Sciatica & Nerve Pain Physio Brisbane

Nerve Pain Rehabilitation

Nerve pain is a strange beast. It doesn't behave like muscle or joint pain, it doesn't always respond to the treatments that work well for those presentations, and it can be genuinely frightening for clients who don't understand why they're feeling burning, shooting, or electric sensations in places that seem completely unrelated to where their original problem started. I get it. Explaining to someone that the numbness in their foot is actually coming from their lower back can be a hard sell the first time you hear it.

Nerve pain, also called neuropathic pain, arises when a nerve becomes compressed, irritated, or sensitised somewhere along its pathway. This might occur at the spine, where a nerve root exits, or further along its journey through the body at a site where the nerve passes through a narrow space or between muscles that have become tight or overactive. Wherever the irritation occurs, the nerve will often refer its symptoms along its entire distribution, which is why sciatic nerve irritation in the lower back can produce burning down the back of the leg and into the foot, seemingly a long way from the actual source.

I take a particular interest in nerve-related presentations because getting the diagnosis right changes everything about the treatment approach. Nerve tissue needs to be treated differently to muscle or joint tissue, and clients who've been given generic advice for what is actually a nerve problem often find themselves stuck, frustrated, and no closer to a resolution.

A woman is receiving a physiotherapy massage on her back.

The anatomy of the nervous system

Nerves exit the spinal cord as nerve roots before travelling out into the body, where they combine and branch to form the peripheral nerves that supply sensation and movement to the arms, legs, and trunk. A nerve can become irritated either at the spine, such as when a disc bulge compresses a nerve root, or further along its peripheral pathway, at a site commonly referred to as an entrapment point.

Certain locations throughout the body are more prone to nerve entrapment because of their narrow anatomy or proximity to muscles that can become tight or overactive. The sciatic nerve can become irritated as it passes beneath or through the piriformis muscle in the buttock. The median nerve can become compressed as it passes through the carpal tunnel at the wrist. The ulnar nerve is vulnerable as it passes around the inside of the elbow. Each of these sites has a distinct pattern of referred symptoms that helps guide diagnosis.

Nerves aren't static structures, they need to glide and stretch slightly as we move our limbs and spine through daily activities. When a nerve becomes irritated or the tissues around it become restricted, this normal gliding capacity can be lost, contributing to ongoing symptoms with certain movements or positions. This concept, known as neurodynamics, forms an important part of both my assessment and treatment approach for nerve-related pain.

Nerve Pain Subjective Assessment

Conducting a thorough subjective assessment is vital as a physiotherapist when assessing a client with nerve pain. The number of different structures that can cause or create nerve pain and referral is large, we need to determine both the severity of the nerve compression or irritation, as well as glean information that assists us in determining where the symptoms are coming from.

What Happened?

Understanding how your symptoms began, whether gradually or following a specific incident, and what if anything has changed since onset, gives me an important starting point for narrowing down the likely source of nerve irritation.

Describing your Symptoms

Nerve pain has a fairly distinctive character compared to muscle or joint pain, often described as burning, shooting, electric, or like pins and needles. I'll ask you to describe exactly what you're feeling, where it starts, and where it travels to, since this pattern of referral is one of the most useful pieces of diagnostic information available to me.

Aggravating and Easing Factors

Nerve symptoms are often quite specifically related to certain positions or movements that either compress or stretch the affected nerve. Understanding exactly what brings your symptoms on and what relieves them helps me identify both the likely site of irritation and the movements we may need to avoid or modify in the short term.

Associated Symptoms

I'll ask specifically about any numbness, weakness, or changes in reflexes, as these can indicate a more significant level of nerve involvement and may influence the urgency and direction of further assessment or referral.

Nerve Pain Objective Assessment

Nerves are funny things sometimes, they can present in strange and different ways and provoke many different sets of symptoms for different people. Some people describe burning sensations, others describe lightning shock types of pain. As with every other part of the body, the key part of an objective assessment is being able to reproduce your symptoms under a specific environment. For nerves, this often involves a series of tests to assess the mobility of the nerve and whether it is gliding properly. Assessing further up the chain is always important, we can never assume that just because the symptoms are only in the forearm that it is coming from there, there is just as good of a chance it could be coming from further up in the neck.

