How Physiotherapy Can Help Alleviate Sciatica Pain in Coquitlam, Port Moody, Port Coquitlam, and Surrey
Sciatica pain can stop you in your tracks—literally. That sharp, shooting pain radiating from your lower back down through your buttock and leg makes even simple activities like sitting at your desk in Coquitlam, walking through Port Moody trails, standing in line at a Port Coquitlam grocery store, or driving around Surrey feel unbearable. If you're one of the many people experiencing this debilitating condition, you're not alone, and more importantly, help is available.
Physiotherapy represents a first-line, evidence-based treatment for sciatica that addresses the root causes of your pain rather than simply masking symptoms. Through comprehensive assessment, targeted exercises, manual therapy, and education, physiotherapists help people with sciatica reduce pain, restore function, and prevent recurrence.
Understanding Sciatica: More Than Just Back Pain
Sciatica refers specifically to pain or other symptoms (numbness, tingling, weakness) that follow the path of the sciatic nerve—the largest nerve in your body. This nerve originates from nerve roots in your lower lumbar and sacral spine (L4-S3), travels through your buttock, and extends down the back of your leg to your foot.
True sciatica results from direct irritation or compression of the sciatic nerve or its nerve roots, distinguishing it from general low back pain or other types of leg pain. Understanding this distinction matters because treatment approaches differ based on the underlying cause of symptoms.
Common Causes of Sciatica
Herniated or Bulging Disc: The most common cause of sciatica, accounting for approximately 90% of cases. When the soft inner material of an intervertebral disc pushes through its tough outer layer, it can compress nearby nerve roots, triggering sciatic symptoms.
Lumbar Spinal Stenosis: Narrowing of the spinal canal—more common in older adults—can compress nerve roots, particularly with certain movements or positions. This often produces symptoms that worsen with standing or walking and improve with sitting or forward bending.
Degenerative Disc Disease: Age-related changes in spinal discs can lead to nerve root irritation and sciatic symptoms, even without obvious disc herniation.
Piriformis Syndrome: The piriformis muscle in your buttock can spasm or tighten, compressing the sciatic nerve as it passes through or beneath the muscle.
Spondylolisthesis: When one vertebra slips forward on the one below it, nerve root compression can occur, producing sciatic pain.
Trauma: Falls, car accidents, or other injuries can cause disc herniation, fractures, or soft tissue damage that affects the sciatic nerve.
Recognizing Sciatica Symptoms
Symptoms vary depending on which nerve root is affected, but typically include:
Sharp, shooting pain radiating from the lower back or buttock down the leg
Burning or tingling sensations (paresthesias) along the nerve path
Numbness in parts of the leg or foot
Muscle weakness in the affected leg—difficulty lifting the foot, standing on tiptoes, or straightening the knee
Pain worsening with certain positions, movements, or activities like sitting, coughing, or sneezing
Symptoms typically affecting one side of the body, though bilateral symptoms can occur
The specific distribution of symptoms provides clues about which nerve root is involved:
L4: Pain, tingling, and numbness in the thigh; weakness straightening the leg; diminished knee reflex
L5: Symptoms extending to the foot and big toe; weakness lifting the foot
S1: Pain, tingling, and numbness on the outer foot; weakness standing on tiptoes
How Physiotherapy Addresses Sciatica
Research indicates that both conservative care (including physiotherapy) and surgical intervention represent relevant treatment options for sciatica lasting at least six weeks. While surgery may provide quicker initial relief, studies show no large differences in success rates between surgical and conservative approaches after one to two years. This evidence supports physiotherapy as a first-line treatment, with surgery reserved for specific situations like severe, progressive neurological deficits or when conservative treatment fails.
Physiotherapy for sciatica focuses on reducing nerve irritation, improving mobility, strengthening supportive structures, and teaching strategies to prevent recurrence. The specific approach depends on the underlying cause of your sciatic symptoms and your individual presentation.
Comprehensive Assessment
Effective treatment begins with understanding your specific situation. Your physiotherapist will:
Take detailed history about symptom onset, patterns, aggravating and relieving factors
Perform physical examination including range of motion, strength, reflexes, and sensation testing
Conduct special orthopedic tests like the straight leg raise to assess nerve involvement
Evaluate posture, movement patterns, and functional limitations
Identify factors contributing to your condition—work demands, lifestyle habits, previous injuries
This thorough assessment distinguishes true sciatica from other conditions that mimic it (like sacroiliac joint dysfunction, hip problems, or referred pain from other structures) and guides treatment planning.
Exercise Therapy: The Cornerstone of Treatment
Exercise represents the most powerful tool for managing sciatica. Systematic reviews examining physiotherapy interventions for sciatica suggest that active treatment approaches prove more effective than passive modalities alone.
Directional Preference Exercises: Many people with sciatica caused by disc problems experience "directional preference"—meaning symptoms improve with movement in one direction and worsen with movement in another direction. Most commonly, extension-based exercises (backward bending) provide relief for disc-related sciatica, though some individuals respond better to flexion-based movements. Your physiotherapist identifies your directional preference and prescribes exercises accordingly.
