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Common Conditions

Sciatica

Symptoms, Common Causes and Treatments

Understanding Sciatica and Its Causes

Sciatica refers to pain that radiates along the sciatic nerve, which extends from the lower back or buttocks down through the back of the legs. This condition can vary from mild discomfort to severe pain and may include symptoms such as numbness or weakness that impact daily activities. Sciatica is not a standalone diagnosis but rather a symptom resulting from various underlying conditions. Common causes include:

  • Herniated Lumbar Discs: A condition where the discs in the lower spine bulge or rupture, potentially compressing the sciatic nerve.
  • Spinal Stenosis: The narrowing of the spinal canal, which can exert pressure on the nerve roots.
  • Deep Gluteal Syndrome: Tightness or injury in the deep gluteal muscles that can irritate or compress the sciatic nerve.
  • Trauma: Injury to the lower limbs affecting the sciatic nerve.

Symptoms of Sciatica

The presentation of sciatica symptoms typically follows a dermatomal pattern, reflecting the specific nerve root affected. Symptoms may include:

  • Pain radiating from the lower back to the back of the leg, potentially reaching the knee or foot.
  • Accompanying low back pain.
  • Numbness or tingling in the affected areas.

To assist in diagnosis, the physiotherapist will conduct a simple Slump Test to identify the potential underlying cause of the patient’s sciatica: while seated in a relaxed slumped posture, the patient looks down, flexes the head, and extends the symptomatic leg with toes pulled up.

Comparison of true and pseudo-sciatica

True or Pseudo-Sciatica? How to Tell the Difference

Many patients assume they have sciatica as soon as they feel pain in the lower back or buttocks radiating down to the thigh or calf. However, in clinical physiotherapy assessment, we distinguish between "True" and "Pseudo" Sciatica. Understanding this difference is vital for effective sciatica treatment.

True Sciatica (Radiculopathy)

True sciatica is a medical condition known as Radiculopathy. It is typically caused by structural issues in the lumbar or sacral spine, such as a herniated disc, bone spurs, or spinal stenosis. When these structures compress the sciatic nerve (most commonly at the L5 or S1 levels), it triggers intense radiating pain.

Symptoms: Pain travels from the back and glutes down to the calf or foot.

Neurological Signs: Accompanied by numbness, tingling, muscle weakness, or difficulty moving the toes and walking.

Pseudo-Sciatica (Referred Pain)

Pseudo-sciatica is not caused by direct nerve compression but by "referred pain" from inflamed soft tissues or tight muscles. For example, when deep gluteal muscles (like the piriforms) become overstretched or inflamed, pain signals spread through the myofascial network.

Distinguishing Features: The pain rarely extends below the knee. Crucially, because the nerve is not compressed, patients do not experience numbness or loss of sensation in the foot.

Comprehensive Approach to Managing Sciatica

Effective management of sciatica involves addressing the underlying cause of the symptoms. At Mobilize, we employ a comprehensive approach including:

Manual Therapy

Joint mobilizations for the hip and lumbar spine, soft tissue therapy to alleviate pressure on the sciatic nerve and reduce pain

Exercise Therapy

Nerve gliding exercises to improve nerve mobility, exercises to enhance the function of surrounding muscles and promote overall comfort.

Electrical Modalities

Utilizing therapies such as shockwave therapy, interferential therapy, and high-energy inductive therapy for acute pain relief

Dry Needling

Applying acupuncture techniques to relax tight deep gluteal muscles, which may be contributing to nerve compression

Patient Education

Explaining the causes of sciatica and advising on modifying daily activities for pain management. Our physiotherapist will also be guiding on proper posture to prevent future episodes.

 Through appropriate and comprehensive treatment approaches, most cases of sciatica can be effectively managed with conservative treatments.

Do I Need an X-ray or MRI for Sciatica?

When faced with sudden, severe lower back and leg pain, many patients’ first reaction is: “Do I need to get an X-ray or MRI immediately to find the cause?” In fact, for the majority of sciatica cases, early imaging is not absolutely necessary. A physiotherapist will provide professional medical advice based on the patient’s clinical presentation.

The Limitations and Myths of Imaging

Research shows that 70-80% of adults have some spinal degeneration (like mild disc protrusion) that is a natural part of aging. Many people have a herniated disc on an MRI but experience zero pain. Imaging "abnormalities" are not always the culprit.

When is an MRI or X-ray Necessary?

At MOBILIZE, we advocate for a "Clinical Signs First" approach. Our experienced physiotherapists conduct thorough consultations, neurological screenings (including reflex, sensation, and muscle strength testing), and specific orthopedic assessments to accurately evaluate the severity and exact location of sciatic nerve compression.

