Sciatica · disc-bias · piriformis-bias

Sciatica is not one thing.
Your routine shouldn't be either.

Two patterns drive most sciatica: a disc irritating a nerve root, or the piriformis compressing the sciatic nerve. The stretches that help one make the other worse. Take the 90-second self-test, then start the matched routine.

Take the 90-second self-test →Or, in pain right now? Acute flare routine →
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Stop. Go to A&E.
Numbness in the groin or sit-bones, bowel or bladder changes, sudden weakness or foot drop, or sciatica after trauma. These are cauda equina red flags. Full red flag list →
The two patterns

Match your pattern, then the routine

Most sciatica falls into one of two patterns. Forward-flexion-tolerant means piriformis is more likely. Forward-flexion-intolerant with leg-dominant pain means disc is more likely. Pick a side; if you genuinely don't know, take the self-test.

Disc-bias pattern
8 min

Pain runs down your leg below the knee

Sharp, electric, follows a specific path (outer thigh and foot, or back of leg and sole). Worse with sitting and bending forward. Walking sometimes helps. Coughing makes it shoot.

  • · McKenzie extension protocol
  • · Centralisation principle as the dial
  • · Prone cobra is the centrepiece
Open disc-bias routine →
Piriformis-bias pattern
8 min

Deep buttock pain, worse on hard chairs

Centred deep in the buttock. May refer down the leg, but the leg pain is vague, not knife-like. Specifically aggravated by sitting on hard surfaces or driving long distances. Common in runners and desk workers.

  • · Figure-4 and supine piriformis stretches
  • · Forward-flexion-tolerant
  • · Add nerve glides for adherence
Open piriformis-bias routine →
Not sure which one? Take the 90-second self-test →
Today

Start with 4 minutes

If you're in pain now, the 4-minute acute flare routine is the safest entry: gentle decompression, a nerve glide (pulse, not hold), and a single piriformis stretch at half the usual hold. No provoking positions.

Piriformis-bias routine

The seven stretches

Every stretch on this site, with the pattern it suits

Supine Piriformis Stretch

Piriformis, Deep external rotators

piriformis

Seated Figure-4 Stretch

Piriformis, Glute max

piriformis

Knee-to-Opposite-Shoulder Stretch

Piriformis, Glute med

piriformis

Hamstring Nerve Glide (Slumped)

Sciatic nerve, Hamstrings

either

Sciatic Nerve Floss

Sciatic nerve, Lumbosacral nerve roots

eitherpulse

Child's Pose (Modified for Sciatica)

Lumbar paraspinals, Glutes

either

Prone Cobra (McKenzie Extension)

Lumbar erectors, Posterior disc structures (decompressed)

disc
Disc-bias · McKenzie method

For when sitting hurts and walking helps

The McKenzie extension protocol is a widely used conservative approach for disc-driven sciatica. In Long, Donelson and Fung's 2004 trial of low back pain with or without sciatica, patients given exercises matching their directional preference (flexion, extension or sideglide/rotation) showed greater improvements in pain and disability than patients given opposite or non-directional exercises.

The watchword is centralisation. If pain moves UP toward the spine as you press up, the protocol is working. If pain moves DOWN further into the leg, stop, you need a different direction.

Disc-bias routine

Common questions

Questions people ask before they start

How do I know if my sciatica is from a disc or from the piriformis?
The 90-second self-test on this site is built around the two signals. Disc-related sciatica tends to follow a specific dermatomal path (outer thigh and top of foot for L5, back of leg and bottom of foot for S1), gets worse with sitting and forward-bending, and may improve with walking. Piriformis-driven sciatica tends to be centred in the buttock and worsen specifically with prolonged sitting on hard surfaces, without a clean dermatomal pattern. The wrong routine makes the wrong cause worse, which is why we split them.
Which routine should I start with?
If you're in the first 48 hours of a fresh sciatica flare, start with the 4-minute acute routine: very gentle, no provoking positions. Beyond that, take the disc-or-piriformis self-test and follow the result. If you genuinely cannot tell, the maintenance routine is the safest fallback because it includes a balanced mix of both directions.
When should I go to A&E instead of stretching?
Immediately if you have saddle anaesthesia (numbness in the groin or sit-bones area), bowel or bladder dysfunction, progressive weakness (foot drop, can't lift toes), or sciatica after significant trauma. These are signs of cauda equina syndrome, a surgical emergency. Do not stretch; do not wait. Go to A&E or call 999/911.
What does "centralisation" mean and why is it on every routine page?
Centralisation is the McKenzie Method's real-time biofeedback signal. As you do a stretch, watch where the pain lives. If pain moves UP toward your spine, the stretch is helping (good). If pain moves DOWN further into the leg, the stretch is the wrong direction for you (bad, stop). The closest trial evidence is the Long, Donelson and Fung 2004 Spine trial, in which exercises matched to a patient's directional preference did better than opposite or non-directional ones.
Why does the sciatic nerve floss say "do not hold"?
Because it's a glide, not a stretch. Sustained traction on an already-irritated nerve typically makes the irritation worse. The flossing motion alternates which end of the nerve is loaded (the foot end and the head end), so the nerve slides in its sheath without sustained tension. That sliding action is the therapeutic part. Holding the end position would convert it from a glide into a tensioner, which is what an inflamed nerve does not need.
Do I need any equipment?
Nothing required. A yoga mat or folded blanket helps for the floor stretches. A small cushion under the head can help during supine work. For the seated figure-4 you just need a sturdy chair.
All 15 FAQ →
Last reviewed 2026-05-12 · stretchesforsciatica.com