Sciatica: Safe Movement, Biomechanical Coaching

Before you receive the diagnosis, sciatica usually arrives with an awareness of the area, some "hints" of pain or some "humming" down the back of the leg. You might have sensed something wasn't quite right but didn't know what it was.

The sciatic nerve runs from your lower back, through your hip, and all the way down your leg. When something along that route irritates the nerve (like a disc bulge or if the nerve is being constricted at a certain point), you can experience its pain. The pain can be burning, buzzing or electric. It is generally pain that goes below the knee rather than staying put in the back.

A back that aches when you get off the sofa and a nerve that fires down your calf when you sneeze are asking for different things. There may be an adhesion of the nerve anywhere along its path or there may be a disc bulge irritating the nerve itself. We can work that out within our sessions.

The instinct during a flare is to protect. Lie still, move carefully, hope it goes.

But nerves are odd in one specific way. They like to move. They slide and glide through their tunnels as you bend and walk, and prolonged stillness makes them grumpier, not calmer. Guided movement, graded and chosen for where you actually are, is usually part of recovery rather than a risk to it. Once you receive the sciatica diagnosis, I would be assigning you a specific nerve floss to encourage the nerve to glide as efficiently through its sheath as possible.

In a 1:1 I can watch what your flare responds to and adjust in real time.

The internet will hand you a generic "to do" list. Most of it is wrong for the majority of people. I always assess first before we start moving. "Test, don't guess" is my rule of thumb. We would be assessing what provokes your pain and teaching your body to understand where your end range is. The goal is to leave you feeling better, not worse. We want you to understand how to do daily movements like taking the rubbish out, bending over to fill the cat bowl or even just getting up out of a chair without provoking your pain. It depends on what your individual provocation is...but that is where we start.

First the flare calms down. Then strength gets rebuilt, slowly, at the pace your body agrees to. Then confidence returns, which is the part nobody puts on the exercise sheet.

In practice that looks like carrying the shopping with one hand again, or sitting through a meeting without quietly rearranging yourself every four minutes. The goal is a back you stop negotiating with.

This paragraph has no jokes in it, on purpose.

Loss of bladder or bowel control. Numbness in the saddle area, the bit of you that would sit on a bike saddle. Weakness in the leg that is getting rapidly worse, including a foot that involuntarily starts slapping the ground out of the blue.

A proper diagnosis belongs to your GP, osteopath or physio, and it comes first. Your medical team leads on your health. Our job is to coordinate and build on each other's findings. Your clinicians diagnose. I teach you to manage pain, understand your edges without pushing into them, and find movement that lets you live your life. Golf, tennis, marathons, those goals are the long term. My role is to support you through the stepping stones towards them. I work with people at the bridge point, after the acute flare, where treatment has helped but the body has not yet remembered how to load and move without paying for it.

The way I work is that everyone starts with an intro package of three sessions. The first one is assessment and teaching, not a workout. We look at how your spine and hips handle load, how you breathe under effort, and what your days actually ask of you. Then we build gradually, at your pace.

And the logistics stay kind. I come to you, so a bad day does not have to include a pilgrimage across London. The session can wait until your body is ready. You just need to be home.

If sciatica has convinced you that your body is fragile, it usually isn't. It is asking for a specific kind of attention, and then for strength rebuilt at a pace it trusts. The back pain page explains how we'd work together.