What Is Sciatica, and Can Physical Therapy Help Without Surgery?

You bend down for the laundry basket and a jolt like electricity runs from your low back down the back of one leg to your calf. It fades, then comes back when you sit in the car. By the third day you've looked it up, found the word sciatica, and every page seems to end with surgery.

But roughly 80 to 90 percent of people with sciatica get better over time without surgery (opens in a new tab), and physical therapy is one of the nonsurgical treatments a doctor may prescribe.

What exactly is sciatica?

Sciatica is a symptom of a problem with the sciatic nerve, the largest nerve in the body (opens in a new tab), and it can cause pain, weakness, numbness, or tingling that starts in the low back and usually runs down one leg. It's a broad term for nerve pain, not a specific diagnosis. Causes include a ruptured disk, narrowing of the spinal canal that presses on the nerve (spinal stenosis), or an injury such as a pelvic fracture, and in many cases no specific cause is found.

It's also common. Somewhere between 10 and 40 percent of people get sciatica at some point in their lives (opens in a new tab), and 1 to 5 percent get it in a given year. New cases peak among people in their thirties.

When is sciatica an emergency?

Sciatica is an emergency when it comes with being unable to urinate, loss of control of your bladder or bowels, numbness between the legs, over the buttocks, or in the inner thighs, or numbness or weakness in the legs that is severe or getting worse. These can be symptoms of cauda equina syndrome, and Cleveland Clinic advises going to the emergency room immediately (opens in a new tab) if you have them. Don't wait for a therapy appointment.

There are other warning signs that, if present, should prompt you to call your physician right away, even in the absence of the emergency symptoms above. Red flags doctors look for in someone with back and leg pain include back pain that started after a severe fall or blow; a history of cancer or tuberculosis; fever, chills, or night sweats; a weakened immune system; and use of blood thinners (opens in a new tab).

Call your physician right away (opens in a new tab), too, if the pain travels down your leg below the knee, you have weakness or numbness in your thigh or leg, the pain is worse when you lie down or wakes you at night, or it's so severe you can't get comfortable. Finally, call your physician if this episode feels different and worse than back pain you've had before, or if it has lasted longer than four weeks.

Does sciatica go away on its own?

Sciatica can get better on its own, though recovery depends on what's causing it. Most cases clear up in less than four to six weeks (opens in a new tab) with no long-term complications, even without medical treatment. When a herniated disk is the cause, people often improve within several weeks.

When bone spurs and spinal stenosis are pressing on the nerve instead, nonsurgical treatment is less successful, though there's still a good chance of improvement. An evaluation can help narrow down the likely cause and guide your care, even if no specific cause turns up.

What can you do in the first few days?

For the first couple of days, self-care for sciatica usually means staying gently active while you ease off your usual activities, not staying in bed. After that, build back toward your normal routine a little at a time, and hold off on heavy lifting or twisting your back for the first six weeks after the pain began. You can try ice for the first two to three days and heat after that. If the area feels numb, check with your provider before using heat or ice. Our post on heat or ice covers how long to use each. This self-care advice is for sciatica without the warning signs above. If any of them apply, follow that section first.

A physical therapist may add a few specifics: avoid whatever makes your symptoms worse, stay active around the house, take short walks several times a day, and sit in firm chairs, because soft couches and easy chairs may make symptoms worse.

Keep track of what changes: which positions ease the leg pain, which make it worse, and whether the area where you feel it shifts. Bring those notes to your appointment.

What happens at a physical therapy evaluation for sciatica?

A physical therapy evaluation starts with questions. The therapist takes your health history and asks how and when the pain started, what time of day it's worse, where you feel it, and what it's keeping you from doing right now. The therapist may also ask whether you've lost control of your bladder or bowel, because that needs immediate medical attention.

Next comes the physical exam. The therapist may check for difficulty moving, muscle weakness or tightness, changes in skin sensation such as numbness, changes in your reflexes, joint stiffness, changes in posture, and trouble walking or balancing.

If something in the evaluation raises a concern, a physical therapist may consult your physician about whether you need special testing, such as an MRI. You may read that you can see a physical therapist without a referral; rules vary, and at Omni a physician's referral is always required.

Plan on about an hour for your first physical therapy evaluation. Bring a photo ID, your insurance card, your physician's referral, and a list of your current medications. Wear comfortable clothes you can move in. Before the visit, write down your questions and the everyday things that have gotten hard to do. Our article on what to expect at your first physical therapy appointment has more on getting ready.

How can physical therapy help with sciatica?

Physical therapy may help reduce pain and restore movement while you rebuild strength, flexibility, and good posture. Most cases respond well to physical therapy, and with a program of posture work, pain relief, stretching, and strengthening, improvement may come in four to eight weeks (opens in a new tab).

What your treatment includes depends on your evaluation. It may include specific movement exercises, cold or heat packs, or gentle electrical stimulation to ease pain. Stretching may target tight muscles, and strengthening may focus on the muscles around your back, hips, abdomen, and pelvis. Your therapist may also give you exercises to do at home and show you how to handle lifting and other daily tasks, with a gradual return to your usual activities. How long improvement takes varies from person to person.

Can the pool help when land exercise hurts too much?

For some people with sciatica, exercise in the water may be easier to tolerate when other exercise hurts. Buoyancy supports part of your body weight (opens in a new tab), which reduces the load on your joints, and the water gives resistance as you move. Our post on why water helps painful joints goes into more detail. At your evaluation, Omni's physical therapy team looks at whether aquatic therapy, a land-based program, or a combination fits you.

Can you lower the chance of sciatica coming back?

Some habits may lower the chance of sciatica coming back, though what helps depends on the cause. Sciatica often gets better, but it's common for it to return. Avoid sitting or lying for long periods with pressure on your buttocks, and keep your back and abdominal muscles strong. Good posture when you sit, stand, and drive, and proper body mechanics when you lift (opens in a new tab), may help too.

If your job has you driving long distances, sitting most of the day, or lifting, tell your therapist at the evaluation. Ask which exercises to keep doing after you feel better and how to fit them into your day. If you lift at work, describe what you lift and how often, and ask whether you should change how you do it.

When is surgery considered?

Surgery may be considered when leg pain doesn't respond to nonsurgical treatment, for instance if it's still disabling after three or more months (opens in a new tab). That timeline doesn't apply to emergencies such as suspected cauda equina syndrome. Your physician can talk with you about whether a surgical evaluation makes sense for your symptoms and exam findings. If surgery does become part of your plan, Omni's physical therapists provide rehabilitation both before and after spinal surgery.

How do you start physical therapy at Omni?

Physical therapy at Omni is based at our Wallingford office at 8 Research Parkway, which is also where the warm-water therapy pool is. Back pain is among the conditions our physical therapists treat. Physical therapy and aquatic therapy both always require a physician's referral at Omni.

If leg pain keeps getting in the way of sitting, driving, or work, ask your physician for a referral if you don't have one yet, then call Omni at (203) 562-8600. Our staff will take care of the rest.