Sciatica & Herniated Disc Physical Therapy

If you have leg pain, numbness, or tingling that starts in your low back or buttock and travels down your leg, you have probably been told it is sciatica. That word gets used as a catch-all, but the real diagnosis matters — because treatment depends on what is actually compressing or irritating the nerve.

The sciatic nerve is the largest nerve in your body. It exits the lower spine, passes through the pelvis, and runs down the back of each leg. When it is compressed or inflamed — by a disc herniation, spinal stenosis, or muscular tightness — it produces pain, numbness, tingling, or weakness that can extend from the buttock to the foot.

Why Most Sciatica Does Not Require Surgery

Imaging studies of people with zero symptoms show that disc herniations are remarkably common. A large systematic review found that 37 percent of 20-year-olds already have disc changes on MRI, and that number rises with age. The presence of a herniation on imaging does not mean it is the cause of your pain.

The majority of disc herniations resorb — your body breaks down the protruding material over time. Larger herniations actually tend to resorb more completely than smaller ones. This means the condition that looks most alarming on an MRI often has the best natural history.

What matters is not the image. What matters is the clinical exam — your movement patterns, your nerve function, your strength, your response to specific loading strategies. That is what a Doctor of Physical Therapy evaluates on day one.

What We Do Differently

Most physical therapy for sciatica follows a generic protocol: some heat, some stretching, maybe a nerve glide exercise, and a follow-up in a week. That is not what happens here.

At Forward Physical Therapy, we evaluate and treat on the same visit. Your first session includes:

• Directional preference testing — We identify specific movements that centralize your symptoms (move them closer to the spine and out of the leg). Centralization is one of the strongest predictors of a good outcome.
• Nerve tension assessment — We test the mobility of the sciatic nerve itself, not just the structures around it. A nerve that is mechanically sensitized needs specific mobilization, not just stretching.
• Strength and movement screening — Weakness in the hip, core, or lower extremity changes how load is distributed through the spine. We measure it, then address it.
• Manual therapy — Joint mobilization, soft tissue work, and dry needling to reduce pain and restore motion. We use these alongside exercise, not instead of it.
• Aerobic capacity — Aerobic exercise is one of the most effective treatments for nerve pain. We measure your ventilatory thresholds and prescribe exercise at the right intensity — not just “go walk.”

Treatment starts immediately. You leave with a home program and a clear plan.

The Conditions We Treat Under This Umbrella

Sciatica is a symptom, not a diagnosis. The conditions that cause it include:

• Lumbar disc herniation — the most common cause in younger patients. A portion of the disc’s inner material pushes outward and compresses a nerve root. Most respond to directional exercise and nerve mobilization.
• Spinal stenosis — narrowing of the spinal canal, more common over age 60. Causes leg symptoms with prolonged standing or walking. Responds well to flexion-based exercise, hip strengthening, and aerobic conditioning.
• Piriformis syndrome — the piriformis muscle in the buttock compresses or irritates the sciatic nerve. Diagnosed by clinical exam (not MRI). Treated with targeted hip and pelvis work.
• Lumbar radiculopathy — a nerve root irritation that causes pain, numbness, or weakness in a specific pattern down the leg. Directional preference and nerve mobilization are first-line.
• SI joint dysfunction — pain from the sacroiliac joint that can mimic sciatica. Differentiated by clinical testing and treated with stabilization exercise.
• Failed back surgery syndrome — persistent pain after spinal surgery. Physical therapy focuses on rebuilding strength, movement confidence, and aerobic fitness.

When Imaging Is Needed — and When It Is Not

If you have leg pain without any red flags (progressive weakness, loss of bladder or bowel control, unexplained weight loss, history of cancer), imaging is not needed before starting physical therapy. Clinical guidelines are clear: early imaging for uncomplicated back and leg pain leads to more intervention and higher costs without better outcomes.

We will refer you for imaging if your symptoms are not responding as expected, if we identify neurological changes that warrant further workup, or if your history suggests something beyond a mechanical cause. That referral comes from clinical reasoning, not from a reflex to “get an MRI first.”

Objective Measurement at Every Visit

We track your progress with numbers, not just how you feel. Every visit includes standardized outcome measures — our Return+ system monitors nerve function, strength, range of motion, and functional testing so you can see exactly where you stand and how far you have come. If something is not improving, we change the approach. If you are ahead of schedule, we progress faster.

Edgerton and Fitchburg

We treat sciatica and disc-related conditions at both our Edgerton and Fitchburg locations. Both clinics are equipped for manual therapy, dry needling, strength training, and aerobic conditioning. You will see the same Doctor of Physical Therapy at every visit.

No Referral Needed

Wisconsin’s direct access law means you can see a physical therapist without a physician referral. Call us today and be seen within 24-48 hours.

We are in-network with Anthem BlueCross BlueShield, Medicare, Humana, The Alliance, UMR, Cigna, and all Workers’ Compensation carriers. HSA/FSA accepted. Competitive self-pay rates available. We verify your benefits before your first visit.

Two Locations

Fitchburg — 6250 Nesbitt Rd, Suite 500, Fitchburg, WI 53719
Edgerton — 102 W Fulton St, Edgerton, WI 53534
Phone: (608) 561-7733

Serving Fitchburg, Madison, Verona, Oregon, Middleton, Edgerton, Milton, Janesville, Stoughton, and surrounding communities.