What Most People Get Wrong About Sciatica

Low back pain and sciatica are two of the most common reasons people seek medical care. In fact, these symptoms are leading causes of missed work and reduced quality of life. While the terms are often used together, they are not synonymous terms. Understanding what’s happening in your body is the first step toward effective, long-lasting relief.

What Is Low Back Pain?

Low back pain refers to discomfort or stiffness felt in the lumbar spine (the lower portion of your back). The pain can feel dull and/or sharp with varying intensity. It may be classified as short-term (acute) or long-standing (chronic).

Common Causes of Low Back Pain

• Muscle or ligament strain from lifting, twisting, or overuse

• Prolonged sitting

• Disc-related issues, such as bulges or herniations

• Joint irritation, including the facet joints or sacroiliac (SI) joint

• Mobility or strength imbalances in the hips, core, or thoracic spine

• Stress and fatigue, which can increase muscle tension and pain perception

A Quick Look at the Anatomy

The sciatic nerve is the largest and longest nerve in the human body. It plays a critical role in both movement and sensation of the lower body.

It acts like a major “communication highway,” carrying signals:

• From the brain to the muscles (to create movement)

• From the leg back to the brain (to report sensation like touch, temperature, or pain)

Understanding the anatomy can help make sense of your symptoms:

• The lumbar spine (low back) consists of five bones called vertebrae (L1–L5) designed for stability and load-bearing.

• Intervertebral discs sit between each vertebra, acting as shock absorbers.

• Nerve roots exit the spine at each level and combine to form the sciatic nerve, the largest nerve in the body.

• The sciatic nerve runs through the pelvis and down the back of each leg, supplying sensation and muscle control.

What Is Sciatica?

Sciatica is not a diagnosis—it’s a symptom. When a nerve root is irritated or compressed—by a disc, joint, or tight tissue—it can result in sciatica-type symptoms. It describes pain, tingling, numbness, or weakness that travels along the sciatic nerve, typically from the low back or buttock down the back or side of the leg and sometimes into the foot.

It is important to note that nerves are highly sensitive to pressure, stretch, and inflammation- This is why nerve pain can come and go with posture or movement.

Common Causes of Sciatica

• Lumbar disc herniation or bulge pressing on a nerve root

• Spinal stenosis (narrowing of the spinal canal)

• Piriformis or deep hip muscle irritation

• Poor movement mechanics or repetitive strain

• Prolonged sitting, especially with poor posture

  
  

Things to Avoid (or Modify)

While complete rest is rarely helpful, certain habits can slow recovery or worsen symptoms:

• Prolonged sitting or bed rest without movement breaks

• Pushing through sharp or worsening pain during exercise

• Repeated bending and twisting without proper mechanics

• Relying solely on passive treatments (such as heat/cold modalities or massage) without addressing movement and strength

Instead, the goal is smart movement—staying active while avoiding positions or activities that consistently aggravate symptoms.

How a Physical Therapist Can Help

Physical therapy addresses not just symptoms, but the root cause of low back pain and sciatica.

A Physical Therapist Will:

• Perform a thorough evaluation to identify movement restrictions, strength deficits, and contributing factors.

• Help determine whether your symptoms are disc-related, nerve-related, joint-related, or muscular. This is important for getting to the WHY!

• Develop a personalized treatment plan based on your specific presentation.

Treatment May Include:

• Targeted mobility work to reduce stiffness and nerve irritation

• Strengthening exercises for the core, hips, and back

• Postural and movement retraining for sitting, lifting, and daily tasks

• Manual therapy to improve joint and soft tissue mobility

• Education to help you understand your pain and prevent future flare-ups

• Positioning for decompressing your low back

  
  

Positioning For Decompressing Your Low Back:

When the sciatic nerve is irritated and producing pain it can often be reduced simply by finding positions that reduce the pressure and irritation on the nerve. Most often there is a reduction in both low back in a laying down position with the hips in a bent or flexed position. This example of positioning in a doorway is one way to further reduce pressure within the low back. By positioning on the back with hips in flexion and then providing a pressure with a stick in the doorway there is a gentle decompression in the low back and frequently provides opening of spaces for the sensitive structures within the spine. During this process the subject is gently providing pressure on the stick and fully relaxing the midsection of the trunk to allow for relaxation within the back. Only the arm muscles are being engaged to allow for the upper trunk to gently rise away from the hips and pelvis which allows for the most relaxation of the low back.

The ultimate goal is to restore confidence in movement, reduce pain, and give you the tools to stay active long-term.

When to Seek Help

If your low back pain or sciatica:

• Persists longer than a few weeks

• Worsens with activity or daily tasks

• Travels down the leg or causes numbness or weakness

• Keeps you from work, exercise, or sleep

A physical therapist can be an excellent first step toward recovery- even BEFORE you go to see your doctor or undergo imaging.

Do not rely on internet instructions to provide self treatment. Always consult a physical therapist or a health care professional with an expertise in the musculoskelatal system and the spine and low back before attempting self treatment.

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Final Thoughts

Low back pain and sciatica can be frustrating, but they are often very treatable with the right approach. Understanding your body, staying active, and addressing movement quality—not just pain—are key to long-term relief.

Questions? We would love to hear them! Leave a comment below.

About The Authors

Dr. Dawn Thomas DScPT, OMPT is a lover of all things movement and a doctor of physical therapy with over 30+ years of experience. She creates innovative programs for all walks of life, ranging from personalized care to group sessions and online education. Passionate about helping people stay active and independent, she specializes in fall prevention and balance training. Outside of work, you can find her hiking, swimming, adventure traveling, and inspiring her community to move at every age.

Dr. Allison Couzens, PT is a doctor of physical therapy passionate about advocating for clients who have felt dismissed within the traditional health care system. She integrates traditional methods with alternative techniques to optimize client outcomes and improve quality of life. She has certifications and post doctoral training in Exercise Performance Specialist through EXOS, golf assessment expert through TPI, functional dry needling, myofacial soft tissue mobilization, and therapuetic taping. She has a special interest and expertise in neurological conditions, women's health, nutrition and injury prevention for golf and running enthusiasts. When she is not working with clients or honing her skills you can find her baking and having fun with her golden retrievers, Maverick and Goose.