Sciatica is a symptom, not a diagnosis
Sciatica isn’t actually a condition. It’s a description of pain travelling down the back of your leg along the sciatic nerve. Saying you have “sciatica” is like saying you have “a sore arm”. It tells you the location, not the cause. And until you address the actual driver, the pain keeps coming back.
The three most common drivers
1. Disc-related irritation
The most common cause in people under 50. A disc bulge or herniation irritates the nerve root as it exits the spine. Symptoms are typically sharp, electric pain down the leg that worsens with sitting, bending forward, or coughing. The good news: most disc bulges settle without surgery, but they improve through progressive loading, not rest alone.
2. Stenosis (narrowing)
More common over 50. Narrowing of the space around the nerve from bone spurs, thickened ligaments and disc changes. Pain usually intensifies with standing and walking, and eases when sitting or leaning forward. The approach differs here: the extension-based exercises that help disc bulges can aggravate stenosis. This is why proper assessment matters.
3. Neural tension
The nerve becomes sensitised and doesn’t glide smoothly through surrounding tissue. You might feel tightness, burning, or pins and needles, especially with stretching. The nerve isn’t compressed, it’s irritated and restricted. This responds to nerve gliding and graded exposure, not aggressive stretching.
Why most sciatica treatment fails
Most treatment is generic rather than targeted. Everyone gets the same stretch sheet regardless of the driver. Rest and anti-inflammatories don’t address the cause. Massage and manipulation can give temporary relief but don’t prevent recurrence.
Effective treatment needs three things:
- Identify the driver. Disc, stenosis and neural tension each need a different strategy.
- Progressive loading. Once identified, load the structures progressively, slightly beyond current capacity, over weeks.
- Address the whole system. Hip stiffness, weak glutes, poor trunk stability and deconditioning all feed the problem.
What a structured approach looks like
Weeks 1-2: settle the acute irritation. Find positions and movements that reduce symptoms, and begin gentle nerve gliding and pain-free loading.
Weeks 3-6: progressive strengthening through the hip, core and lumbar spine, tailored to your driver, with flare management in place.
Weeks 7-12: build capacity with heavier loading and functional patterns, and return to the activities you’d been avoiding.
The stretching myth
If you’ve been told to stretch your hamstrings and piriformis to fix sciatica, understand this: aggressive stretching of an irritated nerve makes it worse. That “good pain” down your leg isn’t tension releasing, it’s the nerve being pulled while it’s inflamed. Gentle nerve glides help. Aggressive stretching doesn’t.
When to get help
If sciatica has lasted beyond six weeks, or it’s limiting training, work or sleep, get it assessed properly rather than self-diagnosing from videos. A structured evaluation of the driver, plus a systematic plan, is what gets lasting change.