Symptoms
Does this sound like you
- Sharp or burning pain from the back into the buttock and down one leg
- Pins and needles or numbness in the leg or foot
- Leg pain that is worse than the back pain
- Pain that is worse sitting, coughing or sneezing
- Leg pain that changes with how you bend, stand or lie
- A weak leg or foot, or a foot that catches when you walk
- Pain from the neck down the arm, with tingling in the hand
Assessment
We start with how it began: a hard landing on skis, a heavy lift at work, or a slow build over months of sitting. Then we ask where the pain goes and what changes it. Does it run below the knee? Is it worse sitting, coughing or bending forward? A pressed nerve sends symptoms along its own path, so where your symptoms go points to the level of the spine involved.
Next we test the nerve itself: strength in the leg and foot, reflexes, and feeling on the skin. We also move your back and leg in set directions and watch what the leg pain does. Movements that draw the pain back toward the spine (centralization) shape the plan; those that push it further down the leg we avoid for now. If the pain is in the arm, we test the nerves from the neck the same way.
Treatment
Staying active is the first treatment. Walking, changing position often and short spells of the movements that ease your leg pain do more for a pressed nerve than lying still. We also show you how to sit, drive and lift at the pace your symptoms allow.
- Direction-specific movements: repeated movements in the direction the assessment found, which draw the leg pain back toward the spine. You repeat them through the day; we adjust them as the pain moves.
- Hands-on treatment: gentle joint movements (mobilization) and soft-tissue work to ease the back and let it move more freely. See manual therapy.
- Needling for guarding muscles: when the muscles around the back and hip tighten to protect the nerve, fine needles in those tight bands can help them release. We practise it as Gunn IMS or functional dry needling, depending on the physiotherapist's training, and only with your agreement. See IMS and dry needling.
- Graded loading: once the leg pain has drawn back and settled, we load the back on purpose, starting light and adding weight and range in steps. The aim is a back that tolerates bending, lifting and sitting again, for work, study and sport.
Getting back to sport
Before the back takes impact again, the pain should have left the leg and strength on that side should match the other. We test for both, then rebuild what your sport asks of the back. For skiing and snowboarding that is absorbing bumps and landing. In the bike park it is long hours bent over the bars and rough trail. Each step goes ahead when it makes the leg pain no more than a little worse.
The Back Fundamentals series is the home program for this stage. Its three levels and abdominal set train pelvic and spinal movement around the power position, a stance that protects the spine under impact and twisting. We set your starting level and say when to move up.
When to come in
Book an assessment if pain, pins and needles or numbness is running from your back into your leg, or from your neck into your arm. Come in too if the leg hurts more than the back, or if your foot feels weak or catches when you walk.
Go to the emergency department right away, or call 911, if any of these happen:
- numbness around the groin or inner thighs
- trouble passing urine, or losing control of your bladder or bowels
- weakness in both legs, or weakness in a leg that is getting worse
- back pain with a fever
- back or neck pain after a major fall or crash
The people
Who treats it
Partner · PhysiotherapistSport physiotherapy and return to sport · Movement analysis and exercise programming · Complex orthopaedic and post-surgical rehabilitationVillage North · Whistler Athlete Centre
Partner · PhysiotherapistHand and upper-limb rehabilitation · Concussion and vestibular rehabilitation · Sports and spinal injuriesVillage North
Partner · PhysiotherapistComplex neck and back problems · Sports injuries · Concussion and vestibular rehabilitationVillage North
PhysiotherapistPelvic health and pelvic floor physiotherapy · Pre- and post-natal rehabilitation · Sports injuries and post-surgical rehabilitationVillage North · Whistler Athlete Centre
PhysiotherapistRunning injuries · Post-surgical rehabilitation, including ACL and rotator cuff · Concussion and vestibular rehabilitationVillage North
PhysiotherapistACL rehabilitation, with or without surgery · Concussion and vestibular rehabilitation · Running injuriesVillage North
PhysiotherapistSnow sports injuries · Acute sporting knee injuries · Strength and conditioningVillage North · Whistler Athlete Centre
PhysiotherapistPelvic health for men and women · Antenatal physiotherapy · Hip, pelvis and spinal injuriesVillage North · Whistler Athlete Centre
- By referral
Care
How we help
Physiotherapy
Assessment, hands-on treatment and a plan built around your sport, from physiotherapists whose patients compete on the World Cup with Canada's ski and snowboard teams.
Read more ServiceManual Therapy
Joint and soft-tissue mobilization and manipulation from physiotherapists with post-graduate manual therapy training, also called musculoskeletal or manipulative physiotherapy: easing pain by treating the underlying problem, without drugs.
Read more ServiceIMS and Dry Needling
Fine, solid needles placed into tight, tender bands of muscle to help them release, practised here as Gunn IMS or as functional dry needling, depending on each physiotherapist's training.
Read more ServiceRegistered Massage Therapy (RMT)
Manual soft-tissue treatment for pain, muscle tension, spasm and trigger points: restoring mobility and promoting recovery.
Read moreFAQ
The questions we hear most
Do I need a scan for sciatica?
Not usually. Scans often show bulging discs in people who have no pain at all, so a scan on its own rarely changes the plan. Your symptoms and our nerve tests tell us most of what we need to start. A doctor or nurse practitioner can order a scan when your symptoms warrant it, or when surgery is being considered.
Will I need surgery for a disc problem?
A surgeon decides. Most disc and nerve pain settles with time and rehab, so surgery is not the usual path. It is considered when leg pain does not settle despite treatment, or when the leg is getting weaker. If you reach that point, we work with your doctor, nurse practitioner or surgeon, and after an operation your surgeon's timing counts alongside our testing. Until then, the plan is to keep you moving and take the pressure off the nerve.
Is it safe to exercise with sciatica?
Yes, within limits. The exercise we give you is part of the treatment, not a risk to it. The rule is that activity makes the leg pain no more than a little worse, and that the pain does not spread further down the leg afterwards. Bed rest beyond the first day or two tends to leave you stiffer and sorer. We set the starting level with you and raise it as the nerve settles.
Has my disc slipped out of place?
No. Discs do not slip. A disc is a tough ring with a soft centre, fixed firmly between the bones of the spine. When the ring weakens, the centre can bulge out and press on or irritate a nerve beside it, which is what sends pain down the leg. That bulge can settle over time, and the nerve calms with it. This is why keeping the back moving, rather than guarding it, is part of the plan.
This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.