orthopedic
UK Evidence-Informed Protocol
Sciatica & Lumbar Radiculopathy
Irritation or compression of the sciatic nerve causing radiating pain down the leg.
Clinical Overview:
Sciatica is a symptom complex resulting from mechanical compression or chemical inflammation of one or more nerve roots (L4, L5, S1, S2, S3) that merge into the sciatic nerve.
Living Anatomical Rig (WebGL)
03 — What Can It Feel Like?
Common Symptoms
Sharp, shooting, or electric shock-like pain radiating from the buttock into the leg or foot
Numbness, tingling, or 'pins and needles' in specific dermatomal patterns
Muscle weakness in the calf or foot (difficulty standing on toes or heels)
Aggravation with sitting, coughing, or sneezing (increased intradiscal pressure)
04 — Movement Consequences
How It Affects Daily Function
Inability to sit comfortably for more than 10–15 minutes
Antalgic lateral list (leaning away from the painful side to open nerve space)
Reduced walking speed and stride length
05 — Clinical Assessment
What Your Physiotherapist Evaluates
Straight Leg Raise (SLR) and Well-Leg Raise testing
Slump Test for neural tension evaluation
Lower extremity motor, sensory, and reflex examinations (L4 patellar, S1 Achilles)
Directional preference assessment (McKenzie method)
06 — Treatment Options
Evidence-Informed Rehabilitation
Directional preference exercises (McKenzie extension or flexion based on response)
Gentle neural slider and tensioner mobilization techniques
Pain neuroscience education and pacing advice
Lumbar mechanical traction / decompression where indicated
07 — Rehabilitation Journey
*Timelines vary based on tissue biologyPhased Recovery Pathway
STAGE 01Weeks 1–3
Phase 1: Centralization
Centralize symptoms (move pain out of the leg toward the back)
Focus: Directional preference exercises, positional relief, gentle nerve sliders.
STAGE 02Weeks 4–8
Phase 2: Mobilization
Restore full forward bending and nerve excursion
Focus: Progressive neural glides, core stabilization, and walking tolerance.
STAGE 03Weeks 8–12+
Phase 3: Resilient Loading
Prevent recurrence with full spinal strength
Focus: Deadlifts, hip hinges, and return to unrestricted physical activity.
08 — Home Support & Education
Daily Self-Management
Use lumbar rolls or supportive seating to prevent slouching
Engage in short, frequent walks rather than long periods of uninterrupted sitting
Perform prescribed directional exercises at regular intervals throughout the day
09 — Urgent Safety Guidance
When to Seek Immediate Medical Attention
Sudden numbness around the anus, genitals, or inner thighs (saddle anesthesia)
Incontinence or inability to pass urine
Rapidly progressing weakness in both legs
10 — Clinical Questions
Frequently Asked Questions
What does centralization of pain mean?
Centralization is a positive clinical sign where pain that was radiating down the leg retreats back toward the lower spine. It indicates that nerve compression is lessening.