Sciatica Pain: What Physical Therapists Recommend to Feel Better

When it comes to sciatica, the phrase hitting a nerve definitely applies. That’s because sciatica refers to symptoms of pain, as well as numbness or weakness, that’s felt along your sciatic nerve, which runs from your lower spine all the way down to your feet and toes. 

Sciatica is very common — as many as 40% of people will experience it at some point in their lives — but there are things you can do that can be very helpful for managing this nerve issue. In particular, exercise and physical therapy can do a lot to relieve sciatica symptoms and improve your quality of life. 

“I actually cancelled my surgery because of the progress I’ve made — I no longer have sciatica pain,” one Hinge Health member recently told us. Another member shared that since working with a physical therapist their “pain and sciatica has greatly improved. It's more like periodic stiffness and minor discomfort.”  

Read on to learn more about sciatica — its symptoms, causes, and treatment options — as well as how to keep it from getting on your nerves with exercises recommended by our Hinge Health physical therapists. 

What Is Sciatica?

Sciatica refers to pain from irritation or injury of the sciatic nerve, the longest and thickest nerve in your body. The sciatic nerve isn’t a single nerve — it’s actually a bundle of nerve roots that branch off from the base of your spine to form the sciatic nerve. All the roots on the left side combine to form your left sciatic nerve; all the roots on the right side form the right sciatic nerve. 

Each nerve then travels from your lower back, through your buttocks (glutes), and down the back of each leg. Once it reaches just below your knee, it splits into other nerves that connect to your lower leg, feet, and toes. Along this pathway, the nerves control movement and sensation of the leg. 

With sciatica you can experience mild to severe pain anywhere along its path where there are nerves that connect to the sciatic nerve. This is why it can feel different for everyone. 

“Think about it like Christmas tree lights,” says Samantha Stewart, PT, DPT, a physical therapist at Hinge Health. “If one light or part of the strand has a short, it can affect only that area or it can have a trickle-down effect, causing issues all along the chain. The sciatic nerve is much the same.”  And while sciatica symptoms can come from anywhere along the path of the sciatic nerve, just like fixing one bulb on Christmas lights or working out a knot in the wiring can restore light, there are many small changes that can improve your sciatica symptoms. 

Sciatica: A Hinge Health Perspective  

One of the biggest myths about sciatica is that rest is best for healing. Scaling back on activity for a day or two when the pain is most intense is often advised, but getting moving is a step toward getting rid of your pain, Dr. Stewart explains. “Movement can change how you experience pain and how you move through it by reducing contributing factors like muscle tension in tissues,” she says.

On the other hand, lack of movement can contribute to factors that heighten pain, including increased muscle tension that can irritate sensitive nerves, causing more discomfort.

If you’re reluctant to move because you think you’ll worsen your sciatica symptoms, ease back into movement with what the Hinge Health care team calls “movement snacks.” 

“Sometimes all I tell people to do is walk around the house for a few minutes because that will stretch out the affected area and release tension on the nerve,” says Dr. Stewart. So no matter how you get moving, even if it’s a little bit at a time as you ramp back up, it will help your sciatica symptoms.

Symptoms of Sciatica

Sciatica can occur with any of these symptoms, anywhere along the sciatic nerve: 

• Pain. Sciatic pain can vary from a mild ache to a sharp, shooting pain. It’s often described as an “electric shock” traveling down the leg. (Indeed, that type of pain is a tip-off for nerve irritation or inflammation.) The classic presentation is that the pain radiates along the same pathway as the nerve, so people with sciatica often develop a pain that starts in their lower back or butt and radiates down the leg on the affected side. Areas like the back of the calf, the knee, and the foot — by themselves or in combination with another area — can also be affected. Depending on the location of the irritated nerve, your symptoms may worsen when you move forcefully and suddenly, such as when you twist, cough, or sneeze.

• Tingling. A “pins and needles” sensation, similar to the feeling you have when your leg falls asleep. 

• Numbness. One part of the leg can be in pain, while another can have a complete or partial loss of feeling. 

Everyone’s experience with sciatica is different. “You can have one symptom or all of them, and you can have them anywhere along the nerve’s path or in an area that the nerve has an effect on,” says Dr. Stewart. “You also don’t have to have pain, so if you only have numbness and tingling, it could still be sciatica.” In short, there’s no one-size-fits-all experience for how sciatica feels or where you might feel it.

