Sciatica physio in Joondalup: finding out why it keeps coming back
Sciatica that keeps coming back usually has a cause nobody has named. See a PhD physio in Joondalup, and leave your first visit knowing the cause and the plan.
By Dr Robert Vander Kraats, Physiotherapist (PhD), Next Generation Physiotherapy, Joondalup
Yes, physiotherapy helps most people with sciatica, but only once the cause has been found. Sciatica is a symptom, not a diagnosis. If yours eases for a week and then comes back, the treatment has probably been aimed at the pain rather than at whatever is irritating the nerve.
At Next Generation Physiotherapy in Joondalup, the first visit is spent working out what is actually going on. You leave knowing the cause, with a clear treatment plan and an estimate of how many sessions it should take.
Book a sciatica assessment or call (08) 9203 7771
What sciatica actually is
Sciatica is pain that travels from the lower back or buttock down the back of the leg, along the path of the sciatic nerve. It often feels burning, sharp or electric. It can come with pins and needles, numbness, or weakness in the leg or foot. It usually affects one side, and sitting, coughing or bending forward often make it worse.
The pain is real, but it is the end of a chain. Something further up is irritating or compressing the nerve root. Common causes include:
- a disc bulge or herniation pressing on a nerve root in the lower back
- narrowing of the space where the nerve leaves the spine, more common after 50
- irritation deep in the buttock, where the nerve passes through or near the gluteal muscles
- a vertebra slipping slightly forward on the one below it
Each of these needs a different plan. That is why two people with identical leg pain can need completely different treatment.
Why sciatica keeps coming back after a few sessions of relief
Most of the people we see for sciatica have already had some treatment. It helped for a while, and then the pain returned. In our experience, there are usually three reasons.
The cause was never named. Massage, heat and hands-on treatment can settle a sensitive nerve for a few days. If nothing changes in how the back is loaded, the nerve gets irritated again.
Treatment stopped when the pain stopped. Pain often settles well before the tissues have recovered their strength and tolerance. Stopping at that point is the most common reason we see the same patient again six months later.
The exercises weren’t specific, or weren’t done. A sheet of generic back stretches can make some types of sciatica worse. The exercises need to match the cause, and you need to do the exercises between visits for them to work.
What happens at your first visit
You see the same senior clinician at your first visit and every visit after it. The first appointment covers:
- Your history. When it started, what eases it, what aggravates it, and what has already been tried.
- A physical and neurological assessment. Movement testing, nerve sensitivity tests, and checks of strength, reflexes and sensation in the leg. This is how we tell a disc problem from a buttock problem from a narrowing problem.
- Here’s what’s actually going on. A plain-English explanation of the cause, so you understand what’s happening and why.
- Your treatment plan. What we will do, what you will do between visits, roughly how many sessions it should take, and how we will know it is working.
Most people also leave with some relief on the day, from targeted hands-on treatment and a change to how they sit, sleep or move.
Do you need a scan?
Most people with sciatica do not need an MRI to get better, and a scan often shows changes that are not causing the pain. A scan is worth having if the leg is getting weaker, if symptoms are not improving after several weeks of the right treatment, or if a specialist referral is being considered.
If your assessment shows you need one, we can help you get it sooner and talk you through the results, so you are not left waiting for answers. Read more about getting a second opinion.
How physiotherapy treats sciatica
Treatment depends on the cause, but a plan usually combines:
- Settling the nerve. Positions, movement and hands-on treatment that reduce irritation in the first one to two weeks.
- Specific exercise. Exercises chosen for your cause, progressed so the back and hips can handle more load.
- Changing the aggravators. Practical changes to sitting, driving, lifting and sleeping, based on what your assessment found.
- Getting back to what you’ve lost. Work, sport, gardening, a full night’s sleep. The plan ends when you can do these again, not just when the pain drops.
When sciatica is an emergency
Go to an emergency department straight away if you have any of these alongside back or leg pain:
- numbness around the groin, genitals or inner thighs (“saddle” numbness)
- new difficulty passing urine, or loss of bladder or bowel control
- weakness in both legs, or a foot that is getting rapidly weaker
These can be signs of serious nerve compression that needs urgent medical care.
Sciatica physio in Joondalup
Next Generation Physiotherapy is at 2/23 Franklin Lane, Joondalup WA 6027, Australia, inside Joondalup Sports Remedial Massage, with free parking on site and in the street. Dr Robert Vander Kraats has 19 years’ experience, a Master’s in Sports Physiotherapy and a PhD.
If you have already tried treatment for sciatica and it keeps coming back, that is exactly the situation we work with. Come in for an assessment and leave knowing the cause, the plan and roughly how many sessions it will take.
Book a sciatica assessment · Call (08) 9203 7771
Open Monday to Saturday, 8am to 6:30pm. Appointments only. Calls answered 24/7, or book online any time.
Frequently asked questions
Can a physio help with sciatica?
Yes. Physiotherapy is a first-line treatment for most sciatica. It works best when the assessment identifies what is irritating the nerve, so treatment and exercises can target that cause.
How many physio sessions does sciatica take?
It depends on the cause and how long you have had it. At your first visit we explain the plan and give you an estimate of how many sessions to expect, and we review it as you progress.
Why does my sciatica keep coming back?
Usually because the cause was never named, treatment stopped once the pain eased, or the exercises didn’t match the cause. Recovery means restoring strength and tolerance, not only settling the pain.
Do I need an MRI for sciatica?
Most people don’t. A scan is useful if your leg is getting weaker, symptoms aren’t improving after several weeks of the right treatment, or a specialist referral is being considered. If you need one, we can help you get it sooner.
Do I need a GP referral to see a physio in Joondalup?
No. You can book directly. If you have a referral from your GP or specialist, bring it to your first appointment.
When is sciatica an emergency?
Go to an emergency department straight away if you have numbness around the groin or inner thighs, new bladder or bowel problems, or weakness in both legs.
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