Nerve Gliding (Neural Mobilization): These gentle exercises encourage the sciatic nerve to move more freely through surrounding tissues. By systematically placing the nerve into and out of tension, nerve gliding techniques can reduce pain and improve function. Your physiotherapist teaches you specific movements that target the involved nerve root.
Core Stabilization: Strengthening the deep core muscles that support your spine reduces stress on discs and nerve roots. Research demonstrates that improved core control helps manage low back-related leg pain. These exercises progress from basic activation to functional integration.
Flexibility Training: Tight muscles in the lower back, hips, and legs can contribute to sciatic symptoms. Stretching programs targeting hip flexors, hamstrings, piriformis, and other muscles help restore normal movement patterns and reduce nerve irritation.
Strengthening Programs: Weak muscles fail to support the spine adequately, potentially increasing disc stress and nerve compression. Progressive strengthening of back extensors, hip muscles, and leg muscles builds resilience and supports long-term recovery.
Manual Therapy Techniques
Hands-on treatment complements exercise therapy by addressing pain, stiffness, and movement restrictions:
Spinal Mobilization: Gentle, controlled movements applied to spinal joints can improve mobility, reduce pain, and facilitate better movement patterns. For sciatica, specific mobilization techniques target restricted segments while avoiding positions that aggravate symptoms.
Soft Tissue Mobilization: Massage and other manual techniques address muscle tension, trigger points, and soft tissue restrictions that may contribute to symptoms. Releasing tight piriformis, gluteal, or hamstring muscles can reduce nerve irritation.
Joint Manipulation: In appropriate cases, manipulation techniques using quick, controlled force can improve joint mobility and reduce pain. Research on manual therapy combined with exercise shows promise for managing lumbar radicular pain.
Pain Management Strategies
Managing pain effectively allows you to participate more fully in therapeutic exercise:
Positioning and Posture: Your physiotherapist teaches positions that reduce nerve irritation. For disc-related sciatica, this often involves avoiding prolonged forward bending and finding neutral or slightly extended spine positions. Proper sitting, standing, and sleeping postures minimize symptom flares.
Activity Modification: Learning which activities aggravate your symptoms and how to modify them prevents flare-ups during recovery. This might include adjusting work station ergonomics, modifying lifting techniques, or temporarily reducing high-impact activities.
Ice and Heat: Applied strategically, thermal modalities can reduce pain and muscle spasm, facilitating exercise participation. Your physiotherapist advises on appropriate use based on your specific situation.
TENS (Transcutaneous Electrical Nerve Stimulation): This modality may help reduce pain through electrical stimulation of sensory nerves, potentially allowing more comfortable participation in therapy.
Education and Self-Management
Understanding your condition empowers you to manage it effectively:
Pain science education helps reduce fear and catastrophizing that can worsen pain perception
Biomechanics instruction teaches you how your movements affect disc pressure and nerve irritation
Prognosis information provides realistic expectations—most sciatica improves significantly within weeks to months with appropriate treatment
Flare-up management equips you to handle symptom increases independently
Long-term prevention strategies reduce recurrence risk through ongoing exercise and postural awareness
What to Expect During Physiotherapy
Treatment typically progresses through several phases:
Initial Phase (Weeks 1-3): Focus on pain reduction, identifying directional preferences, teaching initial exercises, and beginning gentle mobilization. Symptoms often remain significant during this phase, though you should notice some improvement.
Progressive Phase (Weeks 4-8): As pain decreases, exercise difficulty increases. Emphasis shifts toward building strength, improving endurance, and restoring normal movement patterns. Functional activities gradually resume.
Advanced Phase (Weeks 8-12+): Return to full activities, including work, recreation, and sports. Continued strengthening and maintenance exercises prevent recurrence. Treatment frequency decreases as independence increases.
How Long Does Recovery Take?
Recovery timelines vary based on multiple factors:
Severity and duration of symptoms before treatment begins
Underlying cause (disc herniation, stenosis, piriformis syndrome, etc.)
Presence of neurological deficits
Adherence to prescribed exercises and activity modifications
Overall health, fitness level, and lifestyle factors
Many people experience significant improvement within 4-6 weeks of starting physiotherapy, though complete resolution may take 3-6 months. A small percentage of cases prove more resistant to conservative treatment and may require different interventions.
Research indicates that the natural course of sciatica is generally favorable, with many people improving over time. However, physiotherapy accelerates recovery, reduces pain levels, and provides tools for long-term management.
Special Considerations for Pregnancy and Postpartum
Sciatica during pregnancy and postpartum presents unique challenges. Hormonal changes increase ligament laxity, altered biomechanics from weight gain shift spinal loads, and the growing uterus can create pressure on pelvic structures.
