Triage your sciatica before you start stretching
Sciatica is an umbrella term covering several distinct mechanisms. Most are stretch-responsive. A few are surgical emergencies and need A&E, not a yoga mat. Five minutes of triage before you start saves weeks of pushing the wrong protocol.
Is this actually sciatica?
The word “sciatica” gets used for anything from a tight glute to a true L5 radiculopathy. The clinical definition is pain that follows the path of the sciatic nerve or one of its root distributions: down the back or side of the leg, not just “in the back.” If your pain stays in the lower back without travelling, you probably have non-specific lower back pain, not sciatica.
Pain runs down the leg
Buttock to thigh, or further to calf or foot. Follows a recognisable path (dermatomal or piriformis-referred). This is sciatica. Continue with the disc-vs-piriformis triage below.
Pain stays in the back
No leg pain, or only short-distance referral into the upper buttock. This is more likely non-specific low back pain. Different protocol entirely; see lowerbackstretches.com for that pattern.
Disc-bias or piriformis-bias?
The two patterns respond to opposite stretches, so this is the highest-value distinction in self-treatment. The signs cluster fairly reliably.
| Feature | Disc-bias | Piriformis-bias |
|---|---|---|
| Pain quality | Sharp, electric, burning. Sometimes shooting or knife-like | Deep, aching, sometimes squeezing in the buttock |
| Pain location | Below the knee, follows a dermatome (L5: outer thigh + top of foot; S1: back of leg + sole) | Centred in the buttock, may refer down the thigh but rarely below the knee |
| Worse with | Sitting, bending forward, coughing, sneezing | Sitting on hard surfaces specifically, prolonged driving |
| Better with | Lying flat, walking, standing up. Sometimes prone extension | Standing up after sitting too long, hot bath on the buttock |
| Neuro signs | Numbness, weakness, reflex changes possible | Usually no neuro signs, just buttock tenderness |
| Triggers | Often a specific lift, twist, or sneeze | Often a build-up: new running programme, long-distance driving, desk work |
| Stretch direction | Extension-bias (McKenzie). Routine → | Flexion-and-adduction. Routine → |
The 90-second self-test → walks you through five questions in detail with a clear result.
The centralisation principle (Robin McKenzie, 1981)
This is the single most reliable real-time signal for whether a stretch is the right direction for your case. Watch where the pain lives as you do the stretch, not just intensity, but location.
- · If pain moves UP toward the spine, the stretch is centralising your pain. Good. Continue.
- · If pain moves DOWN further into the leg, the stretch is peripheralising your pain. Bad. Stop, try the opposite direction.
- · If pain stays in the same place, the stretch is neutral. Continue gently but do not push intensity.
In Long, Donelson and Fung's 2004 randomised trial in Spine, patients matched to their directional preference (extension or flexion) using centralisation as the signal had substantially better pain and function outcomes at 2 weeks than patients given mismatched or generic exercises.
If you're over 60: rule out stenosis first
Spinal stenosis is narrowing of the canal or foramina, usually from age-related arthritic change. It produces sciatica-like leg pain but follows a different pattern, and the disc-bias McKenzie protocol typically makes stenosis worse.
Stenosis pattern
- · Worse with standing or walking, especially after some distance (neurogenic claudication)
- · Better when sitting or leaning forward (over a shopping trolley, for example)
- · Often bilateral (both legs), not just one side
- · More common over 60
- · The opposite of disc-bias (which is worse with sitting, better walking)
If this pattern fits, see a physiotherapist before starting the disc-bias routine. Extension typically aggravates stenosis. Flexion-bias and walking-tolerance exercises are usually safer.
How long has it been hurting?
Under 48 hours (acute)
Tissue is reactive. Don't provoke. Use the 4-minute acute flare routine for the first two days, then triage and switch.
48 hours to 6 weeks (subacute)
Most flares resolve here. Pick the matched routine (disc-bias or piriformis-bias) and run it daily. If you're not noticeably better in two weeks, see a physiotherapist.
Over 12 weeks (chronic)
Get a clinical assessment if you haven't. Then daily maintenance routine, plus address contributing factors (posture, hip flexor tightness, sitting load).
If your matched routine isn't working after a week
Three possibilities, in order of likelihood:
- You picked the wrong pattern. Re-take the self-test, watching specifically what positions help and what positions hurt. Pattern can be hard to read in the first 48 hours.
- You have a mixed presentation (disc + piriformis, or stenosis overlay). Switch to the maintenance routine for balanced direction.
- The conservative protocol isn't enough on its own. See a physiotherapist for hands-on assessment, neural mobilisation techniques, or referral if needed. The 2018 Lancet series recommends conservative care first, then escalation if no progress in 4-6 weeks.