Understanding Sciatica

Sciatica is the common name for what doctors call lumbar radiculopathy, irritation of a nerve in the lower back, often described as a "pinched nerve". In most cases, this happens when a spinal disc bulges or herniates and irritates a nearby nerve.

When this occurs, the pain doesn't just stay in the back; it often travels down the leg, sometimes as far as the foot. It is commonly described as sharp, burning, shooting, or electric, and may be accompanied by pins and needles, numbness, or weakness. Symptoms often feel worse when sitting for long periods, bending forward, or even when coughing or sneezing. Many people find relief lying on their back with their knees supported. International guidelines recommend conservative (non-surgical) treatment for most people, provided there are no serious warning signs such as worsening weakness or related changes in bowel or bladder function. MRI scans are usually only needed if serious pathology is suspected or symptoms persist beyond 6 to 8 weeks.

But how can this problem be solved without surgery? Research shows that when disc material leaks out, it releases inflammatory chemicals that irritate and sensitise the nerve. This growing understanding of the chemical component of nerve pain helps explain why physiotherapy can be effective without causing any major structural change. Encouragingly, high-quality research shows that most "pinched nerves" improve within 6 to 12 weeks without surgery. Disc herniations often shrink naturally over time, with studies suggesting that around 60 to 70% show some resorption on scans. Many people improve well before any visible change on MRI, as symptoms often settle due to reduced inflammation, decreased nerve irritation, and the body's natural ability to calm pain sensitivity.

Physiotherapy plays an important role in recovery by helping the irritated nerve settle, restoring movement, and gradually building strength and confidence again.

In the early stages, treatment focuses on calming pain and reducing nerve sensitivity. This may include education, guidance on positions that ease pressure on the nerve, gentle movement, and specific exercises tailored to your symptoms.

Physiotherapists often use manual therapy (spinal mobilisation, massage and neural mobilisations) to help reduce pain and improve movement. This is always combined with active rehabilitation, as exercise-based approaches show the strongest evidence for long-term benefit. Staying active, within reason, has been shown to support recovery better than prolonged bed rest! As symptoms begin to settle, rehabilitation shifts toward restoring normal movement in the spine and hips, improving core and trunk strength, and addressing any contributing factors such as stiffness, weakness, or poor movement patterns.

With the right support and a structured rehabilitation plan, most people can return to their usual activities, safely and confidently, without needing more invasive treatment.

Juli-Ann is a highly experienced physiotherapist and director of Riley Physiotherapists, a multi-site practice in the Upper Highway area, for over 23 years. She completed the Advanced Neuromuscular Physiotherapy course with distinction and was trained by the International Association for the Study of Pain (IASP). Her research on lumbar radiculopathy has been published in the South African Journal of Physiotherapy and presented at a national congress.