Sciatica: Causes, Symptoms & Exercises

Sciatica Explained by a Chiropractor

If you're struggling with sciatica, you know how exhausting it can be. The pain shooting down your leg, the sleepless nights, the frustration of not being able to sit comfortably or enjoy the activities you used to take for granted. Even simple things like getting dressed, driving to work or playing with your children can become a challenge.

And perhaps the most frustrating part is not knowing when it's going to get better, or what you can do to help yourself.

In nearly two decades of treating patients as a chiropractor at Active Health Chiropractic Clinic in Portsmouth, I've helped hundreds of people dealing with sciatica. I understand how much it can affect your life, and I want to help you find a way forward.

In this guide, I'll explain what's happening in your back, why you might be experiencing pain and what you can do to start taking control of your recovery — so you can get back to living your life with less pain and more confidence.

What Is Sciatica?

Sciatica is more of a general term used to describe pain caused by irritation of the sciatic nerve, or more commonly, the smaller nerves that join together to form it.

Think of it like a road network. The smaller roads are the nerves that come from the low back. They join up in the buttock to make the sciatic nerve (like the motorway).

What Are The Common Symptoms Of Sciatica?

Sciatic pain can be felt almost anywhere in the leg and even the foot. It is most commonly only in one leg but can be both. The most common symptoms include:

• Sharp shooting pain into the buttock or leg
• Aching into the buttock, hamstring or calf
• Burning or deep nerve pains
• Tingling, pins and needles, or numbness
• Heaviness in the legs
• Weakness in leg or foot muscles (more severe cases)
• Pain worse with sitting or driving
• Pain triggered by bending, coughing, sneezing or lifting

Not everybody will experience all of these symptoms and severity can vary widely.

The most common ‘classic’ pain patterns I see in clinic are:

• Buttock → back of thigh → calf
• Buttock → outside of thigh → shin or top of foot

Sciatic pain vs hamstring or gluteal muscle pain

It’s quite common for people to feel like they may have a simple muscle pull or strain rather than sciatica, especially in the early stages. The common differences are:

• Muscle pains are generally localised and easy to feel where the injured muscle is
• Nerve pains are harder to put your finger on
• Muscle pains won’t normally have any of the associated nerve symptoms (pins and needles, numbness, tingling, pain on coughing etc.)
• Sciatica is often painful when sitting
• Sciatica often has no obvious reason for starting (more on this shortly)
• Muscle strains normally start to improve within days or weeks

Other Problems That Get Mistaken For Sciatica

Not all leg or low back pain is sciatica, and getting this wrong sends people down the wrong treatment path. Three things I regularly see mislabelled:

• Sacroiliac joint pain — centred around the dimple at the back of the pelvis and often felt in the buttock and upper thigh, but rarely below the knee and without true nerve symptoms.
• Mechanical low back pain — can refer into the buttock and feel widespread, but there is no nerve involvement and it tends to move around rather than following a set line down the leg.
• A lumbar disc bulge — a disc can cause back pain and stiffness on its own, with no leg symptoms at all. That is still a disc problem, but it is not sciatica.

If you are not sure which one fits you, the pattern is usually the giveaway. Nerve pain follows a line down the leg. Joint and muscle pain tends to spread.

What Causes Sciatica? (Most Common Reasons)

Sciatica isn’t one single thing — it’s a symptom caused by anything that irritates or pinches the nerves along its pathway. One of the most important things I do in clinic is help people understand what is causing their sciatica, as different causes need slightly different strategies.

Here are some of the most common causes:

Disc bulge or herniation

This is the most common cause I see in clinic, and the NHS also lists a slipped disc as the most common cause of sciatica. A disc can irritate a nerve in the low back, causing symptoms to travel down into the leg.

Spinal Stenosis (also linked with neurogenic claudication)

This is a type of sciatica that I see more commonly in patients over 70. Stenosis basically means narrowing, and relates to narrowing of the gaps where the nerves come out of the spine. When somebody is suffering with sciatic pain due to spinal stenosis, it is also known as neurogenic claudication.

This often happens when the spine starts to develop:

• Arthritic changes
• Bony spurs
• Thickening of the ligaments inside the spinal canal
• Disc degeneration

Stenosis-related sciatic pain is normally worse with walking and standing, and relieved with sitting and bending forward.

If that pattern sounds like yours, read my full guide to spinal stenosis, where I go into the walking strategies and the flexion-based exercises that suit this group.

Piriformis Syndrome

The piriformis is a muscle in the buttock. Tightness in this muscle can put pressure on the sciatic nerve, causing sciatica.

In my experience a true piriformis syndrome is far less common than a disc-related problem, despite how much attention it gets online.

That said, if your pain is mostly buttock-based and eases off with gentle hip stretching, the piriformis stretch is a sensible place to start.