Neurological Screening

A thorough neurological screen assessing sensation, muscle strength, and reflexes helps determine which nerve or nerve root is involved and the extent of any functional impact. A thorough neurological exam should assist in highlighting whether further imaging and investigations are necessary. Gleaning information such as how dampened sensory input is, whether two point discrimination is reduced (your ability to determine whether it is one pin prick or two), whether muscle strength is maintained and if your reflexes are either increased or decreased. All of these contribute information to the clinical picture.

Neurodynamic Testing

Specific neurodynamic tests, which involve moving a limb through a sequence designed to place tension on a particular nerve, help confirm whether a nerve is contributing to your symptoms and identify where along its pathway the irritation is occurring. I often try to think of nerves like a garden hose, they can be lengthened out to their full length but they can never extend past that point - a 25m hose from Bunnings will always be 25m and you can't stretch it to be 30m like you theoretically could do to a muscle. Neurodynamics are designed to be specific in determining where along the nerve pathway the tension or restriction is occurring.

Palpation

Palpation along the pathway of the affected nerve, as well as the surrounding muscles that may be contributing to compression, forms an important part of localising the source of irritation. This is a key skill for physiotherapists, our ability to assess for tissue tone, irritability and sensitivity and delineate a meaning behind these findings is core to our profession.

Functional Assessment

I'll assess how your symptoms behave during relevant functional movements and positions, whether that's sitting, walking, or a specific task from your work or sport, to understand the real-world impact of your symptoms and track your progress over time. As with everything, all of the clinical tests are good for determining a diagnosis, but a diagnosis doesn't equal functional restrictions, I want to understand what you are having difficulties with, and how we can best achieve your goals.

Steps to Success for Managing Nerve Pain

Hands On Treatment

Hands on and manual therapy for this client base can work wonders if the correct diagnosis is made. Hands on treatment assists with reducing muscle tone and improving freedom of movement, as well as reducing restriction and tension upon the nerve pathway. For those with more of a spinal cause such as at the cervical or lumbar spine, treatment will be very heavily targeted towards releasing the lumbar musculature and improving mobility and reducing stiffness of the lumbar spinal segments surrounding the exiting nerve root. For those clients with more of a peripherally driven issue such as piriformis syndrome, or specific restriction of the peroneal nerve, treatment will often be much more targeted locally. For piriformis syndrome, this will involve a lot of treatment targeted towards reducing muscle tone in the gluteals to allow more freedom for the nerve to glide through the region. It's important to remember though, that just because there is restriction at the gluteals, or at the fibular head, this doesn't mean that there isn't also another driver of symptoms higher up. Just because you have piriformis syndrome, doesn't mean that the lumbar spine isn't also contributing to your symptoms.

A woman is receiving physiotherapy from a sports physio.

Exercise and Nerve Gliding

A graded exercise program, often incorporating specific nerve gliding exercises, forms the backbone of nerve pain rehabilitation. These exercises are designed to gradually restore the nerve's normal mobility without provoking a significant increase in symptoms. It's important to remember that while we are focusing on improving the mobility of the nerve, this is very different to a muscle, the nerve can't become longer. So when you are performing these, you have to remember that you don't push into tension and you don't hold these positions, doing this will simply irritate the nerve further as it reduces oxygen supply to the nerve.

As with every other part of the body, strengthening exercises are imperative. Strengthening around the area to reduce the likelihood of recurrent issues is what helps fix things in the long term, manual therapy and hands on treatment is a short term intervention, long term results come from strengthening. Understanding the driving factors behind what caused the issue in the first place is all part of a thorough subjective and objective assessment.

Your Questions About Sciatica and Nerve Pain

What does sciatica feel like?

Sciatica usually feels like pain travelling from the lower back or buttock down the back or side of the leg, often past the knee and sometimes into the foot. People describe it as burning, shooting, electric or a deep ache, and it is often worse than the back pain itself. You may also notice pins and needles, numbness or a feeling that the leg is weak. Symptoms often change with position, so sitting, bending or coughing may make the leg pain worse, while walking or lying down can ease it.

What causes sciatica?

Sciatica is a description of symptoms rather than a diagnosis. It happens when one of the nerve roots that form the sciatic nerve becomes irritated or compressed in the lower back. The most common cause is a disc bulge or herniation pressing on a nerve root, which is why it is often seen in people aged 30 to 50. In older adults, narrowing of the spaces the nerves travel through, called spinal stenosis, is a more common cause. Less often, tight structures in the buttock can irritate the nerve. My assessment helps work out which is most likely for you.

