Sciatica and Physical Therapy: Understanding the Pain, the Nerve, and the Path to Recovery

If you’ve ever felt a shooting pain down your leg that starts in your lower back or buttock, you’re not alone — and you’re likely dealing with a condition known as sciatica. This widespread issue affects millions each year and is one of the most common reasons people seek physical therapy.

But what is sciatica really? Why does it happen? And most importantly — how can you find lasting relief?

At RISE Physical Therapy, we specialize in addressing sciatica from the source. In this comprehensive blog, we’ll break down the science behind sciatica, explore a lesser-known but important concept called neural tension, and explain how physical therapy can help you move freely again — without pain.

What Is Sciatica?

Contrary to popular belief, sciatica is not a condition in and of itself. It’s a symptom — a specific type of nerve pain, numbness or change in sensation that radiates along the path of the sciatic nerve. The sciatic nerve is the longest and largest nerve in the human body, formed by the joining of nerve roots from L4 to S3 in the lower spine.

Once formed, the sciatic nerve travels through the pelvis, passes under (and sometimes through) the piriformis muscle, down the back of the thigh, and into the lower leg, eventually branching into the tibial and common peroneal nerves.

When this nerve is compressed, irritated, or placed under mechanical tension, the result is often sharp, burning, or shooting pain that radiates from the lower back or buttock down the leg — sometimes reaching all the way to the foot.

The Physiology Behind Sciatica

To truly understand sciatica, we need to dig into the neuroanatomy and mechanical dynamics of the nerve system — particularly the peripheral nervous system (PNS), which includes the sciatic nerve.

Sciatic Nerve Function

The sciatic nerve serves both motor (movement) and sensory (feeling) functions in the lower extremities. It innervates muscles like the hamstrings, and contributes to movements like knee flexion and ankle dorsiflexion. It also provides sensory input to the skin of the posterior thigh, leg, and sole of the foot.

When the nerve is working properly, messages travel up and down smoothly — from brain to muscle and back. But when that nerve is irritated — by compression, inflammation, or mechanical stress — those messages get disrupted, leading to pain, numbness, tingling, or weakness.

Mechanisms of Sciatic Nerve Irritation

Here are some key physiological mechanisms that can result in sciatica:

1. Mechanical Compression

   • This can occur due to a herniated or bulging disc, where the nucleus pulposus (inner gel) of the disc pushes through the annulus fibrosus (outer ring) and presses against the nerve root.

   • It can also happen in the case of piriformis syndrome, where the sciatic nerve is compressed by the piriformis muscle as it travels underneath or through it.

2. Chemical Irritation

   • Inflammation caused by disc material, infection, or trauma can release chemical mediators like prostaglandins and cytokines, which sensitize the nerve root even without significant mechanical pressure.

3. Neural Tension

   • This refers to increased mechanical strain along the nerve's path. Just like a rope pulled tightly through a narrow tube, the nerve can become irritated not because it's compressed, but because it's stretched, tethered, or kinked. More on this below.

Neural Tension: The Hidden Contributor to Sciatica

One often overlooked cause of sciatica is neural tension — also referred to as adverse neural tension or neurodynamics dysfunction.

Nerves aren’t like static wires — they are dynamic, living tissues that must glide, slide, and elongate as we move. For example, when you flex your hip and straighten your knee, your sciatic nerve must lengthen by several centimeters to accommodate that movement.

When mobility of the nerve is restricted — due to scarring, inflammation, muscular entrapment, or fascial restrictions — it creates tension along the nerve. This can cause:

• Pain with stretching the leg

• Tingling or numbness with certain positions

• Burning or zapping sensations with sudden movement

This concept is critical, because many people with sciatica symptoms don’t have a disc herniation or bony impingement — they have dysfunctional nerve mobility.

Clinical Signs of Neural Tension

Physical therapists at RISE use specific tests to identify neural tension, including:

• Straight Leg Raise (SLR): Elevating the leg in a straightened position stretches the sciatic nerve; pain reproduction is a key sign of tension.

• Slump Test: In a seated position, flexing the spine and extending the leg places tension on the spinal cord and sciatic nerve.

• Passive Neck Flexion Test: Useful in detecting increased neural mechanosensitivity.

  
  

If these tests provoke symptoms, it doesn’t always mean nerve compression — it may mean nerve irritation or restriction due to loss of mobility in the nerve sheath or surrounding tissues.