Lifestyle and Overload Factors (often the cause of flare-ups)

Even with the above potential causes, sciatica flare-ups are often triggered by:

• Prolonged sitting
• Repetitive bending or twisting
• Poor sleep, stress, or poor general health
• A sudden increase in training or activity
• Lack of muscle strength or flexibility

This is why many patients do not know what has caused the problem. Usually something is gradually building up in the background such as a disc bulge. It is then pushed over the edge by one or several of the above factors, leading to inflammation and nerve irritation.

What Tends To Make Sciatica Worse?

Sciatic flare-ups are often predictable once you start spotting the trends. Here are the things to look out for:

1. Prolonged Sitting: Make Your Workspace Work For Your Back

If you have a disc bulge, sitting for long periods can make your back pain worse. Whether you're commuting, working at a desk or relaxing on the sofa, staying in one position for too long may be contributing to your symptoms.

The good news? You don't have to give up sitting or completely change your lifestyle. A few simple adjustments can help you stay comfortable, keep moving and take control of your recovery.

Most people with sciatica tell me the same thing. It is not the walking that gets them, it is the sitting. The commute, the desk, then the sofa in the evening. By the time they stand up, the leg has already started talking. What wears people down is not just the pain, it is planning the whole day around whether there will be somewhere comfortable to sit.

Let me be straight with you. No chair and no desk fixes sciatica. But the wrong setup, eight hours a day, five days a week, will keep feeding it. That part is worth sorting out.

Here's where to start:

• Break up prolonged sitting: Get up and move around every 20–30 minutes. Even a short walk can help you change position and reduce the time spent sitting.
• Make your workspace more comfortable: Adjust your chair height, screen position and lumbar support to find a sitting position that feels comfortable for your back.
• Keep your back moving: Try this gentle lower back mobility exercise to help you maintain movement throughout the day.
• Consider a standing desk: A sit-stand desk makes it easier to alternate between sitting and standing, rather than remaining in one position for hours.

If you cannot avoid long desk days, two things actually matter: how easily you can change position, and how well supported you are when you are sitting. I have written up what I look for in a sit-stand desk and in an ergonomic chair, including where the money is and is not worth spending.

And if you’re not in a position to upgrade your work space right now, start with my free 7-minute spinal mobility routine instead. It costs nothing, and for most people it does more than any piece of furniture.

Remember, the goal isn't to avoid sitting altogether. It's to find a balance of movement and comfortable positions that helps you manage your symptoms and get back to the activities you enjoy.

2. Repeated bending or twisting

Bending activities often increase disc pressure and can irritate symptoms.

Helpful changes:

• Use your hips and knees when bending or lifting rather than rounding the back
• Activity modification: break tasks up into smaller chunks

Clinic example: I have had many patients over the years who reported feeling worse each week after doing their weekly day of housework chores. When I asked them if they could split the housework over two to three days, there was often no reason why they couldn’t. It had just become a habit to do it all in one day. Once they made this change — alongside others — their sciatica started to ease.

3. Poor mattress support

Many patients report sciatic pain in bed at night due to poor mattress quality. If you’ve not been finding your bed comfortable or your mattress is getting old, it may be worth replacing.

Helpful changes:

• Sleeping on your side with a pillow between your legs can sometimes help relieve sciatic nerve pain in bed

I would not rush out and buy a new mattress on the back of a bad fortnight, though. Sciatica disturbs sleep regardless of what you are lying on. Give the positioning changes a fair go first.

4. Inappropriate stretching

A common mistake is when people are advised to stretch the hamstring muscle to relieve tightness. This will often really hurt (not in a nice stretching way) and only serve to irritate the nerve.

If you do want to stretch something in that area, the gluteal stretch is usually far better tolerated.

What Usually Helps Sciatica?

Which approach works for you depends on the type of sciatica you have. Having read this information you should have a much clearer idea of where to start.

Sciatica usually improves best with three main goals:

• Calm the irritation
• Keep moving (if it relieves the pain)
• Build strength and tolerance

Calm it down stage

Helpful options include:

• Regular short walks
• Gentle mobilisation in a pain-free range (try the McKenzie Extension first)
• Ice or heat, depending on preference (a hot and cold gel pack covers both)
• Avoiding prolonged sitting or standing (variety is the key)

Keep moving without overdoing it

Complete rest often makes sciatica worse. However, for the minority of you who feel worse when standing or walking, you need to stop as soon as you start feeling the pain — ideally before.

This is not just my opinion. Both NICE and the NHS advise staying active and carrying on with normal activities as far as you can, rather than resting up.

Once tolerated, progress through the sciatica exercises further down this page, picking the group that matches your pattern rather than doing all of them at once.

NB: The key is not to do everything at once, but to start with what clearly relieves your symptoms and build gradually from there.

Which Exercises Should You Start With?

This is where most people go wrong. They search for sciatica exercises, find a list of ten, and do all ten. Some will help, some will wind the nerve up, and because they all went in at once there is no way of telling which did what.

Start with the group that matches how your pain actually behaves. Do a small amount, see how you are over the next 24 hours, then build from there.

