2 November 2026 · Flora Muijzer · 6 min read
Sciatica: why the pain runs down your leg, and how to find the real source
Leg pain from sciatica? Physio Flora in Calahonda finds the true source with McKenzie therapy, manual therapy, and dry needling. Home visits in Marbella.
Sciatica can cause pain from the lower back through the buttock and down the leg.
Sciatica is not a diagnosis. It is a symptom, and the same leg pain can come from at least three very different sources. That is why one person recovers with a few simple exercises while another gets worse with the same advice.
The good news is that most sciatica improves with the right plan. However, "the right plan" depends entirely on finding where the nerve is being irritated.
In this guide, you'll find:
- What sciatica actually is, and what it is not
- What's happening in the nerve and surrounding tissue (with a deeper-dive option)
- The most common causes of sciatica in active people
- How we diagnose the root cause at Physio Flora
- Our physiotherapy treatment options for sciatica
- Three physiotherapist-approved exercises to start today
- Answers to the questions our patients ask most
What is sciatica?
The sciatic nerve is the thickest nerve in the body. It starts from several nerve roots in the lower back, passes through the buttock, and runs down the back of the leg.
Sciatica describes pain that follows this path. It is usually felt in the buttock, the back of the thigh, or the calf and foot. Some people also feel tingling, burning, or numbness.
Importantly, the pain often feels worse in the leg than in the back. As a result, many people treat the leg and miss the true source higher up.
Deep dive
Go deeper: the tissue science
This section goes deeper into the physiology for readers who want it. Skip ahead to "Common causes of sciatica in active people" if you'd rather get straight to the practical guidance.
Nerve tissue is made of nerve fibres wrapped in protective layers of connective tissue. A healthy nerve slides and stretches as you move. When it is compressed or inflamed, this movement becomes restricted and the nerve becomes sensitive.
The most common mechanism is irritation at the nerve root. A spinal disc has a tough outer ring and a soft inner core. If the core pushes against the ring, or through it, it can press on a nearby nerve root. In addition, the disc material releases chemicals that inflame the nerve, which is why the pain can feel sharp or electric.
Other mechanisms exist. Narrowing of the space where the nerve exits the spine, called foraminal stenosis, can pinch the root. Tight deep gluteal muscles can also compress the nerve further down, in the buttock.
Healing follows the usual phases, but nerve and disc tissue behave differently from muscle. The inflammatory phase lasts roughly the first one to two weeks. During this time, pain is often at its highest. The repair phase then runs from about two to six weeks, as irritation settles and the nerve tolerates more movement. Remodelling can continue for three months or longer. A disc bulge can also shrink on its own over several months, because the body gradually absorbs displaced disc material.
Two things change this timeline. Long-standing compression can leave the nerve sensitive for longer. Meanwhile, true nerve damage, which shows as progressive weakness, recovers much more slowly and needs medical review.
Common causes of sciatica in active people
Sciatica has several typical triggers. In active patients, we most often see:
- A disc bulge or herniation in the lower back, often after heavy lifting, rotation, or prolonged sitting
- Repeated forward bending, such as in golf swings, rowing, or long hours on a road bike
- Deep gluteal syndrome, where tight muscles in the buttock irritate the nerve (sometimes called piriformis syndrome)
- Spinal narrowing, which is more common after the age of 50
- A sudden increase in training load without enough recovery
Long drives and desk work add to the problem. Sitting increases pressure on the lower discs, so symptoms often build gradually through the day.
How we diagnose the root cause at Physio Flora
Because sciatica has several sources, assessment comes before treatment. Our examination typically includes:
- A detailed history of where the pain starts, what eases it, and what makes it worse
- Repeated movement testing, which shows whether the leg pain moves closer to the spine (called centralisation) or further away
- Nerve tension tests, such as the straight leg raise and slump test
- Strength, reflex, and sensation checks to see whether the nerve root is affected
- Hip and buttock examination to rule out deep gluteal syndrome or hip problems that mimic sciatica
Centralisation matters. When leg pain retreats toward the back during movement testing, the outlook is generally favourable. It also tells us which direction of movement helps.
We refer for medical review urgently if you have loss of bladder or bowel control, numbness around the groin, or fast-worsening leg weakness. These are rare but serious signs.
Our physiotherapy treatment options for sciatica
Treatment is matched to the source of the irritation.
McKenzie method. For disc-related sciatica, McKenzie assessment identifies the movements that reduce leg symptoms. As a result, you receive a short, specific exercise plan you can repeat at home. Many patients feel the leg pain move upward and fade within days.
Manual therapy. Joint mobilisation and soft tissue work reduce stiffness in the lower back and hips. Therefore, the spine moves more freely and nerve irritation can settle.
Dry needling. Needling of the deep gluteal and lower back muscles reduces protective tension. In addition, it can ease the buttock pain that often travels with sciatica.
Nerve mobilisation. Gentle sliding movements help the nerve glide more freely. We introduce these only once irritation has calmed.
Sports massage. Soft tissue work through the glutes, hamstrings, and calves reduces compensatory tightness during recovery.
Sports performance coaching. Once pain settles, EXOS-based coaching rebuilds hip and trunk strength. We also correct the movement patterns that overloaded the spine, whether in a golf swing, a cycling position, or a lifting technique.
Most patients with sciatica do not need surgery. Even so, we coordinate imaging and specialist referral when symptoms do not improve as expected.
Three physiotherapist-approved exercises to start today
Move within a comfortable range. If leg symptoms spread further down the leg, stop that exercise and book an assessment.
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Walking. Walk for five to ten minutes, several times a day. Gentle, regular movement is usually better for irritated nerves than bed rest.
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Lying on your stomach, then propping on your elbows. Lie face down for a minute, then rest on your elbows for a minute. This sometimes reduces disc-related leg pain. Stop if the leg pain gets worse or moves further down.
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Glute bridge. Lie on your back with knees bent. Lift your hips, hold for three seconds, and lower slowly. Do ten repetitions. This builds the buttock strength that supports the lower back.
Because sciatica varies so much, the right exercise for you may be different. A proper assessment avoids guesswork.
Answers to the questions our patients ask most
Is sciatica the same as back pain?
No. Back pain is felt in the spine itself. Sciatica is nerve-related pain that travels into the leg, and it often comes with back pain but not always.
How long does sciatica last?
Most episodes improve significantly within six to twelve weeks. However, the timeline depends on the cause and how early treatment begins.
Should I rest if I have sciatica?
Short rest is fine on the worst days. However, staying inactive for long tends to prolong symptoms. Gentle, guided movement usually helps recovery.
Do I need an MRI?
Not usually. Most sciatica is diagnosed from the clinical examination. Imaging is useful when symptoms persist, worsen, or involve significant weakness.
Can I keep playing golf, cycling, or running with sciatica?
Often yes, with modifications. We adjust load, position, and technique so you can stay active while the nerve settles.
When should I worry?
Seek urgent care for bladder or bowel changes, numbness in the saddle area, or rapidly worsening leg weakness.
Leg pain that follows a nerve is a signal, not a sentence. Find the source, and the plan becomes clear.
At Physio Flora, we combine thorough clinical assessment with evidence-based treatment and a genuine understanding of an active lifestyle, wherever it's lived. No referral needed. Consultations available in English, Dutch, German and Spanish. Same-week appointments available.
Your sciatic nerve runs from your spine to your toes. Give it an assessment that looks at the whole path.
Physio Flora · English, Dutch, German and Spanish-speaking physiotherapy on the Costa del Sol · Specialising in spine and nerve-related pain, McKenzie therapy, and sports rehabilitation