An Osteopath’s Guide to Sciatica
By Bernitta Willoughby M.Ost DO PGD WHO, Principal Osteopath at The Waterside Practice
Sciatica is one of the most commonly used terms in musculoskeletal healthcare, but in my experience, it is also one of the most commonly misunderstood and incorrectly diagnosed.
Many patients arrive at clinic having been told they have “sciatica” by a range of professionals and more often non-professionals, when in reality they have lower back pain, muscular referral, or irritation around the pelvis and lumbar spine without true nerve involvement. Equally, some people dismiss their symptoms as “just back pain” when they are actually experiencing clear neurological signs that suggest irritation of the sciatic nerve.
As an osteopath, one of the most important parts of my role is identifying the difference.
What Is True Sciatica?
True sciatica occurs when one of the lumbar or sacral nerve roots becomes irritated or compressed, creating neurological symptoms along the pathway of the sciatic nerve.
The sciatic nerve is the largest nerve in the body. It originates from nerve roots in the lower spine, primarily between L4 and S3, before travelling through the buttock and down the back of the leg. It continues below the knee and branches into smaller nerves that travel into the foot and toes.
This anatomical pathway explains why true sciatic symptoms tend to travel beyond the knee and often into the calf, foot, or toes.
Sciatica itself comes from the Latin meaning “pain down the back of the leg”, reflecting the distribution of the nerve.
Common Symptoms of True Sciatica
Patients with genuine sciatic nerve irritation often describe:
Shooting or electric shock type pain
Burning pain into the leg
Pins and needles
Numbness
Altered skin sensation
Areas of hypersensitivity on the skin
Weakness in the leg or foot
Symptoms extending below the knee
Sometimes symptoms worsen with coughing, sneezing, prolonged sitting, bending, or driving.
This differs from simple mechanical lower back pain or gluteal referral, where symptoms often remain around the lower back, buttock, or thigh and do not travel below the knee.
That distinction matters clinically because it changes both diagnosis and management.
Why Does Sciatica Happen?
The most common cause is irritation or compression of the nerve root as it exits the spine.
This may occur because of:
Disc bulging or disc prolapse
Inflammation around the nerve root
Degenerative change within the spine
Joint restriction around the lumbar spine
Reduced movement through surrounding soft tissues
Narrowing of the spaces where nerves exit the spine
Despite what many patients fear, a diagnosis of sciatica does not automatically mean surgery.
In fact, the vast majority of patients improve conservatively.
How Osteopathy Can Help
As an osteopath managing both sciatic and non-sciatic pain daily, treatment is focused on improving mobility, reducing irritation around the nerve, and creating better movement through the surrounding joints and soft tissues.
When nerves become irritated, the body often responds with protective muscle tension, stiffness, altered movement patterns, and inflammation. These secondary effects can significantly contribute to pain levels.
Treatment may include:
Gentle joint articulation
Soft tissue massage
Mobilisation of the lumbar spine and pelvis
Stretching techniques
Neurodynamic techniques
Postural advice
Exercise rehabilitation
Advice on pacing and activity modification
Even where there is confirmed nerve impingement, manual therapy can still make meaningful improvements to comfort, mobility, and recovery.
In some cases, we work alongside spinal consultants, pain specialists, or GPs. Occasionally patients may benefit from injection therapy or nerve root blocks to reduce inflammation and irritation. Surgical intervention tends to be reserved for more significant neurological compromise, progressive weakness, or persistent severe symptoms that do not respond to conservative care.
Thankfully, this is relatively uncommon in clinic.
Should You Rest with Sciatica?
This is one of the biggest misconceptions.
Complete rest is rarely helpful for sciatic pain. In fact, prolonged inactivity often increases stiffness, fear, muscular guarding, and sensitivity around the nerve.
Current evidence supports maintaining gentle movement where possible.
This does not mean forcing through severe pain, but it does mean avoiding becoming completely sedentary.
Helpful strategies include:
Short regular walks
Changing positions frequently
Avoiding long periods of sitting
Gentle spinal mobility work
Gradual return to normal movement
Sitting for prolonged periods tends to aggravate symptoms because it increases pressure through the lower lumbar discs and places tension through the sciatic nerve pathway.
Hot or Cold Therapy?
Both can help, depending on the stage and presentation.
Cold therapy may be useful during acute flare ups where inflammation is dominant, particularly in the first 24 to 48 hours.
Heat can be very effective for reducing muscle spasm and improving comfort around the lower back and gluteal muscles.
Many patients find alternating the two helpful.
As a general rule:
Ice tends to calm irritation
Heat tends to relax muscles and improve movement
Exercises That May Help Sciatica
Exercise should always be individualised, particularly if neurological symptoms are severe. However, there are several gentle movements that are commonly helpful for maintaining mobility and reducing stiffness.
Cat-Cow Mobility Exercise
This gentle spinal movement encourages mobility through the lumbar spine without excessive loading.
Start on hands and knees:
Slowly arch the back upwards
Then gently lower and extend the spine
Move within a comfortable range
Repeat slowly for 1 to 2 minutes
Child’s Pose
This can help stretch the lower back and surrounding soft tissues.
Kneel on the floor
Sit back towards the heels
Reach arms forwards
Breathe deeply and relax into the stretch
If symptoms increase significantly into the leg, stop the exercise.
Gentle Walking
Walking remains one of the most evidence supported activities for many patients with sciatica.
Short, regular walks are usually more beneficial than long periods of rest.
Nerve Gliding Exercises
Sometimes known as “nerve flossing”, these exercises aim to improve movement and tolerance around the sciatic nerve.
These should ideally be prescribed individually by a clinician, as incorrect technique or overaggressive stretching can aggravate symptoms.
What Should You Expect When Seeing an Osteopath?
Assessment is about much more than simply locating where pain is felt.
A thorough osteopathic assessment should include:
Neurological testing
Strength assessment
Reflex testing
Sensory testing
Orthopaedic examination
Movement assessment
Discussion around aggravating factors and lifestyle
Treatment plans are then tailored to the individual, not just the diagnosis.
Some patients improve quickly. Others, particularly where symptoms have been present for many months, require longer term rehabilitation and support.
Preventing Future Flare Ups
Long term management is often about improving resilience within the body.
This includes:
Maintaining spinal mobility
Improving core and gluteal strength
Avoiding prolonged sedentary habits
Managing stress and sleep
Gradually increasing activity levels
Addressing workplace ergonomics
Maintaining healthy movement patterns
Recovery is rarely about one single treatment. It is usually the result of consistent movement, appropriate therapy, and gradual rebuilding of confidence in the body.
A Final Note
Sciatica can be frightening, particularly when neurological symptoms appear suddenly or pain becomes intense. However, most cases improve well with appropriate conservative management.
The key is obtaining the correct diagnosis early and understanding the difference between true nerve irritation and more general lower back pain.
At The Waterside Practice, we regularly help patients manage both acute and persistent sciatic symptoms using a combination of hands on treatment, rehabilitation, and practical advice grounded in evidence based care.
If you are struggling with symptoms that sound like sciatica, early assessment can help guide the right treatment approach and support recovery before symptoms become more persistent.
Appointments can be booked online via our Online Booking facility or by calling the clinic on 01487 209084.