In our last blog, we explained what sciatica is and how it feels different from other types of back pain. To quickly review:
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With sciatica, pain starts in the back and travels into the leg, and the leg pain is usually worse than the back pain.
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If your back pain is more severe than the leg pain, it is often referred pain from irritated muscles, discs, facet joints, or the SI joint. This type of pain usually responds well to posture correction, graded exercises, avoiding certain movements for a while, and hands-on care like physiotherapy, chiropractic treatment, or massage.
But when the sciatic nerve root is affected, treatment often needs to be a little different.
Do I Need Surgery for Sciatica?
One of the biggest questions people with sciatica ask is: “Will I need surgery?”
The good news is that in most cases, sciatica improves with time and therapy without surgery. Surgery is sometimes needed, but usually only if symptoms don’t get better, or if there are serious signs like significant muscle weakness or loss of bladder or bowel control.
Not All Sciatica Is the Same
Because sciatica can be caused by different problems in the lower back, the best treatment depends on the cause of your sciatica. Let’s look at the main types we covered in the first blog:
Lumbar disc herniation (slipped disc) – The most common cause of sciatica.
Typical symptoms: Bending forward, sitting, or moving from sitting to standing is very painful.
Treatment focus: At first, moving too much can make things worse. Instead, working with a therapist to find positions that reduce pressure on the nerve is key. Examples include lying on your stomach over a pillow (prone lying) or a “Z-lye” position. Repeating these positions during the day helps reduce the nerve irritation. Avoiding frequent bending forward, like picking things up from the floor or slouching in a chair, can also help. With time, gentle movement and exercises are added, but starting too quickly often prolongs the issue.
Lumbar spinal stenosis (neurogenic claudication) – Narrowing of the spinal canal caused by a bulging disc and/or bone spurs.
Typical symptoms: Standing or walking makes the leg pain worse, but sitting down makes it better.
Treatment focus: The opposite of disc herniation. Strategies like walking while leaning on a cart, using a gentle pelvic tilt, or taking frequent breaks to sit down or crouch forward can reduce symptoms.
Spondylolisthesis – One vertebra slips forward over another.
Typical symptoms: Sciatica may get worse with bending forward (flexion), backward (extension), or sometimes both.
Treatment focus: Treatment depends on whether the person responds better to flexion or extension positions. A physiotherapist can help figure this out.
Piriformis syndrome – The piriformis muscle in the buttock squeezes the sciatic nerve.
Typical symptoms: Buttock pain that may radiate down the leg, often worse with sitting.
Treatment focus: Stretching, movement strategies, and exercises to reduce tension in the piriformis.
Other causes like trauma, tumors, or cysts are less common but require medical guidance.
Why the Right Diagnosis Matters
The important thing to remember is that not all sciatica is treated the same way. Some people do better by avoiding bending forward for a while, while others actually improve by bending forward. That’s why a proper assessment is so important.
Working with a physiotherapist can help you:
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Figure out whether you truly have sciatica or referred pain.
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Identify which positions and movements are helpful vs. harmful.
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Progress safely from resting positions into graded movement and exercise.
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Avoid activities that may prolong the issue.
Take Action Today
If you are experiencing low back pain or sciatica, don’t wait and hope it goes away. Book an Initial Assessment at North 49 Physiotherapy. Our team can help determine the cause of your pain and get you going in the right direction.
Call us at 306-343-7776 or book online through our website to get started.