Is bed rest good for sciatica?

Generally, no. A day or two of taking it easy during a bad flare is fine, but research shows that staying in bed does not speed up recovery and can lead to more stiffness, weaker muscles and a slower return to normal life. Most people do better by staying as active as their symptoms allow, with short walks, regular changes of position and gentle exercises that ease the leg pain. Part of my job is finding the movements and positions that settle your symptoms, so you can keep moving without flaring things up.

What is the best sleeping position with sciatica?

There is no single best position, so the aim is to find what eases your leg pain. Many people find lying on their side with a pillow between their knees comfortable, as it keeps the spine and pelvis in a more neutral position. Others prefer lying on their back with one or two pillows under their knees. Lying on your stomach often aggravates sciatica, although a few people find it helps. A medium-firm mattress tends to suit most people, and changing position through the night is normal.

Will I need surgery for sciatica?

Most people with sciatica do not need surgery. Many cases improve over weeks to a few months with physio, staying active and time. Surgery is usually considered when severe leg pain has not improved after several months of good conservative care, when weakness in the leg or foot is getting worse, or in rare emergencies. Loss of bladder or bowel control, or numbness around the groin or saddle area, needs urgent medical attention at an emergency department. If I think a surgical opinion is worth getting, I will tell you and help you organise it.

Can exercise make sciatica worse?

The wrong exercise at the wrong time can flare up sciatica, but the right exercise is one of the most helpful things you can do. Movements that load or stretch the irritated nerve too much, such as aggressive hamstring stretches or heavy lifting early on, can increase leg pain. I start with movements that centralise or ease your symptoms, then build up gradually. A useful rule is that leg pain should not spread further down the leg during or after an exercise. If it does, we change the exercise rather than push through it.

Common Nerve Pain Presentations

Some of the most common nerve pain presentations I see include sciatica, where irritation of the sciatic nerve or its nerve roots produces symptoms travelling down the back of the leg. Another common presentation of sciatica can be what is called piriformis syndrome, this occurs when the restriction to the sciatic nerve pathway occurs as the sciatic nerve travels within the piriformis and gluteal muscle region. Unfortunately, sciatica is not always treated the same, determining where along the sciatic nerve the restriction is occurring is the key to determining the correct treatment pathway.

Carpal tunnel syndrome, where compression of the median nerve at the wrist produces numbness and tingling in the thumb, index, and middle fingers. Cervical radiculopathy, involving compression of a nerve root in the neck, can produce similar referred symptoms travelling into the arm and hand. Each of these presentations requires an accurate diagnosis of the specific nerve and level of involvement to guide an effective treatment pathway.

Physiotherapist assessing a client's hip and groin on a treatment table

Nerve Pain FAQs

Many cases of sciatica improve a lot within 6 to 12 weeks. Some take longer, particularly where a nerve root is compressed. I will give you a realistic timeframe once we know where along the nerve the problem is.

Go to an emergency department straight away if you have loss of bladder or bowel control or difficulty passing urine, numbness around the groin or genitals, rapidly worsening weakness in a leg or foot, or nerve symptoms in both legs. These can be signs of cauda equina syndrome, which needs urgent treatment.

No. Most nerve pain can be diagnosed with a thorough neurological and nerve mobility assessment. A scan is usually only needed if you have weakness that is getting worse, symptoms that are not improving after 6 to 8 weeks, or if an injection or surgery is being considered.

Each consultation is 45 minutes and costs $110, for both your first appointment and follow-ups. Dry needling, taping and exercise bands are included at no extra cost. If you need a longer course of rehab, my 3, 6 and 12 week rehabilitation programs work out cheaper than paying per session.

Yes. You can claim a rebate from your health fund for every session. PRP Physio is not a preferred provider for any fund, so your rebate may be slightly smaller than at a preferred provider. Your fund can confirm the exact amount using item code 500 for your first consultation and 505 for follow-ups.

Yes, if your nerve pain was caused by a work injury. Your GP starts the claim and gives you a WorkCover certificate, which acts as your referral. Once your claim is accepted, I bill WorkCover directly, so there are no out-of-pocket costs for you. WorkCover covers your first five sessions, and I speak with your case manager if you need more.

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Sciatica & Nerve Pain Physiotherapy