Physio Bangkok/Conditions
Sciatica and Slipped Disc Treatment in Bangkok
Sciatica is pain that travels from your lower back or buttock down your leg because a nerve root in your spine is irritated, most often by a slipped disc. At Aspire Physio Bangkok, our physiotherapists check it’s safe to treat and settle the nerve first, then rebuild your movement and strength on our gym floor so you can get back to full activity. The clinic is on the 2nd floor of Jasmine Building, Sukhumvit Soi 23, a short walk from Asok BTS and Sukhumvit MRT, and your first consultation is free. Book through our contact page or call 082-281-8009.
- Free first consultation
- Licensed physiotherapists
- English and Thai
- Sukhumvit 23, near Asok BTS
Your physio team
Licensed physiotherapists who assess and treat you themselves, in English or Thai, from treatment through to the gym floor.
At a glance
| Most common cause | A slipped (herniated) disc irritating a nerve root in the lower back |
|---|---|
| Typical recovery | A few weeks to a few months for most people; some take longer |
| Can a disc heal? | Often. Herniated disc material shrank back on its own in 70% of extrusions in one review |
| Surgery or wait? | Early surgery eased leg pain faster in a major trial, but results were similar at 1 and 5 years |
| Scans | Not routinely needed. Considered if pain lasts beyond about 12 weeks or weakness is getting worse |
| Emergency signs | Saddle numbness or new bladder, bowel or sexual problems: go to an emergency department now |
What sciatica and a slipped disc are
Sciatica describes a set of symptoms: pain, and sometimes tingling, numbness or weakness, that travels from your lower back or buttock down your leg. It happens when a nerve root at the bottom of your spine is irritated or compressed. The roots usually involved are L4 to S1 [3], and they feed the sciatic nerve, which runs from your lower back to your feet [2].
The most common cause is a slipped disc [2]. Your discs are soft cushions of tissue between the bones of your spine. When part of a disc pushes out (also called a disc herniation, prolapse or HNP, short for herniated nucleus pulposus), it can press on a nearby nerve root and inflame it [3]. Other causes include narrowing of the spinal canal (spinal stenosis), one vertebra slipping forward on another (spondylolisthesis) and back injuries [2]. Less often, the sciatic nerve is irritated deep in the buttock, away from the spine. Piriformis syndrome is the most familiar example of this group, which is called deep gluteal syndrome [14].
Slipped discs become more likely as you get older [2]. Smoking and obesity are both linked to a higher risk of sciatica serious enough to need hospital care, while walking or cycling to work is linked to a lower risk [13]. Once you’ve had sciatica, there’s a chance it will come back at some point [2].
Symptoms
Sciatica usually affects one leg [3]. Symptoms tend to run from the buttock down the back of the leg, often into the foot and toes, and the leg pain is usually worse than any back pain [2]. You may notice [2]:
- sharp, burning or shooting pain down the back of the leg, often reaching below the knee
- pins and needles
- numbness
- weakness in the leg or foot
- pain that’s worse when you move, sneeze or cough
Symptoms can start suddenly or build slowly [2]. Some people find that certain positions ease the leg pain while others sharpen it. Finding those positions is part of your first session.
If you only have back pain, with nothing travelling down the leg, it’s probably not sciatica [2]. Our back pain physiotherapy page covers that.
When to see a doctor first
Go to a hospital emergency department straight away, or call 1669 for an ambulance, if you have back pain or sciatica together with any of these, especially if they’re new or getting worse [4][2]:
- numbness, tingling or altered feeling around your genitals, inner thighs, bottom or back passage (the “saddle” area), including a change in feeling when you wipe after using the toilet
- new difficulty starting to pass urine, reduced feeling of urine flow, not knowing when your bladder is full, or leaking urine
- loss of bowel control, or not feeling when you need to open your bowels
- new problems getting an erection or ejaculating, or loss of feeling in your genitals during sex
- sciatica in both legs, or weakness or numbness in both legs that’s severe or getting worse
These can be signs of cauda equina syndrome, where the bundle of nerves at the bottom of the spinal canal is compressed, most commonly by a large disc prolapse. It’s rare, around 1 to 3 in 100,000 people, but it’s a surgical emergency. If treatment is delayed, it can cause permanent loss of bladder, bowel and sexual function [4]. Don’t wait for a physio appointment, and don’t drive yourself: ask someone to take you or call an ambulance [2].
