Physiotherapy · Sciatica
Sciatica physio in Phuket
Nerve pain down the leg is frightening, but the outlook is good. Our physios check your nerves, find movements that ease your leg and keep you moving, then your coach rebuilds your strength.
For leg pain that started this week, has lasted months, or has a doctor talking about injections or surgery.
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What the research says
Most people improve over weeks to months
Sciatica is leg pain from an irritated nerve in your lower back, for example from a disc bulge. Most people improve substantially over weeks to months.1,2 For some it takes longer, so the plan is to stay safe, keep moving and rebuild.
87%
reported improvement by 12 weeks in one trial, whether they had two weeks of bed rest or simply waited and saw.1
96%
of herniations where a disc fragment had broken free had shrunk on later scans, in pooled studies. A big disc on MRI is not bad news.3
2yrs
after surgery or non-surgical care, leg pain was similar either way, in pooled trials.4
Your nerve can settle. The work is staying safe, keeping moving and rebuilding the strength to do what you love.
How we work
Stay safe, keep moving, build back
Bed rest does not speed recovery, and staying active is safe.5 Your physio checks your nerves, finds movements that ease your leg and guides a short exercise course. Then we rebuild strength for work and sport.
Nerve checks at every stage
Your physio checks the strength, reflexes and feeling in your legs at the start and at every stage. Any new numbness or weakness is checked the same day.
Let symptoms guide the exercise
We look for movements and positions that ease your leg or draw pain back toward your back. In one trial, a four-week physio course built this way improved disability more than advice alone, in the first weeks.6
Finish with a coach
The last two phases are training, not treatment. Your physio signs off each stage before your coach builds the strength, power and confidence for work, lifting and sport.
Your recovery
Four phases, moved through by milestones
Timeframes are typical. Your milestones decide when you move on, and a flare may mean a short step back. That is normal.
- 01
Typically 0 to 2 weeks
Calm the nerve
Your physio checks your nerves and warning signs, explains what is going on and finds positions and movements that ease your leg. Short, regular walks keep you moving while the nerve settles.
Move on whenLeg symptoms are easing, stable or moving toward your back for 3 to 5 days, you can walk 10 minutes without spreading, and your nerve check is stable.
- 02
Typically 2 to 6 weeks
Move with confidence
Easing movements as needed, longer walks, better sitting and bending tolerance, and gentle strength work: bridges, box squats, step-ups, calf raises, side bridges and hip hinges.
The handover gateLeg pain down 30% or 2 points for 2 weeks, no spreading with your exercises, and a stable nerve check on two visits in a row. Your physio signs it off.
- 03
Typically 6 to 12 weeks
Build strength
Your coach builds whole-body strength with progressive lifting, single-leg work, carries and trunk endurance, plus fitness you enjoy. A quick nerve check every session, and physio reviews every 3 to 4 weeks.
Ready for impact and sport whenTrap bar deadlift three quarters of bodyweight for 5, single-leg calf raises within 10% of the other side, and 30 minutes of brisk walking without spreading.
- 04
From about 12 weeks
Back to full training
Heavier lifting, power, rotation, running and your sport, step by step. Spine surgeons do not agree on when to return to sport after disc surgery,8 so we use milestones, not the calendar.
Full sport whenTwo weeks of full training with a green response every morning, your sport ladder completed without spreading, and a flare plan you are confident with.
A Dutch physio guideline advises a medical review if symptoms are not clearly improving after 6 to 8 weeks.9 If it has lasted over three months, you may start at phase two, and each phase may take longer.
Between sessions
Watch where the leg pain goes
Watch where your leg symptoms go, not just how much they hurt. If you are unsure, ask your physio.
During and the morning after each session, check three things: where your leg symptoms are, your leg pain against your normal, and any new numbness or weakness.
Green: progress
Leg symptoms stay put or move up toward your back. Back pain may rise but settles by next morning. Progress as planned.
Amber: hold
Leg symptoms spread during an exercise but settle within minutes, or leg pain is up under 2 points and settles within a day. Repeat, or adjust.
Red: step back
Spreading, or leg pain up 2 points that lasts over a day: step back and tell your physio. New numbness or weakness: see them today.
Go to hospital now if
Call 1669 in Thailand.
- Numbness around your genitals, bottom or inner thighs
- Difficulty peeing, new leaking, or changed feeling when peeing
- You can’t feel a full bowel, or new bowel leaks
- New sexual problems, or symptoms spreading into both legs
- Severe or worsening leg weakness, or a dragging foot
- Fever with back pain, or a major injury
See a doctor within days if you have a history of cancer, weakened immunity, unexplained weight loss, night pain, or osteoporosis with new pain.
Thinking about surgery or an injection?
Faster is not always further
Surgery and injections are real options, and for some people they are the right call. But for most, they change how fast you recover, not where you end up.10,4,11
Early surgery eased leg pain faster, but within a year 95% had reported recovery either way.10 For sciatica lasting 4 to 12 months, one trial found surgery eased leg pain more at six months.12 Steroid injections ease leg pain a little, for weeks, not months.11 Your physio talks you through the options honestly and refers you when needed.