Pregnancy-Related Sciatica: True sciatic nerve compression is relatively uncommon during pregnancy, though many pregnant individuals experience similar symptoms from pelvic girdle pain or sacroiliac joint dysfunction. Physiotherapy focuses on:
Exercises safe for pregnancy stage
Pelvic alignment and stability
Postural strategies that reduce lumbar stress
Manual therapy appropriate for pregnancy
Support devices when helpful (pregnancy belts, pillows)
Postpartum Sciatica: Following delivery, biomechanics gradually normalize, but new demands arise—frequent lifting and carrying, prolonged feeding positions, sleep deprivation affecting pain perception. Postpartum physiotherapy addresses:
Progressive return to full activity including exercise
Core and pelvic floor rehabilitation alongside sciatica treatment
Ergonomic strategies for infant care
Gradual resumption of pre-pregnancy activities
The 2025 Canadian Guidelines for Physical Activity throughout the First Year Postpartum emphasize individualized, gradual progression of activity—principles that apply to managing postpartum sciatica while building overall strength and function.
When to Seek Immediate Medical Attention
While most sciatica responds well to physiotherapy, certain "red flags" require urgent medical evaluation:
Cauda equina syndrome symptoms: Loss of bowel or bladder control, numbness in the saddle region (inner thighs, buttocks, genitals), severe or progressive leg weakness. This represents a surgical emergency.
Progressive neurological deficits: Rapidly worsening weakness or numbness
Severe, unrelenting pain unresponsive to position changes or medication
Symptoms following significant trauma
Associated fever, unexplained weight loss, or history of cancer
Your physiotherapist monitors for these concerning features and coordinates care with your physician when necessary.
Preventing Sciatica Recurrence
Once recovered, maintaining gains requires ongoing attention:
Continue Exercise: A home maintenance program focusing on core stability, flexibility, and overall fitness reduces recurrence risk. Even 15-20 minutes several times weekly provides benefit.
Maintain Good Posture: Be mindful of positions and movements that previously triggered symptoms. Use proper lifting mechanics, take breaks from prolonged sitting, and maintain neutral spine positions during activities.
Stay Active: Regular physical activity keeps muscles strong, joints mobile, and discs healthy. Low-impact activities like walking, swimming, or cycling provide excellent options.
Manage Weight: Excess body weight increases spinal loading, raising disc injury and sciatic recurrence risk.
Ergonomics: Whether at work, home, or recreation, optimize your environment to support healthy spine positioning.
Early Intervention: If symptoms begin returning, contact your physiotherapist promptly. Early treatment prevents minor flare-ups from becoming major problems.
Finding Physiotherapy Care in Your Community
Residents of Coquitlam, Port Moody, Port Coquitlam, and Surrey have access to physiotherapists experienced in treating sciatica. Look for providers who:
Conduct comprehensive assessments
Emphasize active treatment approaches
Provide clear education about your condition
Develop individualized programs based on your specific presentation
Coordinate care with your physician when needed
Most clinics offer direct billing to insurance, and ICBC coverage applies if sciatica resulted from a motor vehicle accident. Initial consultations typically include thorough assessment and treatment plan development.
The Bottom Line
Sciatica significantly impacts daily life, but physiotherapy provides evidence-based interventions that address root causes, reduce pain, restore function, and prevent recurrence. While recovery requires time and consistent participation in prescribed exercises, the majority of people with sciatica experience substantial improvement with conservative physiotherapy management.
The most effective approach combines education about your condition, active exercise therapy tailored to your specific needs, manual therapy to address restrictions, and strategies for self-management and prevention. This comprehensive approach gives you the tools to take control of your sciatica rather than remaining a passive recipient of treatment.
Don't let sciatica limit your life. If you're experiencing sciatic symptoms, schedule an assessment with a qualified physiotherapist in Coquitlam, Port Moody, Port Coquitlam, or Surrey. Early intervention, appropriate treatment, and commitment to your prescribed program offer the best chance for full recovery and return to the activities you value.
References
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Toronto Physiotherapy. (2020). Patient Guide to Sciatica Treatment. https://torontophysiotherapy.ca/patient-guide-to-sciatica-treatment/
Valat, J. P., Genevay, S., Marty, M., Rozenberg, S., & Koes, B. (2010). Sciatica. Best Practice & Research Clinical Rheumatology, 24(2), 241-252.
Davenport, M. H., Ruchat, S. M., Jaramillo Garcia, A., Adamo, K. B., Brunet-Pagé, É., Chari, R., et al. (2025). Canadian Guideline for Physical Activity, Sedentary Behaviour, and Sleep throughout the First Year Postpartum. Canadian Society for Exercise Physiology. https://csep.ca/2025/06/24/guideline-for-postpartum/
Jensen, R. K., Kongsted, A., Kjaer, P., & Koes, B. (2019). Diagnosis and treatment of sciatica. BMJ, 367, l6273.
Davis, D., Taqi, M., & Vasudevan, A. (2024). Sciatica. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507908/