Sciatica is one of those conditions that sounds simple but rarely is. For most people, it starts as a dull ache — sometimes in the lower back, sometimes deep in the buttock. Then the shooting pain begins, running down the back of the leg, often as far as the foot. For some, it's a burning sensation; for others, numbness or tingling that makes sitting, standing, or sleeping feel impossible.

If this sounds familiar, you're not alone. Sciatica is among the most common reasons people seek physiotherapy in British Columbia, and presentations climb in late spring and early summer — when residents return to gardening, hiking the North Shore trails, or cycling after months of relative inactivity.

What Is the Sciatic Nerve?

The sciatic nerve is the longest nerve in the body. It originates from five nerve roots in the lumbar spine (L3 to S3), runs through the buttock, and branches down both legs to the feet. When any part of this pathway is compressed or irritated — usually at the spine itself — pain radiates along its course. That's sciatica.

"Sciatica" describes a symptom, not a single diagnosis. Identifying what's irritating the nerve is what drives effective treatment.

Common Causes

Herniated or bulging disc is the most frequent culprit. The discs between your vertebrae act as shock absorbers; when the inner material pushes outward and presses on a nerve root, pain follows the nerve's path. Prolonged desk work, heavy lifting, or a sudden awkward twist can trigger a herniation.

Motor vehicle accidents are another leading cause. A rear-end collision on Highway 1 or a fender-bender on Hastings Street can compress or inflame spinal structures in ways that take weeks to surface as nerve pain. If your sciatica began after an accident, ICBC-funded physiotherapy may cover your care at no out-of-pocket cost.

Spinal stenosis — narrowing of the spinal canal — is more common after 60 and typically causes sciatica that worsens with walking or prolonged standing.

Piriformis syndrome occurs when the piriformis muscle, deep in the gluteal region, compresses the sciatic nerve. Runners, cyclists, and people who spend long hours sitting on hard surfaces are particularly prone.

Pregnancy can bring on sciatica as the growing uterus presses on the nerve, compounded by the postural shifts of later trimesters.

Recognising the Symptoms

Sciatica follows the nerve's path. Typical signs include:

Sharp, shooting, or burning pain from the lower back through the buttock and down one leg
Numbness or tingling in the thigh, calf, or foot
Muscle weakness in the affected leg
Pain that worsens with prolonged sitting, coughing, or sneezing
Difficulty rising from a chair or walking any distance

Most cases affect one side only. Bilateral leg symptoms, sudden bladder or bowel changes, or rapid-onset weakness in both legs require immediate medical attention — these may indicate cauda equina syndrome, a surgical emergency.

How Physiotherapy Treats Sciatica

Physiotherapy is the evidence-supported first choice for sciatica management, and most people improve significantly within 6–12 weeks with consistent treatment.

A registered physiotherapist begins with a thorough assessment: your history, a physical examination, and identification of the likely irritation source. Treatment is tailored to your specific cause — not a generic protocol.

Manual therapy including joint mobilisation of the lumbar spine and sacroiliac joint reduces mechanical pressure on the affected nerve root.

Neural mobilisation (nerve gliding exercises) helps restore the sciatic nerve's ability to move freely through surrounding tissue, reducing pain sensitivity and improving range. These are gentle, targeted movements — very different from the aggressive stretching that sometimes makes things worse.

Exercise prescription addresses the underlying weakness and instability that allows the nerve to be repeatedly compressed. Core stability, hip mobility, and gradual return to activity are all part of the program.

Postural and ergonomic coaching ensures your daily setup — desk, car seat, sleep position — isn't re-aggravating the nerve between sessions.

For people managing persistent nerve pain, our chronic pain management program integrates physiotherapy with education and self-management strategies for longer-term relief.

Why In-Home Care Makes Sense for Sciatica

For many people with sciatica, getting to a clinic is the hardest part. Sitting in a car for 30 minutes — then waiting in a clinic chair — can worsen symptoms before treatment even begins.

Mobile physiotherapy removes this barrier entirely. Your physiotherapist comes to you, arriving at your home in Vancouver, Burnaby, North or West Vancouver, Coquitlam, Port Moody, New Westminster, Surrey, or Richmond with everything needed for a full assessment and hands-on treatment.

There's a clinical advantage too: treating patients in their actual environment reveals postural and ergonomic contributors that a clinic visit misses. Your physiotherapist can observe how you sit, how you move through your space, and where your daily setup might be working against recovery.

For patients recently discharged from Lions Gate Hospital in North Vancouver, Royal Columbian in New Westminster, or Surrey Memorial after a spinal procedure or related admission, in-home physiotherapy provides continuity of care without the strain of travel during an acute flare.

What to Expect at Your First Visit

A typical initial visit lasts 60 minutes and covers:

1. Detailed history and physical assessment

2. Clear explanation of the likely cause and what recovery involves

3. Hands-on treatment

4. A home exercise program with written instructions

5. A plan for follow-up visits and recovery milestones

Subsequent visits are usually 45–60 minutes. Most people with acute sciatica notice meaningful improvement within the first 2–4 sessions.

Physiotherapy for sciatica is covered under most extended health benefit plans. If your symptoms followed a motor vehicle accident, ICBC funding likely applies — PhysioHome direct-bills ICBC with no upfront cost to you. WorkSafeBC covers work-related injuries that cause or aggravate nerve pain. See our fees and billing information for current rates and coverage options.

When to See a Doctor First

Physiotherapy is appropriate as a first step for most sciatica presentations — no referral needed in BC. However, see your GP or go to an emergency department if you experience:

Loss of bladder or bowel control
Progressive weakness in one or both legs (e.g., foot drop developing rapidly)
Sciatica that began after significant trauma
Fever alongside back and leg pain

These need medical investigation before physiotherapy starts.

Ready to Get Started?

Sciatica responds best to early, targeted treatment. Left unaddressed, the nervous system can become sensitised to pain in ways that slow recovery considerably. If you're in Greater Vancouver and dealing with lower back and leg pain that radiates into your leg, our team can assess you at home — typically within a few days of your call. No referral needed.

Book your in-home assessment today — we come to you.

Frequently Asked Questions

How do I know if it's sciatica or just back pain?

Back pain stays in the lower back. Sciatica radiates from the back through the buttock and down the leg, often past the knee. Numbness, tingling, or weakness in the leg points strongly to nerve involvement. A physiotherapist can differentiate the two in a single assessment visit.

Can I manage sciatica at home without seeing a physiotherapist?

Gentle movement, avoiding prolonged sitting, and careful use of ice or heat can reduce symptoms short-term. But without addressing the underlying cause — a herniated disc, piriformis tightness, poor posture under load — most people find symptoms return. Physiotherapy targets the root issue, not just the pain.

How long does sciatica take to resolve with physiotherapy?

Acute sciatica (under 6 weeks) typically resolves in 4–8 weeks with regular treatment. Chronic cases take longer but still respond well. Consistency with your home exercise program between sessions is the biggest variable in recovery speed.

Does ICBC cover physiotherapy for sciatica from a car accident?

Yes. If your sciatica followed a motor vehicle accident, ICBC typically funds physiotherapy as part of your injury claim. PhysioHome direct-bills ICBC — no upfront cost to you. Learn more about ICBC physiotherapy.

What's the difference between seeing a physio in-clinic versus at home?

The assessment and hands-on treatment are the same. In-home care removes the barrier of travel — particularly important when sitting aggravates your symptoms — and lets your physiotherapist see your actual living and working environment. ICBC, WorkSafeBC, and most extended health plans cover in-home visits the same as clinic visits.

Sciatica and Sciatic Nerve Pain: A Guide for Greater Vancouver Residents