If sitting and bending make it worse (the disc pattern)

This is the biggest group. You are generally better on your feet and worse getting out of the car or up off the sofa. Extension-based movements usually suit you.

• McKenzie Extension — usually the first thing I give this group
• Cobra Stretch — a progression of the same idea once the first one is comfortable

If standing and walking make it worse (the stenosis pattern)

Less common, and the advice is close to the opposite. Flexed, forward-leaning positions tend to settle things, and pacing your walking matters far more than pushing through it.

• Child's Pose — a rest position that opens the space the nerves pass through
• Supine Leg Rotations — gentle rotational movement without loading the spine

If the pain sits mostly in the buttock

• Piriformis Stretch
• Gluteal Stretch

Once it has calmed down, build tolerance

This is the part people skip, and it is the part that stops it coming back. Strength work here is not about having a six-pack. It is about your back coping with a normal day without complaining about it afterwards.

• Bird Dog
• Dead Bug
• Glute Bridge
• Cat/Cow Stretch
• The Plank

If you would rather follow a longer-term plan than a list of individual exercises, I have written about building long term strength and the everyday habits that keep people pain free.

What Treatment Options Are There For Sciatica?

Most sciatica settles without anything invasive. But people always want to know what the ladder looks like, so here it is, roughly in the order it tends to get climbed.

Self-management and staying active

The foundation, and the part with the best evidence behind it. NICE's guideline on low back pain and sciatica puts information, reassurance and encouragement to carry on with normal activities at every step of the pathway.

Exercise and manual therapy

This is where I fit in. NICE supports manual therapy — spinal manipulation, mobilisation or soft tissue work — for low back pain and sciatica, but specifically as part of a package that includes exercise, not as a treatment on its own. That matches how I work in practice: hands-on treatment to settle things down, exercise to keep them settled.

If you would like me to take a look at yours, you can find out how I can help.

Medication

Worth a conversation with your GP or pharmacist rather than guesswork. NICE advises against gabapentinoids, oral corticosteroids and benzodiazepines for sciatica, and notes there is limited evidence of benefit from anti-inflammatories for sciatica specifically. I cannot prescribe, so this one is genuinely not my lane.

Do you need a scan?

One of the questions I get asked most. NICE advises against routine imaging in a non-specialist setting, and the reasoning is practical: scans very often show disc bulges and wear and tear in people who have no pain whatsoever. A scan on its own rarely changes what we do. It becomes useful when the result would genuinely change the plan, which usually means when injections or surgery are on the table.

Injections and surgery

For the small number of people whose symptoms are severe and not settling, NICE says epidural injections of local anaesthetic and steroid can be considered in acute, severe sciatica, and that spinal decompression surgery can be considered when non-surgical treatment has not improved pain or function and the scan findings match the symptoms. In my experience most people never need to get anywhere near this stage.

If a disc is behind your symptoms, my guide to lumbar disc bulge goes into more detail on what actually happens to the disc over time.

How long will it take to get better?

This is one of the most common questions I get asked in clinic and the honest answer is: it depends.

Recovery time varies

based on:

• The underlying cause
• How irritated the nerve is
• Your daily habits
• How long you’ve had it for

These are the patterns I tend to see in clinic rather than fixed rules, and they line up broadly with the NHS, which says sciatica usually gets better in a few weeks to a few months but can last longer:

• Mild or early sciatica: often starts easing within 2 to 4 weeks
• Moderate symptoms: more commonly settle over 4 to 8 weeks
• Long-standing or recurring sciatica: can take several months, particularly if the lifestyle factors behind it are not addressed

It’s often a rocky road to recovery. Flare-ups along the way are very common. This doesn’t mean you are getting worse again — it’s often just part of the healing process.

The most important thing is to reduce nerve irritation as best you can with everything you do. Keep moving in ways that feel relieving, and gradually rebuild strength and tolerance over time.

If things are not improving after a few weeks of sensible self-management, or they are getting worse, that is the point to get it properly looked at rather than waiting it out.

Final Thoughts

Sciatica can be painful, frustrating and at times worrying. It can affect every aspect of life. The good news is that most cases improve with time and the right approach, once the underlying cause is understood.

Use the links on this page to explore the cause most relevant to you, the exercises that feel appropriate, and the lifestyle changes that can support recovery.

Next steps

• Explore the related conditions on the lower back hub
• Start the appropriate exercises
• If your symptoms aren’t improving, find out how Christopher can help

Related guides

• Lower back pain hub — groups lower-back conditions and exercises
• Lumbar disc bulge — the most common cause of sciatica, explained in full
• Spinal stenosis — if your pain comes on with standing and walking
• Sacroiliac joint pain — often mistaken for sciatica
• Mechanical low back pain — back pain without nerve involvement
• Spinal arthritis — age-related change that can contribute to narrowing
• Disc degeneration — what wear and tear in the disc actually means
• Movement assessment — a simple way to check how your back, neck and shoulders are moving

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