For most acute flare-ups of sciatica, we typically recommend a four-to-six-week period of conservative treatment. This includes manual therapy, electrotherapy for inflammation, and targeted rehabilitative exercises. If any of the following symptoms are identified during our assessment, our physiotherapists will strongly advise the patient to seek immediate specialist medical attention and undergo a detailed MRI scan:

  1. Severe neurological deficit (inability to stand or walk).
  2. Signs of Cauda Equina Syndrome (numbness in the “saddle area” or groin).
  3. Sudden bowel or bladder incontinence.
  4. No improvement after 6–8 weeks of active sciatica treatment.
  5. History of cancer, trauma, or unexplained fever/weight loss.

Frequently Asked Questions

Massage can be a supportive treatment, but it needs to be combined with other therapies like exercise and acupuncture for lasting relief.

Not all lower limb numbness comes from the spine, scatica-like symptoms (Pseudo Sciatica) can also arise from muscle tightness, peripheral nerve entrapment and increased neurotension. Detailed physical examination is essential to understand the root cause of symptoms.

Worsening sciatica can lead to muscle weakness, sensory issues, and even bowel/bladder problems. Prompt professional treatment is crucial.

Sciatica has a high recurrence rate, often due to unresolved underlying causes, failure to adjust lifestyle, and weak core muscles.

Referral

Seek immediate medical attention if sciatica symptoms worsen rapidly, affecting both legs and accompanied by bowel or bladder dysfunction. These signs may indicate a serious condition requiring urgent medical intervention.

Testimonials & Reviews

Sharing my experiences with Mobilize, I've been fortunate to step away from the commercial physios that are the usual options post a specialist visit...

I've had a myriad of issues sadly and lived with much of it as I assumed after long periods of rehab in "traditional physios" I by chance got referred by a friend and forever thankful as I had ACL reconstruction where I suffered for near on 2 years until the approach adopted by Avery from Mobilize gave me hope and the direction + progress led me to return back to sports... and obstacle course racing (where it was torn in the first place), had sciatica which was carefully treated, then I had ankle sprain with mixture of grade 1 and 2 tears after a trial run...

It's one of those secrets you don't want to share as booking because a challenge but everyone deserves to benefit from Mobilize Physiotherapy... Back again recently after rugby injury led to high ankle grade 2 tear on the ATibFib ligament... Avery was able to diagnose the exact injury without the MRI results coming back... They've just expanded and it's fully stacked!
Alex Pang
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Physiotherapist Will had been thorough and efficient on my recovey from a surgery of a bone fracture. He was thoughtful with the treatment based on my Orthopedist's doctor's note on the limitations during each recovery stage.

Throughout the sessions , whenever there's indescribable uncomfort throughout the progress of my recovery, Will had been patient to diagonise and advise on the next course of action, including listing questions to advise for my follow up appointments from my Orthopedist. His programme of the training sessions were tailored-made on building up specific weaker muscle groups, and I apprechiate his close attention to details on finding out the limiting factors during recovery.

The appointments with the receptionist were seamless and they were flexible with my work schedule.
Ben Chan
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I had never been a believer in physio therapy in the past or that my experience with multiple chain medical physiotherapy center had brought me nothing but temporary improvements. Until I had came across mobilize physiotherapy where they take the extra mile to examine your situation and tailor a physiotherapy session. The physiotherapists at Mobilize not only identifies the root cause and provide massages for pain relievers but also to provide take home exercises for improvements. I was never rush out the door for the next session and they ensure that I had receive the right treatment before the session ends.
I would highly recommend this physiotherapy center.
Edmond Chan
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I went to MOBILIZE while on holiday here in Hong Kong, visiting from the UK and had an excellent experience. The physio Will was empathetic and incredibly thorough - more so than any physio I’d met with back home. As opposed to only providing me with temporary relief, there was genuine interest to get to the bottom of the back/neck issues I’d been suffering with for a number of years.

I can’t thank Will and the MOBILIZE staff enough for booking me in for multiple appointments on such short notice, giving me some relief from my pain and, most i
William Burdett
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I can't recommend my physio partner enough! They are always patient and provide valuable guidance to help me relieve chronic pain and improve my performance in jiu-jitsu. Their expertise has been invaluable to me. Highly recommended!
Felix Kung
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I hurt my back whilst I was in Hong Kong. The physiotherapist at Mobilize was very knowledgeable and professional. I don't proclaim miracle workers but the treatment definitely helped my strained back and allowed me to continue my holiday with much comfort. The facility is clean and the staff are professional and speak English.
Dominic Teo
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