Physiotherapist's guide
Sciatica: why the pain runs down your leg and what to do so it does not stop you
Pain that starts in your lower back and runs down your buttock to your foot is not “a strain”: it is a nerve warning you. Here is why it happens and what really helps.
What sciatica is (and what it is not)
The sciatic nerve is the thickest nerve in the body. It leaves the lumbar area, crosses the buttock and runs down the back of the leg to the foot. When something irritates it along that path, the pain follows the same route and we call it sciatica.
One common confusion is worth clearing up: sciatica is not a diagnosis, it is a symptom. Behind it there may be a disc herniation, a narrow spinal canal, a deep gluteal contraction or simply a sensitised nerve. Treatment is not the same in each case, which is why the assessment matters.
Why the pain travels down and does not stay in the back
When a nerve root is irritated, the signal travels along the whole nerve: hence the tingling in your toes or the feeling of an electric current. The area that hurts is not always the area that is irritated, and confusing the two leads to treating the wrong place.
If the pain has lasted for months, the nervous system also learns to protect that path: the alarm stays switched on. Sitting for long hours, sleeping badly or living in fear of movement keep it that way. That is why some people improve with medication and then relapse: the symptom calmed down, but the alarm was still on.
What actually helps
- Measured movement from day one. Staying still calms you for a while and then makes everything worse.
- Mapping the exact path of the pain and which movements set it off, so you stop avoiding all of them.
- Working on posture and breathing (RPG): sciatica almost always coexists with a hip and lower back that do not coordinate.
- Adjusting your workstation and your sitting hours: it is the most common trigger I see in consultation.
- Returning to walking distances, in stages, until you get your life back.
What is worth stopping
- Prolonged bed rest.
- Forcing stretches on the nerve “so it releases”: it usually irritates it more.
- Deep massage on the buttock as the only treatment; it relieves today and returns tomorrow if the cause is still there.
- Long walks on the day you feel better, to “make the most of it”: that is the classic relapse.
- Self-medicating with painkillers for months without looking at the cause.
Warning signs
When not to wait and to seek urgent care
Some signs are not handled over WhatsApp or with exercises. If any of these appear, go to an emergency department today:
- Progressive weakness in the leg or foot (your foot trips as you walk).
- Numbness in the area that touches a bicycle saddle: between the legs and the genitals.
- Difficulty urinating, or losing control of your bladder.
- Pain that started after a hard blow or a fall.
- Fever, unexplained weight loss or a history of cancer.
- Pain that wakes you every night and does not ease in any position.
Questions I get about this
Does sciatica go away on its own?
It can settle within weeks, but it often comes back if the cause is not corrected. Behind it there is almost always a posture pattern, long hours sitting and a nervous system on alert: that does not resolve with time alone.
Can I walk with sciatica?
Almost always yes, and you should. The detail is the dose and the distance: we start short and frequent, and build up according to how your leg responds.
Is sciatica the same as a herniation?
No. A herniation is one possible cause of sciatica, which is the symptom. There is sciatica without a herniation, and herniations that never cause sciatica.
What if I have already had spine surgery?
We work on it too, with different timings and precautions. The assessment reviews what was done and where you are now.
Do you see patients outside Medellín?
Yes. Assessment and sessions are virtual: I work from Medellín for any country, in Spanish or English.
Educational content
Written and reviewed by Juliana Lopera Isaza . Physiotherapist specialised in the spine, RPG and pain neuroscience.
Sciatica that will not settle needs a plan, not patience
Tell me where the pain travels and what you have tried. In the assessment I will tell you whether I can help.