What Is Sciatica — and Can It Be Treated Without Surgery?

Sciatica is a common term used to describe a specific type of nerve-related leg pain. While it’s often thought of as a condition in itself, sciatica is actually a symptom, not a standalone diagnosis. It refers to irritation or compression of the sciatic nerve, which runs from the lower back through the hips and buttocks, and down each leg. This can cause a combination of pain, tingling, numbness, or weakness, usually affecting one side of the body. Understanding the underlying cause of sciatica is key to choosing the most appropriate treatment — and for most people, that does not involve surgery.

Sciatica often leads to debilitating lower back and buttock, which radiates down the back of the leg.

Understanding the Symptoms

Sciatic pain may be felt:

• In the buttock, hamstring, or calf

• As a shooting or burning pain, often aggravated by movement or sitting

• With associated numbness, pins and needles, or muscle weakness

• On one side of the body (although both sides can be affected in rare cases)

Symptoms often fluctuate with activity levels, posture, and time of day.

What Causes Sciatica?

The most well-known cause is a lumbar disc herniation, where the disc material presses on one of the lumbar nerve roots. However, other causes are common and often overlooked. These include:

• Chemical irritation of the nerve from inflammation in spinal structures

• Piriformis syndrome, where the nerve is compressed by deep gluteal muscles

• Sacroiliac joint dysfunction leading to referred symptoms

• Deconditioning, poor load tolerance, or altered movement patterns

• Neural sensitivity or sensitisation, where the nervous system becomes more reactive to movement or load

  
  

It’s important to note that disc bulges are frequently found in people without pain. Imaging alone is rarely enough to determine the cause of symptoms (Steffens et al., 2016).

Why Stretching and Rest May Not Be Effective

Traditional approaches to sciatica often involve rest, stretching, or foam rolling. While these may offer temporary relief, they don’t always resolve the problem — especially when the pain is related to instability, poor neuromuscular control, or sensitisation of the nerve tissue.

In some cases, over-stretching may even increase nerve irritation or delay recovery.

An active, structured approach based on individual assessment tends to produce better long-term outcomes. This involves understanding how different parts of the body contribute to load management, movement control, and nerve sensitivity.

Although stretching can offer temporary relief, it's often ineffective with over-stretching potentially delaying recovery

What an Evidence-Based Approach Looks Like

A more effective way to manage sciatica often includes:

• Thorough biomechanical assessment, looking at how the spine, pelvis, and limbs work together

• Testing for strength and control, particularly in the glutes, trunk, and lower limb

• Identification of compensatory movement patterns, such as stiff ankles or overactive hip flexors

• Progressive loading, rather than complete rest or avoidance

• Graded exposure to movement, helping to desensitise the nervous system

• In some cases, manual therapy to address secondary issues like joint restriction or muscular tension

  
  

This approach is informed by a biopsychosocial understanding of pain — recognising the role of physical, emotional, and behavioural factors in both pain and recovery (Cheng et al., 2020).

Is Surgery Necessary?

Surgery may be considered in rare cases, particularly when there are signs of serious neurological compromise — such as foot drop or changes to bowel or bladder control.

However, the majority of people with sciatica recover without the need for surgical intervention. A large body of evidence supports conservative treatment — especially strength-based rehabilitation combined with education and self-management strategies (Deyo et al., 2009).

Even when disc herniation is involved, natural healing processes often lead to improvement over time, particularly when supported by appropriate movement and loading strategies.

Key Takeaways

• Sciatica is a symptom, not a diagnosis — and the underlying cause varies from person to person

• It can be related to discs, joints, muscles, or nervous system sensitivity

• Stretching or resting may help temporarily, but long-term change often requires a structured, active approach

• Most cases resolve without surgery, especially with assessment-led, strength-based rehabilitation

• Understanding your body’s movement patterns and how they contribute to symptoms is central to recovery

References

Cheng, Y., MacIntyre, T. E. and Igou, E. R. (2020) ‘A biopsychosocial analysis of low back pain and disc herniation’, Journal of Pain Research, 13, pp. 3831–3843. Available at: https://doi.org/10.2147/JPR.S279707

Deyo, R. A., Mirza, S. K., Turner, J. A. and Martin, B. I. (2009) ‘Overtreating chronic back pain: Time to back off?’, Journal of the American Board of Family Medicine, 22(1), pp. 62–68. Available at: https://doi.org/10.3122/jabfm.2009.01.080102

Steffens, D., Maher, C. G., Pereira, L. S. M., et al. (2016) ‘Prevention of low back pain: A systematic review and meta-analysis’, JAMA Internal Medicine, 176(2), pp. 199–208. Available at: https://doi.org/10.1001/jamainternmed.2015.7431