What Is Sciatica?

(Symptoms, causes, how long it lasts, and what actually helps)

(Updated February 2026)

“Sciatica” is a common term, but it’s often misunderstood. Many people use it to describe any pain in the back of the hip or leg — but true sciatica usually means nerve-root irritation in the low back that can cause leg pain, numbness, tingling, or weakness.

The good news: most cases improve with time and the right conservative plan — especially when you stay active and build back tolerance gradually.

What sciatica is (and what it isn’t)

Sciatica (most accurate meaning)

Sciatica typically refers to lumbar radiculopathy — irritation or compression of a lumbar nerve root that creates symptoms down the leg (often below the knee).

Not always sciatica

Pain in the glute/hamstring area can also be:

• Referred pain from the low back (not nerve-root)

• Hip-related pain

• Muscle/tendon irritation

• General sensitivity/tightness

That’s why the exam matters — the plan is different depending on what’s driving the symptoms.

Common sciatica symptoms

Sciatica often includes leg-dominant symptoms, such as:

• Sharp, burning, or electric pain down the leg

• Numbness or tingling into the calf/foot

• Pain that changes with positions (sitting, bending, coughing/sneezing)

• Weakness in the leg or foot (in more significant cases)

Some people have back pain with it; others mostly feel it in the leg.

What causes sciatica?

Common causes include:

1) Lumbar disc herniation

A disc bulge/extrusion can irritate a nerve root and cause radiating symptoms.

A reassuring note: disc herniations can shrink/resorb over time, and that’s one reason symptoms often improve with conservative care.

2) Lumbar spinal stenosis

Narrowing around the nerves (more common with age) can lead to leg symptoms, often worse with walking/standing and better with sitting or bending forward.

3) Irritation without major compression

Sometimes symptoms are driven more by inflammation/sensitivity than a dramatic “pinch.” The plan is still usually conservative first.

How long does sciatica last?

Many cases improve with conservative care. In a major study of sciatica from lumbar disc herniation, it’s commonly expected to improve over time, and a large portion of patients improve within months.

Also, evidence shows disc herniations can resorb in many patients treated conservatively (rates vary by herniation type).

Practical timeline (typical, not a promise):

• First 2–6 weeks: symptoms often change noticeably (better or worse) as irritability settles and tolerance improves

• 6–12 weeks: many people can regain function with the right plan

• >3 months: still treatable — but you may need a more structured progression and/or a medical consult depending on severity

Red flags: when sciatica needs urgent medical attention

Seek urgent care immediately if you have:

• Loss of bowel/bladder control

• Numbness in the groin/saddle region

• Rapidly worsening or significant leg weakness (e.g., foot drop)

• Severe symptoms after major trauma (fall, car accident)

These can indicate serious conditions that require immediate evaluation.

What to do right now (first 7–14 days)

1) Keep moving — but dose it

Guidelines consistently recommend self-management advice and staying active rather than bed rest.

Simple plan:

• Short walks (even 5–10 minutes, multiple times/day)

• Change positions often (don’t marinate in one posture)

• Avoid repeatedly “testing” painful positions every hour

2) Find your “tolerable direction”

Some people feel better with:

• Gentle back extension work (standing press-ups)
  Others feel better with:

• Slight flexion bias (knees-to-chest positioning, short periods)

A PT exam helps identify which direction reduces symptoms and which irritates them.

3) Modify lifting temporarily

This is not “never lift again.” It’s “reduce the spike.”

• Avoid heavy bending + twisting under load early on

• Keep loads closer to your body

• Use hip hinge strategies and smaller ranges at first

Do you need an MRI for sciatica?

Often, not right away.

NICE guidance recommends imaging mainly in specialist settings and only if results are likely to change management.
ACR guidance similarly supports imaging when there are red flags or when symptoms persist despite an appropriate trial of conservative care.

When imaging is more likely to be appropriate:

• Red-flag symptoms (above)

• Significant/progressive neurological deficit

• Symptoms not improving after a solid course of conservative care

• When planning injections or surgery

What physical therapy does for sciatica

Sciatica is not just about “stretching the piriformis.” Effective PT focuses on:

• Reducing nerve irritation and improving symptom behavior

• Restoring mobility where it’s limited (hips, thoracic spine, low back)

• Building strength and endurance so your spine and legs tolerate life again

• Graded return to sitting, walking, lifting, and workouts

NICE recommends exercise approaches and notes manual therapy can be considered only as part of a package that includes exercise (not as a standalone).

At Quincy Physical Therapy, sciatica plans often blend:

• Targeted exercise progression (symptom-guided)

• Movement retraining and load management

• Supportive hands-on care like Manual Physical Therapy when it helps you move and train better

• When appropriate, Dry Needling to reduce protective muscle guarding so you can progress rehab

• Low Back Pain Physical Therapy

• Strength Training and Performance to properly progress and regain function under supervision

What about injections or surgery?

Epidural steroid injections

Evidence supports that epidural steroid injections can help short-to-medium-term pain relief for some people with disc-herniation-related sciatica — they’re often used to reduce pain enough to keep progressing conservative care.

Surgery

Surgery can be appropriate when there is:

• Progressive neurological deficit

• Severe symptoms not improving with conservative management

• Clear imaging correlation and functional limitation

One high-quality trial found that surgery and conservative care both improved outcomes, with surgery often improving symptoms faster for some patients with persistent sciatica due to disc herniation.

Sciatica FAQs

Is sciatica the same as piriformis syndrome?

Not usually. True sciatica most often involves the spine/nerve root. Piriformis syndrome is less common and needs a different clinical picture.

Should I stretch my hamstrings?

If stretching helps without increasing leg symptoms, fine — but aggressive stretching can flare symptoms in some people. Sciatica is often more about nerve irritability and load tolerance than “tightness.”

Why does it hurt more when I sit?

Sitting can increase disc/nerve irritation for some people and reduce movement variability. Your plan should include graded sitting tolerance and movement breaks.

How do I know if my symptoms are getting worse?

Watch for progressive weakness, increasing numbness, or rapidly worsening pain that isn’t changing with positions — those are reasons to get evaluated.

References

Follow Quincy Physical Therapy on Facebook, LinkedIn, and Instagram!