening to protect your back.
Do I need a referral to see a physical therapist for sciatica?
You can schedule physical therapy, occupational therapy and speech therapy directly. Some insurance plans require a referral for coverage; our staff will verify your benefits.
When is sciatica an emergency?
Go to the emergency room if you have numbness in the groin, inner thighs or buttocks, new trouble controlling your bladder or bowels, or leg weakness that is getting worse. Fever, a history of cancer, or pain after a major fall also need prompt medical care.
This article is for general education and isn't a substitute for an evaluation by a licensed clinician.