Back & Sciatica Physiotherapy

Introduction

Lower back pain and sciatica are among the most common reasons people seek healthcare worldwide, affecting everything from sitting and sleeping to working, exercising, and simply getting through the day comfortably. Research shows that up to 80% of adults will experience lower back pain at some point in their lives, while sciatica affects roughly 2 to 5% of the population at any given time.

When pain starts travelling into the buttock or leg, it can feel alarming and unpredictable, often leading people to worry that something serious is wrong. The reassuring reality is that most back and sciatic pain is mechanical, manageable, and responds extremely well to physiotherapy, especially when treatment focuses on restoring movement, strength, and confidence.

Anatomy & Biomechanics

The lower back, known as the lumbar spine, is built to balance strength and mobility. It connects the upper body to the pelvis and plays a major role in bending, lifting, twisting, walking, and absorbing load throughout the day. Rather than being rigid, the spine is designed to move and to share load across multiple structures.

Key structures involved include:

• Lumbar vertebrae – providing structural support
• Intervertebral discs – acting as shock absorbers between the bones
• Facet joints – guiding and controlling spinal movement
• Muscles and ligaments – providing stability and movement
• Nerves – including the sciatic nerve, which travels from the lower back into the leg

Pain often develops when these structures are exposed to repeated strain, prolonged postures, reduced movement variety, or sudden changes in activity levels. Importantly, this does not mean the spine is fragile or "out of alignment." The spine is remarkably strong and adaptable, and symptoms usually reflect temporary sensitivity or reduced load tolerance rather than damage. Sciatic pain occurs when nerves become irritated or sensitised, leading to symptoms that may travel into the leg without necessarily indicating nerve injury.

What Causes the Pain (Acute vs Chronic)

Back pain and sciatica can begin suddenly or develop gradually over time, and both patterns are very common.

Acute pain often starts after a clear trigger such as lifting something heavy, bending and twisting awkwardly, a sudden movement during sport, or even getting out of the car after a long drive. These episodes can feel intense, but they usually reflect temporary overload or irritation, not serious injury.

Chronic or persistent pain tends to build up slowly and is often linked to a combination of factors rather than one single cause. Prolonged sitting, reduced activity, poor sleep, work-related postures, repeated lifting, stress, or returning to exercise too quickly can all contribute. Over time, the spine and nervous system may become more sensitive to everyday loads.

Key points for recovery:

• These conditions are extremely common
• There is often no single clear cause
• Pain usually develops from a build-up of smaller stresses
• The body’s tissues are adaptable and respond well to rehabilitation

Common Symptoms

Back and sciatic pain can vary widely, but commonly includes:

• A dull ache, stiffness, or sharp pain in the lower back
• Pain that travels into the buttock, thigh, or leg, sometimes below the knee
• Tightness, burning, tingling, or pins-and-needles in the leg or foot
• Symptoms aggravated by sitting, bending, lifting, or twisting
• Increased stiffness after long periods of rest or first thing in the morning
• Partial relief with movement, walking, or changing positions

Common Diagnoses

Many different labels are used for back and sciatic pain. While diagnoses can be helpful, they don’t always predict pain levels or recovery, and imaging findings often do not match symptoms.

• Non-specific lower back pain – the most common presentation, with no single structure responsible
• Lumbar disc bulge or herniation – disc changes that may irritate nearby nerves but often settle with rehab
• Sciatica (lumbar radiculopathy) – nerve-related leg pain due to irritation or sensitivity
• Facet joint pain – stiffness or irritation in the small spinal joints
• Degenerative disc disease – normal, expected findings that don’t mean the spine is failing
• Muscle or ligament strain – temporary overload of soft tissues

How Physiotherapy Can Help

Physiotherapy for back pain and sciatica starts with a thorough assessment. This includes understanding your symptoms, movement patterns, daily demands, and goals. You’ll receive a clear explanation of what’s happening and why, without unnecessary medical jargon or fear.

Your treatment plan may include:

• Hands-on therapy to reduce pain, stiffness, and sensitivity
• Rehabilitation exercises to improve movement, strength, and control
• Education and reassurance to rebuild confidence in your back
• Gradual return to work, daily activities, and sport

Recovery timelines vary, but most people see steady improvement when treatment focuses on restoring function rather than avoiding movement. The aim is not just short-term relief, but long-term resilience and prevention of recurrence.

At our physiotherapy practice in Pretoria, we regularly treat patients from The Moot, Mayville, and surrounding areas, with treatment always tailored to the individual, not just the diagnosis.