Can Physical Therapy Make Sciatica Worse? Sure, Only If You Do It Wrong.

Sure, Physical Therapy (PT) Can Make Sciatica Worse!

Some people believe in “No pain, no gain.” I’m here to set the record straight: you don’t need to feel pain to benefit from physical therapy, and in most cases, it’s better if you don’t.

Sciatica can be very painful, so we strive to prevent it from worsening. Those who say PT made them worse often didn't listen to their PT, or the therapist tried to do too much too fast.

While increased pain is not the goal of physical therapy, it can happen—sometimes your symptoms may temporarily worsen before they improve. This isn’t always the case, and when it is, it’s typically short-lived. In the long run, physical therapy is one of the most effective conservative treatments for sciatica. A study by Fritz et al. (2021) found that early referral to physical therapy for acute back pain with sciatica significantly improved patient outcomes and reduced long-term disability.

So, Why Can Pain Sometimes Increase at First?

Because every person—and every case of sciatica—is different. People vary in their:

• Symptom severity
• Response to exercse
• Baseline fitness and health
• Tolerance for movement and exercise

In the early stages of therapy, you and your therapist will work together to understand your body’s limits. How much can the nerve be pushed, and how fast can we recover? This discovery phase is a crucial part of the healing journey. It allows your therapist to design a highly individualized program tailored to your specific needs and goals.

Yes, increased discomfort can occur, but it’s typically mild and temporary. Rest assured, your therapist will closely monitor your progress and make necessary adjustments to support your healing every step of the way.

After 10 Years of Being a Therapist, This is What I Have Learned About Sciatica

Learn What Sciatica Actually Is and What's Causing It

Sciatica is a condition in which the sciatic nerve becomes compressed or inflamed, resulting in symptoms along its pathway. It most commonly presents as pain, tingling, or numbness in the leg. Learn more about it here! 

Often caused by things pressing on the nerve, such as stenosis or the disc.

I created this quiz to help you figure it out! Take this short quiz to figure out where your sciatica is coming from and what to do about it! 

You Should Avoid Movements or Exercises That Make It Worse

Specific movements and exercises can aggravate sciatica pain, so it's important to know what to avoid to prevent a flare-up. In general, flexion-based movements, such as bending forward, can increase intradiscal pressure and worsen nerve compression when you have a disc issue. This can potentially leading to more pain (Oliveira et al., 2018).

I go over a very detailed list of what to do and what to avoid in my Revision Sciatica Book.

Full Sciatica Recovery Is Different For Everyone

Most mild cases of sciatica resolve within 4-6 weeks with physical therapy and consistent self-care at home. For more severe cases, this time frame can extend up to several months. Most cases improve on their own.

In severe cases of sciatica in which there is leg or foot weakness, that weakness usually sticks around, but you may not notice it. Most of my patients only care about pain, so once their pain is better, they are in a good place.

If you are not sure, here are five ways you can track your sciatica healing! 

Exercise Has It's Place but It's Not For Everyone

When dealing with sciatica pain, gentle movement is generally much more beneficial than complete rest, but with an important caveat: not all exercises are appropriate at all times.

As the nerve it's important to know when to exercise and when to not. This can be hard to know on your own but in general:

• Weeks 1-2 you should be resting and trying to control the pain.
• Weeks 3-4 Improve range of motion while keeping the pain low
• Weeks 5-6 Strengthen while improving nerve health
• Weeks 7-8 Build Resiliency

I go over each of these in great detail in my book, Revision Sciatica.

It includes 50+ exercises with pictures and exact instructions for each week so that you can make sure you recover.

Summary

Physical therapy doesn’t have to exacerbate sciatica. When done right, with the right timing, movements, and expert guidance, it can be one of the most powerful tools for long-term relief. Revision Sciatica gives you everything you need: a clear understanding of your condition, step-by-step recovery plans, and over 50 exercises tailored to your stage of healing. Don’t leave your recovery to guesswork—take control of your sciatica today with a proven plan that works.