I Was 30 Years Old and I Thought That Was It
It was a routine patient transfer. The kind you do hundreds of times without thinking.
The patient lost their footing mid-transfer and dropped their full weight into my arms. I caught them. But something in my lower back did not prepare for the catch.
Within a few hours, the electrical-like pain was radiating from my right glute, down the bottom of my foot.
I knew exactly what I was feeling. Disc herniation. Sciatica.
And my first thought, not as a patient but as a physical therapist who'd spent years helping other people fix this exact problem, was: my career might be over. Why? Because it happened to one of my colleagues at Columbia resulting in permanent disability.
Thankfully, it wasn't. I haven't had a significant recurrence in twenty years. But getting there required learning something that most athletes and runners never hear until they've already made the problem worse:
What you do in the first few weeks of a sciatica flare matters more than almost anything else you'll do in your recovery.
What Sciatica Actually Is (And What It Isn't)
Sciatica is not a diagnosis. It's a symptom.
The sciatic nerve is the longest nerve in the human body. It runs from your lower lumbar spine, through the piriformis and deep hip rotators, and travels down the back of the leg to the foot. When something compresses or irritates that nerve, the result is what most people call sciatica: pain, numbness, tingling, or weakness running down one leg.
The most common causes in active adults over 30:
- Disc herniation (the most common, and what I had): the inner material of a spinal disc pushes out and contacts the nerve root
- Lumbar stenosis: narrowing of the spinal canal, more common in adults over 50
- Piriformis syndrome: the piriformis muscle compresses the sciatic nerve, often mimicking disc-related sciatica
- Spondylolisthesis: a vertebra slips slightly out of position and irritates the nerve
- Degenerative disc disease: disc wear over time that reduces the cushion between vertebrae
What sciatica is not: General low back pain, muscle tightness, or soreness after a hard training session. If your symptoms stay in your back and do not travel below your glute into your leg, you likely do not have true sciatic nerve involvement.
The distinction matters because the management is different.
The Movements That Make Sciatica Worse During a Flare
This is where most athletes and runners run into trouble. They feel the symptoms and immediately try to lacross ball, foam roll, and train through them, or they look up "sciatica stretches on YouTube" and end up doing exercises that are completely wrong for their type of sciatica.
When you're in an acute flare, particularly with disc-related sciatica, there are movements that consistently increase nerve irritation and slow your recovery.
Prolonged Sitting
Sitting, especially in a slumped posture, increases intradiscal pressure significantly compared to standing or walking. Research by Nachemson and later refined by Wilke et al. showed that a slumped seated posture produces some of the highest spinal loads of any position.
The fix during a flare: limit sitting to 10 to 15 minute intervals. Get up, walk, change position. Prone lying (on your stomach) is often one of the most relieving positions during an acute disc-related flare.
Forward Bending (Spinal Flexion)
Bending forward under load, or even unloaded in some cases, pushes disc material further posteriorly and toward the nerve. This is why movements like conventional deadlifts, toe touches, bent-over rows, and even tying your shoes can spike symptoms during a flare.
The fix: avoid sustained forward flexion during acute symptoms. Extension-based movements and positions, where you gently move the spine backward, often centralize symptoms and provide relief.
Loaded Squats and Deadlifts
Here's the important nuance: squats and deadlifts are not inherently dangerous. They are among the best long-term strengthening tools for a healthy spine. But when you are acutely flared, the spinal compression and flexion demands of these movements are often more than an irritated nerve root can handle. Remember, this is a temporary load management conversation.
Here's What I Did After My Disc Herniation (And It Worked)
I want to be clear: I had professional guidance through my own recovery (namely, me!). I'm not suggesting you do this alone, especially if you're severe. But this is the process that worked for me, and it reflects what the evidence supports for disc-related sciatica with leg symptoms.
Phase 1: Calm the Nervous System and Centralize Symptoms
My first priority was to stop making things worse. That meant limiting sitting, avoiding forward bending, and finding positions that centralized my pain, meaning the symptoms moved from my leg back toward my spine.
Standing and extension-based exercises were my early go-to. Prone lying, prone props (lying on my stomach and propping up on my elbows), and gentle press-ups (the McKenzie press-up) all helped centralize my symptoms within the first week.
I was religious about not sitting for more than 20 to 30 minutes at a stretch. Standing and walking were my friends.
Phase 2: Stability and Isometrics
Once my symptoms had centralized (meaning, they no longer traveled down my leg) and the intensity was dropping, I moved into stability work. This is where most people get impatient and jump back to their normal training too early.
Isometric exercises, where you contract the muscle without movement, were where I started. Dead bugs, bird dogs, isometric glute work, and gentle core bracing drills. No load or range of motion exercises that provoked symptoms.
Isometrics are a powerful early-stage tool because they allow you to load tissue and rebuild neuromuscular control without the compressive or shear forces that come with dynamic movement.
Phase 3: Gradual Load and Expose
After a few weeks of stability work, I began reintroducing load. Conservatively. In a way that a lot of athletes, especially competitive ones, struggle with because it feels like going backward.
I started with 1 to 3 sets of 15 to 20 repetitions at bodyweight and very light loads. Light enough that form was perfect and I felt zero symptoms during or after.
The 24-hour rule became my guide: how I felt the next morning told me more than how I felt during the exercise. If I woke up with more symptoms than the day before, I had done too much. If I felt the same or better, I had dosed it right.
Over the following month, I gradually increased volume and load. By month two, I was back to training. By month three, I was training harder than I had been before the injury.
And twenty years later, I have not had a recurrence.
How to Know You're Ready to Return to Lifting
This is one of the most common questions I get from our athletes and runners. Here’s the general guidelines I use at Next Level Physio, and the same one I applied on myself.
The 24-Hour Test: The Most Important Metric in Your Recovery
Most athletes make the mistake of measuring their recovery by how they feel during the workout or immediately after. That is the wrong window.
The most important information comes the next morning.
How you feel when you wake up the day after a training session is a safe indicator of whether you dosed your activity correctly. If your morning symptoms are the same or reduced compared to the day before, you are progressing. If they are worse, you did too much and need to pull back.
This single principle, applied consistently over four to eight weeks, is what separates the athletes who recover fully from the ones who keep re-aggravating their sciatica in cycles.
It requires some patience. It requires some ego management, especially when you see your training partners moving well and loading heavy. But the athletes who follow this process come back stronger.
The Bottom Line
Sciatica is not a career-ender!
It is not the beginning of a life without the things you love.
Twenty years ago, I thought lifting a patient had ended my ability to do the work I was trained to do. It hadn't. But only because I knew the process.
Don’t let fear keep you sedentary because it won’t help you recover. Movement, dosed correctly, is medicine.
Don’t let impatience push you back under a heavy bar before your nervous system is ready. Heavy loading, timed wrong, can cause a setback.
The window between those two errors is where your recovery lives. And it is wider than most athletes realize, once you understand where the boundaries are.
**Disclaimer:
The information in this article is educational and not a substitute for individualized medical advice. If you're currently experiencing a sciatica flare, consult your local physical therapist or physician before starting any new exercise program.