You bend to pick something up, and a few days later your back is not the only thing complaining. Now there is a deep ache in your hip, and maybe a burning or tingling line down your leg. That pattern is common, and it has an explanation. This article walks through what sciatica is, why the pain travels, and what a physical therapist looks at. It is general education, not a diagnosis, so check with your doctor or a physical therapist about your own symptoms.
What is sciatica, and why does it reach past the back?
Sciatica is pain that follows the path of the sciatic nerve, which starts in the low back and runs through the buttock and down the back of the leg. The nerve is the longest in the body, so when something irritates it near the spine, you can feel it far from the spine.
Think of a garden hose that is pinched near the faucet. The trouble is at one spot, but the effect shows up all along the hose. Nerves work in a similar way. The signal gets stirred up at the source, and your brain reads it as pain in the hip, thigh, calf or even the foot.
That is why some people with sciatica say their back feels only a little stiff while their leg feels awful. The location of the pain and the location of the problem are not always the same place.
Why does the pain settle in the hip?
The hip and buttock are the first stretch of the nerve’s path after it leaves the low back, so that area often gets hit first. Pain there can come from the nerve itself, from tight muscles around it, or from both at once.
When a nerve is irritated, nearby muscles often guard. They tighten to protect the area. Tight muscles in the buttock and hip can then ache on their own and make the nerve feel more squeezed. The result is a cycle: irritation, guarding, more irritation.
Sitting makes it worse for many people. A long drive or a desk shift keeps the hip bent and the low back rounded, which can add pressure in the area. A therapist will often ask what position eases your pain and what position stirs it up, because those answers point toward the cause.
What can be pressing on the nerve?
Several things in the low back can irritate the nerve, and the right plan depends on which one is involved. Our lower back pain rehab page lists conditions we commonly treat, and several of them can be tied to sciatica:
- A slipped or herniated disc, where disc material presses near a nerve root
- A pinched nerve in the low back
- Degenerative disc disease or arthritis that narrows the space around a nerve
- Spondylolisthesis, where one bone in the spine slides over the next
- SI dysfunction, which involves the joint where the spine meets the pelvis
- A lumbar sprain or strain with muscle guarding
Imaging and a doctor’s diagnosis can confirm a structural problem. A physical therapist works from your history and a hands on exam to see how your body moves and responds. Two people with the same leg pain can have different causes, which is why a copied exercise list from the internet sometimes helps one person and aggravates another.
How does a physical therapist find the root cause?
A therapist starts by listening, then tests. At Rehab Solutions, a first visit includes a discussion of your medical history, your current complaints, what aggravates and eases the pain, and how it limits your daily activities. Then comes an objective evaluation.
For sciatica, several parts of that evaluation matter:
- Range of motion: the therapist moves your joints to check for restrictions and the quality of movement.
- Muscle testing: strength is checked, and this also serves as part of a neurological screening.
- Neurological screening: the therapist may check how your nerves sense touch, pain, vibration or temperature, and may assess reflexes.
- Posture assessment: the positions of your joints relative to each other may be assessed.
- Palpation: touching around the painful area to check for tenderness and soft tissue changes.
From there, a plan is built with your input. It covers how often you come in, how many weeks, a home program, education and goals. Your doctor is part of that picture too.
What does treatment for sciatica usually include?
Our approach to low back problems combines patient education, manual techniques and therapeutic exercise. Our lower back pain rehab page describes that combination as proven to reduce pain and help patients recover their independence, and it notes that physical therapy is conservative and rarely has side effects. Read more on our lower back pain rehab page.
In practice, that can mean hands on work to ease tight tissue, stretching and strengthening exercises, and lumbar stabilization work to build support around the spine. Other tools on our list include heat and ice, TENS, and posture education. Dry needling is also offered for muscle pain.
Education matters as much as any technique. When you know which positions calm the nerve and which ones provoke it, you can make smarter choices at work and at home. Once the pain settles, the goal is to give you tools that help you avoid repeat episodes.
When should you stop waiting it out?
Many people hope sciatica will fade on its own, and sometimes it does ease. But our back pain page makes the point that early intervention helps reduce pain and recover function, so waiting months is not a plan to rely on.
Some signs call for medical attention right away rather than a therapy appointment. As general safety guidance, new weakness in a leg, numbness in the groin or inner thighs, or trouble controlling your bladder or bowels need urgent evaluation. Pain after a significant fall or accident also deserves a doctor’s check first.
If your symptoms are steady, keep you from sleeping, or limit things like walking or sitting through a meal, it is reasonable to have a therapist take a look. Check in with your doctor too, especially if you have other health conditions.
Getting started with physical therapy in Newnan
If you live in Newnan and your leg pain is wearing you down, the Rehab Solutions clinic in Newnan is at 1741 Newnan Crossing Blvd E, STE C. You can call 470-414-1631 or use the Appointment Request form on the website, and the clinic will contact you about scheduling.
No referral is required, and the site says first visits are available within 24 to 48 hours. If you do have a referral from your doctor, you can bring it. The group also accepts most insurances and offers private pay.
You do not need to have your diagnosis figured out before you call. Describe where it hurts and what makes it worse, and a therapist can help sort out the rest. Pain that spreads from the back into the hip and leg is not something you have to just live with.
Frequently asked questions
Do I need a referral to see a physical therapist for sciatica?
No. Rehab Solutions states that no referral is required. If you have one from your doctor, you can bring it, and the FAQ notes a referral is not always needed.
How long does each therapy visit last?
Treatment sessions typically last 30 to 60 minutes per visit. The number of visits varies widely with your diagnosis, how severe your symptoms are and your medical history, and you are re-evaluated monthly.
What should I wear to my appointment?
Loose fitting clothing. For low back problems, a loose shirt and pants let the therapist do a thorough examination.
Is sciatica the same as a pinched nerve?
Not exactly. Sciatica describes the leg pain pattern, while a pinched nerve, a herniated disc or another back problem may be the cause behind it. A therapist or doctor can help work out which is involved.
Related pages
This article draws on the following pages.