Sciatica Treatment: Why It Keeps Coming Back and What to Do About It

Sciatica Is a Symptom. Not a Diagnosis.

Let's clear something up first: sciatica is not a condition. It's a description of where pain travels - down the back of your leg, following the path of the sciatic nerve. Saying you have "sciatica" is like saying you have "a sore arm." It tells you where it hurts. It says nothing about why.

And the "why" is everything. Because until you address the actual driver, the pain keeps coming back. Every. Single. Time.

The Three Most Common Drivers

1. Disc-Related Irritation

The most common cause in people under 50. A disc bulge or herniation compresses or irritates the nerve root as it exits the spine. This usually presents as sharp, electric pain down the leg - often worse with sitting, bending forward, or coughing.

The good news: most disc bulges resolve without surgery. The research is clear on this. But they don't resolve with rest alone. They resolve with progressive loading that allows the disc to heal while maintaining movement and building tolerance.

2. Stenosis (Narrowing)

More common in people over 50. The space around the nerve narrows due to age-related changes - bone spurs, thickened ligaments, disc degeneration. Pain is typically worse with standing and walking, and eases when you sit or lean forward.

Management is different here. Extension-based exercises that help disc bulges can aggravate stenosis. This is why a proper assessment matters - the wrong exercises for your specific driver make things worse, not better.

3. Neural Tension

The nerve itself becomes sensitised and doesn't glide properly through the tissues around it. You might feel tightness, burning, or pins and needles - especially with stretching or certain positions. The nerve isn't compressed; it's irritated and stuck.

This responds to nerve gliding techniques and progressive exposure to the movements that provoke it - not aggressive stretching (which usually makes it worse).

Why Most Sciatica Treatment Fails

Because most treatment is generic. You get the same stretch sheet regardless of what's driving your pain. You get told to "rest and take anti-inflammatories." You get 6 sessions of massage and manipulation that feel great for 48 hours and then the pain returns.

None of that addresses the driver. None of it changes your capacity to tolerate load. And none of it stops the cycle.

Effective sciatica treatment requires three things:

1. Identify the driver. Is it disc, stenosis, or neural tension? Each one requires a fundamentally different approach. Get this wrong and you're spinning your wheels.

2. Progressive loading. Once the driver is identified, the structures involved need to be loaded progressively. This means exercises that challenge the system slightly beyond its current capacity - consistently, over weeks. Not one good week followed by a flare because you did too much.

3. Address the whole system. Sciatica rarely exists in isolation. Hip stiffness, weak glutes, poor trunk stability, deconditioning from months of avoiding activity - these all contribute. The nerve is the symptom. The system is the problem.

What a Structured Approach Looks Like

Week 1-2: Settle the acute irritation. Find positions and movements that reduce symptoms. Begin gentle nerve gliding and pain-free loading. The goal isn't to "fix" anything yet - it's to give the system some breathing room.

Week 3-6: Progressive strengthening. Hip, core, and lumbar spine exercises tailored to the specific driver. Load increases systematically. Flare management protocol in place so you know exactly what to do if symptoms spike.

Week 7-12: Capacity building. Heavier loading, functional movement patterns, return to the activities that were previously limited. The goal is to build enough capacity that the structures involved can handle your life without complaining.

The Stretching Myth

If you've been told to stretch your hamstrings and piriformis to fix sciatica, I need you to hear this: aggressive stretching of an irritated nerve makes it worse.

When you stretch into that "good pain" down your leg, you're not releasing tension. You're pulling on an inflamed nerve. It feels like it's doing something - and it is. Just not what you want.

Gentle nerve glides: yes. Aggressive hamstring stretches: no. This is one of the most common mistakes I see in my clinic.

When to Get Help

If your sciatica has lasted more than 6 weeks, or if it's limiting your ability to train, work, or sleep - you need a proper assessment. Not a Google diagnosis. Not a stretch video. A structured evaluation of what's driving the pain and a plan to systematically resolve it.

At Feel Good Physio Co. in Greenfields, Adelaide, that's exactly what you get. Stop managing the symptom. Start fixing the system.

Book a consultation or learn about The Comeback Code for recurring injuries.