1. Introduction / Plain Theory

Sciatica refers to pain that radiates along the path of the sciatic nerve, which runs from the lower back, through the buttock, and down the back of the leg.
It is a symptom, not a diagnosis — meaning the underlying cause must be identified to guide appropriate care.

The sciatic nerve is the body’s largest nerve, formed by nerve roots exiting the lumbar and sacral spine (L4–S3).
When these roots are compressed, irritated, or inflamed, they can produce pain, numbness, or tingling that radiates down the leg — sometimes as far as the foot.

Common causes include:

• Lumbar disc herniation or protrusion.

• Degenerative changes in the spine (e.g. osteophytes or narrowing of the canal).

• Piriformis muscle entrapment (“piriformis syndrome”).

• Sacroiliac joint dysfunction affecting local nerve mobility.

Sciatica can vary from mild discomfort to severe, disabling pain.
Understanding its mechanical, inflammatory, and neurophysiological aspects is essential for effective management.

2. Typical Symptoms and Functional Impact

• Sharp, burning, or shooting pain radiating from the lower back or buttock down one leg.

• Tingling (“pins and needles”) or numbness in the thigh, calf, or foot.

• Weakness or heaviness in the affected leg.

• Pain aggravated by coughing, sitting, or bending forward.

• Relief when standing or walking slowly (in some cases).

Functional impact:
Sciatica can severely limit movement, sleep, and daily activities.
Persistent symptoms often lead to guarded movement, muscle imbalance, and fear of activity — which can prolong recovery even after nerve irritation subsides.

Red flags:
Loss of bladder or bowel control, numbness in the saddle area, or progressive leg weakness require immediate medical evaluation for possible cauda equina syndrome or severe nerve compression.

3. Contributing Factors / Underlying Causes

Sciatica usually develops from a combination of mechanical and inflammatory influences.
Key contributing factors include:

• Lumbar disc injury: herniation or bulging pressing on nerve roots.

• Degenerative changes: narrowing of the spinal canal (stenosis).

• Joint dysfunction: altered motion in lumbar or sacroiliac joints.

• Piriformis or gluteal tension: compressing or irritating the sciatic nerve.

• Postural strain or imbalance: prolonged sitting, poor lifting technique, or weak core stability.

• Systemic factors: metabolic or inflammatory conditions (e.g. diabetes, spondyloarthritis).

From an osteopathic perspective, sciatica often reflects a broader pattern of mechanical overload and compensatory dysfunction, not just a local nerve problem.
Assessing and treating related areas — the pelvis, diaphragm, and lower limbs — helps reduce recurrence and improve long-term function.

4. Osteopathic Approach

Osteopathic care for sciatica aims to reduce mechanical tension, improve mobility, and support the body’s natural recovery mechanisms while respecting neural sensitivity.

An osteopathic assessment may include:

• Thorough history-taking to determine the underlying cause and screen for red flags.

• Evaluation of lumbar, sacroiliac, and pelvic mobility.

• Gentle soft-tissue and myofascial techniques to reduce local muscle guarding and improve circulation.

• Mobilisation or articulation of restricted joints to restore balanced motion.

• Neural mobilization (when appropriate) to improve nerve glide and reduce sensitivity.

• Breathing and postural work to reduce load on the spine and improve recovery.

• Collaboration with medical practitioners or physiotherapists for imaging, medication, or exercise-based rehabilitation when indicated.

The osteopathic approach is supportive, not aggressive — focused on helping the nervous system calm down, restoring functional movement, and reducing recurrence risk.

5. Scientific Evidence & References

Research supports manual therapy and exercise-based approaches for non-surgical management of sciatica and related lumbar radiculopathy.
Studies show that osteopathic and physiotherapy interventions can reduce pain intensity, improve function, and accelerate return to activity, especially when combined with patient education and active rehabilitation.

Osteopathic techniques are considered safe and effective when applied after appropriate screening for neurological or structural red flags.

References

1. Konstantinou K, Dunn KM. Sciatica: review of epidemiology, pathophysiology, and management. Br J Gen Pract. 2008;58(553):449–453. Link

2. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth. 2007;99(4):461–473. Link

3. Fernandez M, Hartvigsen J, Ferreira ML, et al. Management of sciatica: systematic review and network meta-analysis. BMJ. 2020;369:m1184. Link

4. Vanti C, Ferrari S, et al. Manual therapy and exercise for lumbar radiculopathy: systematic review and meta-analysis. Spine J. 2021;21(3):466–476. Link

5. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic care and pain modulation in patients with lumbar and radicular symptoms: a pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

6. Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for lumbar and radicular pain: systematic review and meta-analysis. Pain Physician. 2021;24(3):205–216. Link

7. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for lumbar radiculopathy and sciatica: a network meta-analysis. Front Pain Res. 2024;15:1507345. Link