Common Causes of Sciatica

Sciatica is typically linked to inflammation of the nerve without any nerve compression. “Inflammation can happen in any part of the sciatic nerve and in many different ways, but it comes down to the same thing: the nerve is irritated and hyper-sensitive,” explains Dr. Stewart. 

Sciatica may also be linked with nerve compression when there is weakness in the legs or a loss of sensation. The good news: There’s a lot you can do to manage symptoms and get relief, regardless of which factors may be contributing. Here are some of the most common reasons you may experience sciatica:

• Disc changes: Changes to the intervertebral discs, which serve as cushions between the vertebrae (bones) in the spine, can lead to conditions that cause sciatica symptoms. Conditions such as herniated discs, degenerative disc disease, spinal stenosis, and bone spurs can all irritate sciatic nerves. 

• Piriformis muscle issues. The piriformis muscle is a small, band-like muscle located in the buttocks, near the top of the hip joint. When the piriformis muscle becomes inflamed, it can irritate or compress the nearby sciatic nerve. This can lead to pain in the buttocks and muscle spasms, as well as numbness, tingling, and pain down the back of the leg and into the foot. These symptoms are sometimes referred to as “piriformis syndrome,”  but there’s actually some debate about whether this is different from sciatica. 

• Sitting too much. If you are sitting too much and too often, you might have a higher risk of developing sciatica when the inactivity is coupled with other factors, like extra weight, tense muscles, chronic stress, and low physical fitness. These can all play a role in creating more inflammation around the sciatic nerve.

Treatment Options for Sciatica Pain

Most cases of sciatica resolve within a few weeks, but you can help speed recovery, decrease pain, and increase mobility with these self-care treatment options: 

• Ice and heat therapy. “I tell people to go with what feels right for them because the causes of sciatica can vary,” says Dr. Stewart. For instance, if your symptoms stem from a tight muscle putting pressure on the nerve, heat will help relax the muscle fibers. If your symptoms are due to swelling in the area from an injury, ice will help decrease inflammation. 

• Medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for sciatica pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Physical therapy. “The goal of working with a physical therapist (PT) is not only to help you understand what’s going on with your body and to feel better, but to also help you feel equipped to deal with it on your own,” says Dr. Stewart. To help treat sciatica, a PT will teach you exercises that reduce irritation or pressure on the sciatic nerve, as well as targeted moves to strengthen your muscles and improve muscle flexibility. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Most nerve pain resolves within three months, but you might consider consulting your doctor if you’re not seeing progress, or you want more guidance. While uncommon, if you have progressive weakness in the leg(s), loss of sensation in the genital area, or an inability to pass urine, it is important to seek urgent medical attention.

Movement is medicine is the mantra of our healthcare team and why Hinge Health members, including those with sciatica, attest that exercise therapy makes a big difference in their ability to get back to their lives. “I have been having less sciatica pain and my movements are now less painful,” said one Hinge Health member, who credited the change to daily stretching. 

The above exercises are recommended by our PT team to help with sciatica-related pain. Keep in mind that even if you have some discomfort with movement, it’s usually still safe to stay active. As long as you don’t push past unacceptable levels of pain for you, you should feel confident moving, stretching, and strengthening your body. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Stick With the Program

With sciatica pain, it’s important to ease into movement when you’re feeling pain. But once the pain has subsided, don’t just stop your exercises. Work the above moves into a weekly routine so that you can keep the nerve happy and help prevent future episodes of sciatica, advises Dr. Stewart. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Sciatica Treatment. (n.d.). Body Logic. Retrieved from https://bodylogic.physio/conditions/sciatica-treatment/. 

2. Sciatica. (2023, May 21). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12792-sciatica

3. Sciatica. (n.d.). Hospital for Special Surgery. Retrieved from https://www.hss.edu/condition-list_sciatica.asp. 

4. Atlas, S. J. (2017, July 12). Taming the pain of sciatica: For most people, time heals and less is more. Harvard Health. https://www.health.harvard.edu/blog/taming-pain-sciatica-people-time-heals-less-2017071212048