How can I tell if my pain is from sciatica?

Sciatica usually follows a line from the low back or buttock down the back or side of one leg, sometimes into the calf or foot, and may come with tingling, numbness or weakness. Pain that stays in the back, or a sore spot in the buttock that never travels, is usually something else. A physical therapist or physician can sort it out by testing strength, sensation, reflexes and how your leg symptoms respond to movement.

Does sciatic nerve pain go away?

Often, yes. MedlinePlus notes that sciatica frequently gets better on its own, but it commonly comes back. Physical therapy aims to ease the current episode and leave you with a plan for handling the next one.

What are some signs that sciatica is improving?

The clearest sign is symptoms retreating from the foot and calf toward the buttock or back, even if back pain briefly increases. Being able to sit, walk and sleep longer before symptoms start is another good sign. Weakness or numbness that is getting worse is not improvement and needs a physician.

Is it okay to stretch with sciatica pain?

Sometimes, but not every stretch suits an irritated nerve. A hard hamstring stretch, for example, can pull on the sciatic nerve and flare symptoms. If a stretch sends symptoms farther down your leg or leaves you worse afterward, stop and have the movement checked.

What is piriformis syndrome?

Piriformis syndrome is a pain problem involving the piriformis, a narrow muscle deep in the buttock near the sciatic nerve. It can cause buttock pain with symptoms down the leg, a pattern the lower back can also produce. That's why we check the spine first, then treat the hip and buttock directly if that is where the problem is.

Sciatica Physical Therapy in Buffalo, NY | Lake Erie Physical Therapy

Sciatica describes a route, not a cause. Pain, tingling or numbness starts in the low back or buttock and travels down the back or side of the leg, sometimes into the calf or the sole of the foot. Good sciatica physical therapy starts by working out what is irritating the nerve, because a disc, a narrowed spinal canal and a tight muscle deep in the buttock can all produce leg symptoms that feel alike. At Lake Erie Physical Therapy in Buffalo, that question shapes the first visit, and the answer decides which sciatica treatments make sense for you.

Check these warning signs first

Most sciatica settles with conservative care. A few symptoms, though, mean you should see a physician or go to an emergency department before starting physical therapy:

Loss of control of your bladder or bowels, or new numbness between your legs or around your genitals
Weakness or numbness in the buttock, thigh, leg or pelvis, especially if it is getting worse
Fever with back pain, or redness or swelling over the spine
Back pain after a severe fall or blow
Pain that is worse lying down, wakes you at night, or is so severe you can’t get comfortable
Unintentional weight loss, a history of cancer, steroid use or injected drug use

MedlinePlus also advises contacting a provider if an episode lasts longer than 4 weeks or feels different and worse than past episodes. Physical therapy does not replace a medical diagnosis. If your exam turns up something that needs one, we’ll send you to your physician.

Where the leg pain is coming from

MedlinePlus lists these common causes of sciatica:

A herniated or slipped disc. Symptoms often get worse with sitting, coughing, sneezing or straining. Our herniated disc page covers this in detail.
Spinal stenosis. Symptoms tend to build with walking more than a short distance or bending backward.
Piriformis syndrome, a pain problem involving a narrow muscle deep in the buttock that lies close to the sciatic nerve.
Spondylolisthesis, pelvic injury and, rarely, tumors.

Piriformis syndrome gets plenty of attention online, but the lower back can produce the same buttock-and-leg pattern. That’s why we test the spine first. If back movements don’t change your leg symptoms and the exam points to the hip and buttock, physical therapy for piriformis syndrome focuses on that region directly, with targeted exercise and hands-on work.

What sciatica physical therapy looks like, step by step

A detailed history. Where your symptoms reach today compared with last week, what sitting, walking and bending do, and how you’re sleeping.
A nerve check. Strength, sensation and reflexes in both legs, plus nerve tension tests. Most people don’t need imaging to start; MedlinePlus notes that tests are often unnecessary unless pain is severe or long-lasting.
Repeated movement testing. Using the McKenzie Method (MDT), you’ll repeat specific back movements while we watch your leg symptoms. If they retreat toward your spine (centralize), we’ve likely found your direction. If they spread farther down the leg, we stop and try another.
A short home program. One or two movements done at regular intervals through the day. APTA’s guide to sciatica stresses that the exercises your therapist found reduce your leg pain are the important ones to keep doing.
Progression. As leg symptoms settle, we add trunk and hip strengthening, walking and lifting practice. The 2021 low back pain guideline supports trunk strengthening and endurance exercise for recent back pain with leg pain, and it lists MDT among reasonable classification approaches.
Hands-on care when it helps. Manual therapy can make movement easier, but your own exercises do most of the work.

Between visits: what helps and what usually doesn’t

Keep moving. MedlinePlus says bed rest is not recommended. Short walks several times a day are a better bet than lying still.
Skip heavy lifting and twisting for the first 6 weeks after the pain begins.
Watch where symptoms go after a movement, not only how much it hurts. Symptoms retreating toward your back is progress. Symptoms spreading toward your foot means stop.
Break up long sitting, and choose a firm chair over a soft couch.
Use ice or heat for comfort. MedlinePlus suggests ice for the first 48 to 72 hours, then heat.

Starting care

With most plans, you can start physical therapy in New York without a referral for up to 10 visits or 30 days, whichever comes first, though some plans still require one to pay. Medicare patients don’t need a referral to start; your physician certifies the plan of care. If the pain runs into your arm instead of your leg, read about pinched nerves in the neck.

Leg pain that keeps interrupting your sleep or your workday deserves a proper look. Call (716) 332-4838 or request an evaluation online, and bring any imaging reports you have.

Sources

Written by the Lake Erie Physical Therapy clinical team. This page is general information, not a diagnosis; your physical therapist will assess your situation in person.

Physical Therapy for Sciatica