Question 1

What is the main cause of sciatica?

Accepted Answer

The most common cause of sciatica is lumbar nerve root irritation or compression (usually L4–S1), often related to a disc herniation/bulge or degenerative narrowing (spinal stenosis/arthritic change) that reduces the space available for the nerve. Sciatica is therefore a clinical syndrome of leg-dominant radiating pain linked to irritation of the lumbosacral nerve roots rather than “tight muscles” alone.

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Question 2

How can I tell if my pain is sciatica?

Accepted Answer

Sciatica is most likely when pain:
 • Radiates down one leg (often below the knee) in a line-like pattern
 • Feels burning, sharp, electric, or is accompanied by pins and needles/numbness
 • May include weakness in specific muscle groups
 • Often worsens with coughing/sneezing/straining or certain spinal positions

However, “sciatica-like” pain can mimic this (deep gluteal syndrome, referred pain, sensitisation). A proper clinical exam typically includes a focused neurological screen (strength, reflexes, sensation) plus mechanical testing. Sciatica remains primarily a clinical diagnosis—imaging is not always required initially unless red flags are present or symptoms persist.

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Question 3

What causes sciatica flare up?

Accepted Answer

Flare-ups usually happen when the irritated nerve is exposed to a spike in mechanical load, compression, or sustained positions beyond its current tolerance. Common triggers include:

• Prolonged sitting/driving
 • Bending/twisting under load (e.g., lifting, repeated flexion)
 • Sudden training load increases
 • Reduced sleep/recovery + higher stress (often increases pain sensitivity)

Importantly, a flare-up does not automatically mean “damage” is worsening it often reflects a temporary increase in nerve sensitivity and mechanical irritation. Staying gently active and progressively restoring tolerance is a common evidence-based approach.

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Question 4

What not to do with sciatica?

Accepted Answer

Avoid behaviours that commonly prolong symptoms:

• Prolonged bed rest / total inactivity (can increase stiffness and slow recovery)
 • Repeatedly forcing into movements that clearly shoot pain down the leg
 • Returning to heavy lifting/twisting too quickly after a flare
 • Ignoring progressive weakness, saddle numbness, or bladder/bowel changes (urgent assessment needed)

Most guidelines encourage staying as active as tolerated, using graded exposure rather than complete rest.

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Question 5

What sleeping position is best for sciatica?

Accepted Answer

There’s no single “best” position for everyone, but most people with sciatica do well with positions that keep the spine neutral and supported, such as:

• On your back with a pillow under your knees (reduces lumbar extension strain)
 • On your side with a pillow between your knees (reduces pelvic rotation and nerve tension)

Stomach sleeping is commonly uncomfortable for sciatica because it can increase lumbar extension/rotation. If night pain is severe or progressively worsening, it’s worth reassessing the diagnosis.

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Question 6

What exercises improve sciatica?

Accepted Answer

The best exercises are individualised to the mechanism (disc-related radicular pain vs stenosis vs sciatica-like presentations). In general, exercise should:

• Reduce leg symptoms (centralisation is often a good sign)
 • Build tolerance to walking/standing/sitting
 • Restore hip and trunk capacity without provoking sharp radiating pain

Common categories used in guideline-based care include:

• Gentle mobility (e.g., repeated movements that reduce leg pain)
 • Nerve-friendly graded activity (walking programmes)
 • Trunk/hip strengthening (progressed gradually)

Most contemporary guidance supports supervised exercise programmes and staying active, often combined with manual therapy where appropriate.

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Question 7

Can acupuncture help sciatica?

Accepted Answer

Yes—when used appropriately and for the right presentation, acupuncture can be a valuable component of sciatica care.

From a Western medical and neurophysiological perspective, acupuncture may help sciatica by:

• Modulating pain through central and peripheral nervous system pathways
 • Reducing neurogenic inflammation and local tissue sensitivity
 • Influencing segmental spinal mechanisms linked to the affected nerve roots
 • Improving muscle tone and movement patterns that may be perpetuating nerve irritation

Research suggests acupuncture can reduce pain intensity and improve function in people with sciatica, particularly when symptoms are driven by nerve irritation or sensitisation rather than severe structural compression.

Importantly, acupuncture is rarely used in isolation. Best outcomes are typically seen when it is integrated with manual therapy, movement-based rehabilitation, and accurate diagnosis to address both neural and mechanical contributors to symptoms.

Acupuncture is not a substitute for urgent medical care where red flags are present, but it can be an effective, evidence-informed option within a comprehensive treatment plan.

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Sciatica & Sciatica-Like Pain Treatment in Auckland

EVIDENCE-BASED OSTEOPATHY AT MOVEMENT MECHANICS BROWNS BAY NORTH SHORE

Understanding Sciatica vs Sciatica-Like Pain

Symptoms That Suggest Sciatic Nerve Involvement

How Osteopathy Treats Sciatica at a Clinical Level

Disc-Related Sciatica & Nerve Root Compression

Non-Disc Sciatica & Deep Gluteal Nerve Pain

Shockwave Therapy for Sciatica-Like Pain

When to Seek Expert Sciatica Assessment

Frequently asked questions