Common Causes of Sciatica (Excluding Degenerative Disc Disease)

While degenerative disc disease is frequently mentioned as a cause, it’s not always clinically relevant or symptomatic. Many people with disc degeneration on imaging have no pain at all.

Instead, here are more functionally meaningful causes we address at RISE:

1. Lumbar Disc Herniation

Disc herniation remains one of the most well-documented causes of sciatica. When the disc material presses on a nerve root, it can trigger intense pain down the leg, especially during sitting, bending, or coughing.

2. Piriformis Syndrome

This is a muscular condition where the piriformis, a small muscle deep in the gluteal region, compresses the sciatic nerve. It’s more common in runners, cyclists, and people with tight hips or poor biomechanics.

3. Spinal Stenosis

This refers to a narrowing of the spinal canal or nerve root openings, which can lead to compression of the sciatic nerve roots. It’s often associated with leg pain that worsens with standing or walking and improves with sitting.

4. Postural Imbalance and Movement Dysfunction

Repetitive poor postural habits — such as prolonged sitting, forward-flexed posture, or one-sided loading (like always carrying a bag on one shoulder) — can create asymmetries in the pelvis and spine, contributing to sciatic irritation.

5. Trauma or Scar Tissue

Following surgery or injury, scar tissue can adhere to nerve roots or fascial planes, reducing nerve mobility and creating tension that mimics or produces sciatica symptoms.

How Physical Therapy at RISE Helps Sciatica

Sciatica is not a one-size-fits-all problem — and it doesn’t deserve a one-size-fits-all solution. At RISE Physical Therapy, we don’t just treat symptoms; we identify the root cause using movement analysis, neurodynamic testing, and orthopedic screening.

Here’s how we help:

1. Accurate Diagnosis

We begin with a detailed assessment that includes:

• Medical history and symptom mapping

• Spinal and neural mobility tests

• Muscle strength and flexibility evaluation

• Gait and postural assessment

From there, we develop a diagnosis that’s not based solely on imaging — but on function.

2. Manual Therapy and Mobilization

Hands-on techniques can:

• Release soft tissue tension (especially piriformis or hamstring tightness)

• Mobilize restricted joints (such as the sacroiliac joint or lumbar spine)

• Restore normal gliding of the sciatic nerve (nerve gliding techniques)

3. Neural Mobilization

Also called nerve flossing, these are gentle movement-based exercises that help:

• Reduce nerve hypersensitivity

• Restore gliding and sliding of the nerve through surrounding tissues

• Improve range of motion without triggering symptoms

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This is particularly useful when neural tension is the primary issue.

4. Customized Exercise Programs

Once pain is managed, we shift our focus to long-term resilience and prevention — but there’s no cookie-cutter routine here. Your exercise plan will be carefully tailored to your unique presentation, taking into account the exact cause of your sciatica, your movement patterns, lifestyle, goals, and any contributing imbalances we identify during your evaluation.

Depending on your specific needs, your program may include:

• Core stabilization to support and unload the lumbar spine

• Hip mobility and glute strength to improve alignment and reduce strain on the sciatic nerve

• Functional movement re-training to correct poor mechanics in walking, lifting, or sport-specific tasks

5. Education and Prevention

We equip you with:

• Proper lifting and bending techniques

• Ergonomic strategies for work or home

• Posture correction and movement awareness

• Tools for self-mobilization and home exercises

Empowering you is at the heart of our approach.

When to Seek Help

Sciatica often starts with a small ache or tingle — but it can progress quickly if left untreated. If you experience any of the following, it’s time to consult a physical therapist:

• Persistent leg pain for more than a week

• Numbness or weakness in the leg or foot

• Pain that worsens with movement or sitting

• A history of back pain followed by leg symptoms

Remember: early intervention leads to faster recovery.

You Don’t Have to Live With Sciatica

At RISE Physical Therapy, we help you move better, feel stronger, and live life on your terms. Whether you’re a weekend warrior, a desk-bound professional, or recovering from injury, our expert therapists will design a plan that gets to the source of your pain — and gets you back to doing what you love.

Your pain-free future starts now. Whether you're ready to dive into a full recovery plan or just want to talk through your symptoms, we're here to listen. Set up a free call with a RISE physical therapist to discuss what you're experiencing, ask questions, and learn how we can help you get back to feeling like yourself again.