Sciatica: Symptoms, Causes, and Non-Surgical Treatment Options

Sciatica is one of the most painful and debilitating conditions that a physiotherapy clinic sees. The term describes pain that travels along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. In most cases, sciatica affects only one side of the body. The pain can range from a mild ache to a sharp, burning sensation, or even feel like an electric shock travelling down the leg. For many patients in Kathmandu, sciatica severely limits their ability to sit, stand, walk, and sleep comfortably.

At TRX Physiotherapy and Chiropractic Centre, sciatica is one of the most common conditions we treat. Under the guidance of Dr. Prawesh Upreti, Ph.D (PMR), the majority of our sciatica patients achieve full or near-full recovery without surgery, using a combination of evidence-based physiotherapy, chiropractic care, and advanced spinal decompression technology. In this article, we explain the anatomy of sciatica, its common causes, how to recognise its symptoms, and the non-surgical treatment options available at TRX.

Anatomy of the Sciatic Nerve

The sciatic nerve is the longest and widest nerve in the human body. It originates from five nerve roots in the lumbar and sacral spine, specifically L4, L5, S1, S2, and S3, which combine to form a single large nerve that exits the pelvis through the greater sciatic foramen, passes behind the hip joint, and runs down the back of the thigh. Just above the knee, it divides into the tibial nerve and the common peroneal nerve, which continue into the lower leg and foot.

Because the sciatic nerve supplies sensation and motor control to most of the lower leg, any compression or irritation of its nerve roots in the lumbar or sacral spine can produce symptoms that are felt anywhere along its entire length, from the buttock down to the toes. This is why a disc herniation at L4-L5 in the spine can cause pain, numbness, or weakness in the foot.

Common Symptoms of Sciatica

The hallmark symptom of sciatica is pain that radiates from the lower back or buttock down one leg, following the course of the sciatic nerve. However, sciatica presents differently depending on which nerve root is affected and the severity of the compression. Common symptoms include a sharp, shooting, or burning pain in the lower back, buttock, or leg; numbness or tingling in the leg, calf, or foot; weakness in the leg making it difficult to lift the foot or stand on tiptoe; pain that worsens with prolonged sitting; and pain that intensifies with sneezing, coughing, or straining.

Many patients describe the pain as feeling like an electric shock or hot poker running down the leg. Some experience constant pain while others have intermittent episodes. In severe cases, patients may lose control of bladder or bowel function, which is a medical emergency known as cauda equina syndrome and requires immediate hospital attention. For the vast majority of sciatica patients, however, the condition is painful but not dangerous, and responds well to conservative treatment.

What Causes Sciatica?

Sciatica is a symptom rather than a diagnosis, meaning it is always caused by compression or irritation of the sciatic nerve or its roots. The most common cause is a lumbar disc herniation, where the soft inner gel of an intervertebral disc bulges through its outer casing and presses on an adjacent nerve root. This accounts for approximately 90 percent of sciatica cases. At TRX, we see disc-related sciatica most frequently in patients between the ages of 30 and 50.

Other causes include lumbar spinal stenosis, a narrowing of the spinal canal usually due to degenerative changes that is more common in patients over 50; spondylolisthesis, where one vertebra slips forward over the one below it; piriformis syndrome, where the piriformis muscle in the buttock compresses the sciatic nerve as it passes through or beneath it; and less commonly, tumours, infections, or trauma. Accurate diagnosis of the underlying cause is essential because the treatment approach differs significantly between these conditions.

Diagnosis at TRX Physiotherapy

When a patient presents to TRX with suspected sciatica, Dr. Prawesh Upreti performs a detailed clinical examination. This includes a thorough history to understand the onset, location, and behaviour of the pain; a neurological examination assessing reflexes, sensation, and muscle strength; special orthopaedic tests such as the straight leg raise and slump test to identify nerve root tension; and a postural and movement analysis.

Imaging such as MRI is not always necessary for diagnosis but may be requested when the clinical picture suggests a significant disc herniation or spinal stenosis, particularly if there is neurological deficit such as weakness or loss of reflexes. At TRX, we review all available imaging and correlate the findings with the clinical examination to formulate a precise diagnosis and treatment plan.

Non-Surgical Spinal Decompression for Sciatica

Non-surgical spinal decompression is one of the most effective treatments for disc-related sciatica and is a speciality of TRX Physiotherapy. The treatment uses a motorised traction table to gently stretch the spine in a carefully controlled manner. This creates a negative intradiscal pressure, essentially a vacuum effect within the affected disc, which draws the herniated material back towards the centre of the disc and relieves pressure on the compressed nerve root.

Each session lasts approximately 20 to 30 minutes. The patient lies comfortably on the table while the computer-controlled system applies and releases traction forces in a rhythmic pattern, ensuring the spinal muscles remain relaxed throughout. Most patients feel an immediate sense of relief and decompression during the treatment. A course of 10 to 15 sessions is typically recommended, combined with core strengthening exercises to support long-term recovery.

Manual Therapy and Chiropractic Care

In addition to spinal decompression, manual therapy and chiropractic spinal adjustment play an important role in the treatment of sciatica at TRX. Chiropractic adjustments can restore normal movement to restricted lumbar and sacral joints, reducing mechanical stress on the disc and nerve roots. Manual therapy techniques including joint mobilisation and soft tissue release address the muscle guarding and secondary dysfunction that develops around the primary source of nerve compression.

Neural mobilisation, also known as nerve gliding or nerve flossing, is another technique used at TRX. These are specific exercises and hands-on techniques designed to restore the normal mobility of the sciatic nerve within its tissue sheath. When a nerve is compressed or inflamed, it can lose its ability to slide freely through the surrounding tissues, which perpetuates symptoms. Neural mobilisation techniques gently restore this mobility, reducing pain and accelerating recovery.

Exercise Therapy and Home Programme

Exercise is a critical component of sciatica recovery. At TRX, every patient is prescribed a personalised home exercise programme designed around their specific diagnosis and stage of recovery. In the early acute phase, gentle exercises focus on reducing nerve tension and maintaining movement without aggravating symptoms. As recovery progresses, the programme advances to include targeted strengthening of the lumbar stabilisers, hip extensors, and gluteal muscles that support and protect the sciatic nerve and lumbar spine.

Patients are also educated about posture, lifting technique, and activity modification to avoid positions and movements that increase intradiscal pressure and aggravate nerve compression. This education component is invaluable in preventing recurrence, which is a real risk for patients who recover from one episode of sciatica without addressing the underlying mechanical dysfunction.

If you are suffering from sciatica in Kathmandu and have been told you may need surgery, we strongly encourage you to explore non-surgical options first. At TRX Physiotherapy at Thapathali Complex, our team has helped hundreds of patients recover from even severe sciatica without surgical intervention. Call us on +977-9851408989 or WhatsApp to schedule a consultation with Dr. Prawesh Upreti today.