What Is It?
The sciatic nerve (L4–S3) is the largest peripheral nerve in the body. "Sciatica" describes pain radiating from the lumbar spine through the posterior buttock and down the posterior or lateral thigh, often extending below the knee. It is frequently accompanied by neurological symptoms — numbness, tingling, burning, or weakness in a specific dermatomal pattern.
The two most common mechanisms are lumbar disc herniation (where displaced disc material compresses a nerve root) and piriformis syndrome (where the piriformis muscle or its anatomical relationship with the sciatic nerve generates irritation without disc involvement). These require different treatment approaches. Non-discogenic causes including sacroiliac joint dysfunction and deep gluteal syndrome (sciatic nerve entrapment in the deep gluteal space) are also seen in practice.
Common Causes
- Lumbar disc herniation — most commonly L4/L5 or L5/S1 — with nerve root compression or chemical irritation
- Piriformis tightness or hypertrophy compressing or irritating the sciatic nerve in the deep gluteal space
- Spinal stenosis — narrowing of the spinal canal reducing the available space for nerve roots
- Sacroiliac joint dysfunction generating referred pain into the posterior thigh
- Prolonged sitting — increasing intradiscal pressure and compressing the piriformis
- Heavy repetitive lifting in flexion and rotation — a common mechanism for disc herniation
How Myotherapy Can Help
- Neural mobilisation (nerve sliders and tensioners) — restores mechanical mobility of the sciatic nerve through its surrounding tissues; most effective when neural mechanosensitivity is confirmed on assessment
- Soft tissue therapy — piriformis, deep hip rotators, gluteus maximus, and lumbar paraspinals to reduce mechanical compression and improve tissue extensibility
- Dry needling — deactivation of gluteal and deep hip rotator trigger points that maintain sciatic nerve irritation
- Exercise rehabilitation — nerve mobility exercises as a home programme; core stability and lumbar decompression exercises for disc-related presentations
- Postural education — sitting position modification, lifting mechanics, and load management
Note: Myotherapy does not treat disc herniation structurally. Medical referral is appropriate where progressive neurological deficit (worsening weakness, bladder or bowel dysfunction) is present.
Expected Outcomes
70–90% of lumbar disc-related sciatica resolves within 6–12 weeks with conservative management. Neural mobilisation is most effective when neural mechanosensitivity is the primary driver. Piriformis syndrome responds well to a combined manual therapy and neural mobilisation approach over 4–8 sessions. Chronic sciatica with established central sensitisation requires a more gradual approach over 10–16 weeks.
Likely Symptom Changes
Early in treatment: reduction in local buttock pain and muscle guarding; neurological symptoms (tingling, numbness) may persist or temporarily increase — this is not a sign of harm if it resolves within 24 hours post-session. Progressive sessions: the distribution of pain tends to "centralise" (move from the foot/leg back toward the lumbar spine) before resolving — this centralisation is a positive prognostic sign. Complete resolution of nerve symptoms typically lags behind pain resolution by several weeks.
References
- Stynes, S., et al. (2018). Classification of patients with low back-related leg pain: A systematic review. BMC Musculoskeletal Disorders, 19(1), 226.
- Ellis, R. F., & Hing, W. A. (2008). Neural mobilization: A systematic review of randomized controlled trials. Journal of Manual & Manipulative Therapy, 16(1), 8–22.
- Hicks, B. L., et al. (2023). Sciatica. StatPearls Publishing. Treasure Island, FL.
Dealing with leg pain, tingling, or numbness?
Shaun will assess whether your symptoms are neural, discogenic, or muscular — and treat accordingly.