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Sciatica: what it is, why it happens and how physiotherapy helps
Pain running down the leg from the buttock: what sciatica is, causes, warning signs and how physiotherapy helps with graded movement.
Short answer: sciatica is pain that runs from the lower back or buttock down the back of the leg, sometimes with tingling or numbness. It is a symptom: it is almost always caused by irritation of a sciatic nerve root in the lower spine. Many cases are managed with graded movement and guided exercise, but some warning signs need a doctor right away.
First: when to see a doctor or go to the emergency room
Seek care immediately if you have:
- Difficulty urinating, incontinence or loss of bowel control.
- Numbness in the genital area or between the legs ("saddle area").
- Increasing weakness in the leg or foot (for example, the foot "drops" when walking).
- Symptoms in both legs, fever, unexplained weight loss, a history of cancer or a recent hard fall or blow.
What is the sciatic nerve and why does it hurt?
It is the longest nerve in the body: it is formed by roots leaving the lumbar and sacral spine and runs through the buttock and the back of the thigh. When a root is irritated or compressed, pain is felt along its path, even though the source is in the back.
Common causes
| Cause | What happens |
|---|---|
| Disc herniation or bulge | The disc irritates a nerve root; the most common cause |
| Lumbar spinal stenosis | Narrowing that usually bothers more when walking or standing and eases when sitting |
| Others | Degenerative changes, spondylolisthesis; less often, causes the doctor needs to investigate |
"Piriformis syndrome" is often mentioned, but it is a debated diagnosis and should be assessed by a professional.
Typical symptoms
- Pain running down the buttock and the back of the leg, sometimes worse than the back pain.
- Tingling, burning or numbness in the leg or foot.
- Pain that changes when sitting, coughing, sneezing or bending.
How physiotherapy helps
- 60-minute assessment: history, red flags, basic neurological tests (strength, sensation, reflexes) and which postures ease or aggravate it.
- Education: understanding what is happening reduces fear of movement; pain does not always mean damage.
- Graded movement and [therapeutic exercise](/es/herramientas/ejercicio-terapeutico): relief positions, tolerable mobility and progressive trunk and leg strength.
- Manual therapy when it makes moving with less pain easier.
- Day-to-day plan: how to sit, work, sleep and return to physical activity, with exercises in my exercises and reassessments. If there is no progress, we advise you to see a doctor.
What usually helps at home and what does not
- Helps: staying active with short walks, changing position often, finding the postures that ease it.
- Avoid: prolonged bed rest, forced stretches that increase tingling, sudden heavy lifting while pain is high.
- Medication is prescribed by your doctor.
See our physiotherapy for back pain in Medellín service or read about exercise and chronic pain.
Frequently asked questions
What is sciatica? It is pain that follows the path of the sciatic nerve: from the lower back or buttock down the back of the leg, sometimes to the foot, with or without tingling. It is a symptom, not a diagnosis; the most common cause is irritation of a nerve root in the lower spine. Does sciatica go away on its own? Many episodes improve over time with conservative care, but the course is individual. If you have loss of strength, bladder or bowel changes, or worsening pain, see a doctor without waiting. Is bed rest better? Staying active within tolerable limits is generally recommended over prolonged bed rest, adjusting activities that increase pain. Your doctor or physiotherapist will tell you what suits your case. What does a physiotherapist do for sciatica? They assess how pain relates to postures and movements, screen for red flags, explain what is happening and design a plan with graded movement, exercise and, when helpful, manual therapy, with reassessments. What about sciatica during pregnancy? Lower back and buttock pain is common in pregnancy. Talk to your obstetrician and mention it when booking; the assessment is adapted to your stage.
Book your assessment
If pain runs down your leg and limits sitting, walking or sleeping (with no warning signs), an assessment helps make sense of the problem. Book your 60-minute assessment via WhatsApp or at /es/agenda. Private, one-to-one (1:1) care at Torre Médica El Tesoro 2, El Poblado, Medellín. We also see patients in English.
This content is for educational purposes and does not replace an assessment by your doctor or physiotherapist.