Patient reviews
What our patients say
Rated 5.0 from 57 Google reviews
“I came to Optimize with chronic back pain and absolutely no ability to train. I was first matched with Khun Meaw, a highly skilled rehabilitation trainer who helped me eliminate my back pain completely. … After that, I continued training with Kate for a full year.”
nesterzhzhotGoogle review “Meaw has been incredible. She helped me recover from long term neck and lower back pain and gave me personalized exercises that I now do daily. These have made a huge difference in my strength, mobility, and overall well-being. I’m so grateful for her expertise and highly recommend her to anyone looking for real, lasting results!”
Jeff CraigGoogle review “I honestly can’t thank Karim at Optimisefit enough … I’ve lived in five different countries and, unfortunately, had to deal with many injuries, so I’ve seen quite a few physios over the years. But no one has ever come close to the level of knowledge, care, and clarity that he brings.”
Unfiltered OpinionsGoogle review “I have been seeing Karim for long term issues with my neck and the results have been fantastic. I have attended several physios in the past and none compare to Karim. His skills and knowledge helped to pinpoint the exact cause of the issues and the treatment plan has made massive improvements.”
joyce billingtonGoogle review “I have been working with Khun Meaw on some strengthening exercises for my shoulders, hips and knees. … Her goal has been to give me the tools I need to work on my specific areas of need and not to keep me in an endless cycle of needing help……so professional and a joy to work with.”
Catlin McCrackenGoogle review “Optimise is a fantastic set up, I have been working with Khun Meaw on a physio front, and she is awesome and really gets to the root of the problem and starts from there – could not recommend highly enough. Having seen a couple of different physios on the island, Khun Meaw is certainly number 1.”
Jamie AllworkGoogle review “I started seeing Khun Maew last August for a knee issue and within 15 minutes she had identified a multitude of issues I’d been dealing with for more than 20 years … I have been pain free for 6 months and am now in the gym working to rebuild my mobility and strength.”
Michelle LawlorGoogle review
Questions
Sciatica questions
A big disc on my scan: do I need surgery?
Not on the scan alone. Herniations that push out furthest, or break off, are the type most likely to shrink by themselves.3 Surgery decisions depend on your symptoms, strength and how long it has lasted.
Should I rest in bed until it settles?
Will an injection sort it out for good?
On average, steroid injections reduce leg pain a little, for weeks rather than months.11 They can help you get moving when pain is severe, but there is little evidence of benefit beyond three months.
Does sciatica always go away on its own?
I have leg weakness. Do I need surgery straight away?
In a trial of mostly moderate weakness, about 80% recovered full strength within a year, with or without early surgery.14 Severe or worsening weakness is different: go to hospital now for an urgent surgical opinion.
What about nerve pain tablets?
In one trial, pregabalin worked no better than placebo for sciatica and caused more side effects.15 Physios do not advise on medicines, so ask your doctor, and keep walking.
Physio team
Your physio team
Meaw leads our clinical standards and checks every handover to your coach.
How physiotherapy works here
Meaw
Head Physiotherapist
Karim
Physiotherapist
Also on the team Sukanya, Physiotherapist
Next step
Find out where your nerve stands
Message us on WhatsApp to book your free physio assessment. We check for warning signs, test your nerves and build your plan.
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Questions first? WhatsApp +66 65 914 1604
Sources (15)
- Vroomen PC, et al. Lack of effectiveness of bed rest for sciatica. N Engl J Med. 1999;340(6):418-423.
- Konstantinou K, et al. Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. Spine J. 2018;18(6):1030-1040.
- Chiu CC, et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-195.
- Liu C, et al. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ. 2023;381:e070730.
- Dahm KT, et al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010;(6):CD007612.
- Fritz JM, et al. Physical therapy referral from primary care for acute back pain with sciatica: a randomized controlled trial. Ann Intern Med. 2021;174(1):8-17.
- Dove L, et al. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J. 2023;32(2):517-533.
- Bäcker HC, et al. Return to sports following discectomy: does a consensus exist? Eur Spine J. 2024;33(1):111-117.
- Apeldoorn AT, et al. Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF). Eur J Phys Rehabil Med. 2024;60(2):292-318.
- Peul WC, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-2256.
- Oliveira CB, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):CD013577.
- Bailey CS, et al. Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. N Engl J Med. 2020;382(12):1093-1102.
- Lequin MB, et al. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open. 2013;3(5):e002534.
- Overdevest GM, et al. Recovery of motor deficit accompanying sciatica: subgroup analysis of a randomized controlled trial. Spine J. 2014;14(9):1817-1824.
- Mathieson S, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med. 2017;376(12):1111-1120.
This page is general information based on the research listed here. It is not a diagnosis. Your physio will tailor the plan to you, and your surgeon’s or doctor’s instructions come first. Clinically reviewed by Meaw, Head Physiotherapist at Optimise, November 2026.