Sciatica pain: what actually helps, and what to skip
A sharp line of pain, numbness or tingling running from the lower back down one leg. It gets worse sitting or coughing, and often eases when you walk or lie flat. Most of the time it settles without surgery — but 'rest' and 'movement' aren't interchangeable, and knowing which one you need is the whole game.
What sciatica actually is
Sciatica isn't a separate disease. It's a description: your sciatic nerve is being irritated somewhere along its route, usually where the disc presses on the nerve root in the lower back. The pain doesn't have to be dramatic to qualify. A dull ache below the knee, tingling in the toes, or a leg that feels slightly weaker than the other can all be it.
The useful thing to know is that nerve irritation is partly mechanical and partly sensitised. The disc can be pinching the nerve, yes. But the nervous system also turns the signal up, so what started as a minor irritation starts feeling like a fire alarm. Treating only the disc and ignoring that amplification is why so many people feel better for a week and then slide straight back.
The three things that actually move it
- 1Positional control. You need to find the positions that calm the nerve and learn to spend more time in them. This is genuinely different person to person, which is why the generic 'avoid all bending' advice so often backfires.
- 2Nerve mobility work. Small, repeated movements that teach the nerve to glide instead of catching. Done at the right dose this is one of the most effective things we have. Done aggressively and badly it makes a flare worse, which is why the dose has to be assessed rather than guessed.
- 3Core and hip loading, in stages. The back doesn't get irritated because you're weak in general. It gets irritated because certain movements load the disc in a direction it can't handle. You strengthen the muscles that change that load path, not everything at once.
What usually makes it worse
- Two weeks of complete rest. A disc that isn't being gently loaded stays stiff, and the surrounding muscles switch off faster than they recover.
- Repetitive heavy end-range flexion. Reaching for something on the floor with a rounded back, every day, for years, adds up to far more than any single lift.
- Long stretches in one position. Sitting through a whole workday on a soft sofa is a bigger driver of flare-ups than most people's exercise habits ever are.
- Bouncing back to the same movement that caused it. If lifting your child from the floor was the trigger, you don't learn to lift your child from the floor faster. You change the movement.
How long does it take?
Most mechanical sciatica with no neurological deficit settles over 4 to 6 weeks of structured work, with the leg symptoms usually improving before the back does. Some people see the worst of it inside a week once the positioning changes. If it hasn't shifted meaningfully after a month of proper assessment and a real plan, that's worth re-evaluating rather than extending the same plan.
Numbness or weakness that's getting worse, loss of bladder or bowel control, saddle numbness around the groin, or severe pain after a fall or accident. These need medical assessment, and if you're unsure it's always better to be seen sooner.
None of this is a substitute for your own assessment. Sciatica presents differently enough person to person that a plan written for a stranger is usually wrong. If you want it looked at properly rather than guessed at, the clinics are listed below.
Still not sure it's a physio case?
The articles here are general guidance, not your specific case. If you're unsure whether to go to physio, get it looked at properly rather than guessed at.