See a doctor promptly if you have:
- weakness or numbness in one leg that’s spreading or getting worse, including foot drop, where your foot slaps down or your toes catch as you walk [3]
- fever, feeling generally unwell, unexplained weight loss, a history of cancer, or pain that started after a significant fall or accident. Doctors need to rule out causes such as infection, cancer, trauma and inflammatory disease [1]
- leg pain that’s getting worse, hasn’t improved after a few weeks of self-care, or is stopping you doing your normal activities [2]
Our physiotherapists screen for these at your first visit and will tell you if you need to see a doctor. We can recommend clinics nearby.
Your first consultation is free. A physiotherapist will assess you properly and explain what’s going on, with no pressure to book more.
The phases of sciatica recovery
| Phase | Typical timeframe | What you notice | What rehab focuses on | We move on when you can |
|---|---|---|---|---|
| 1. Calm the nerve (acute) | Typically the first few weeks. In one trial, about two in three people reported improvement after 2 weeks [5]. | Leg pain is the main problem. Moving, sneezing or coughing can sharpen it [2]. | A clear explanation of what’s going on. Positions of relief. Keeping you moving within tolerance with short walks and regular position changes, since bed rest doesn’t help [5]. Hands-on treatment if it helps you move, alongside exercise [1]. Monitoring strength and sensation. | Find comfortable positions, walk short distances and sleep reasonably. Leg pain is steady or easing, with no new or worsening numbness or weakness. |
| 2. Restore movement (subacute) | Typically from the first few weeks up to about 3 months. In the same trial, 87% reported improvement by 12 weeks [5]. | Pain eases on more days than not. You can sit and walk for longer. Flare-ups still happen but settle faster. | Nerve mobility exercises (sliders) [11]. A graded walking plan. Trunk and hip strengthening. Bending and lifting reintroduced at light loads. Exercise in line with NICE guidance [1]. | Get through a normal day of sitting and walking without leg pain building. Strength is similar side to side on testing. Flare-ups settle quickly with your plan. |
| 3. Return to full activity and lifting | Varies widely, from several weeks to several months, and longer for some people [2][6]. | Little or no leg pain day to day. Occasional stiffness or twinges after long sitting or a heavy day. | Progressive strength training on the gym floor, including squats, hip hinges, carries and the lifting patterns your work or sport needs. Aerobic fitness. A plan for flare-ups. | Work, train and lift at your normal level without symptoms returning, and you know what to do if they flare. |
| Not improving | Symptoms not improving after about 6 to 8 weeks of conservative care, or pain lasting beyond 12 weeks [3]. | Leg pain still dominates your day, or weakness or numbness is getting worse. | Referral to a doctor to discuss imaging, injections or a surgical opinion [1][3]. We keep you as active as possible in the meantime. | Have a medical plan in place, with rehab continuing around it. |
These timeframes are typical ranges, not deadlines. We progress you on what you can do, so some people move through in weeks and others take months. Symptoms can go up and down along the way [9], and a flare doesn’t mean you’re back to square one. Moving with some pain isn’t harmful and can help you recover faster [2].
The disc itself often settles too. A systematic review of repeat scans found spontaneous regression in 96% of sequestrated discs, 70% of extrusions, 41% of protrusions and 13% of bulges [7]. The more pronounced herniations were the most likely to regress.
How we treat sciatica
Check it’s safe and find the source
Your first session is a full assessment with one of our licensed physiotherapists, in English or Thai. We take a detailed history, test the strength, sensation and reflexes in your legs, and use nerve tension tests to judge whether a nerve root is involved. We screen for the red flags above. We also check whether the hip or deep buttock could be the source [14].
You don’t need a scan to start. NICE advises against routine imaging outside specialist settings for low back pain with or without sciatica [1], and disc changes are common in people with no pain at all. Disc protrusions show up on scans in 29% of pain-free 20-year-olds, rising to 43% by age 80 [10]. If imaging could change your management, we’ll refer you to a doctor.
Calm the nerve
Early on, the aim is to settle an irritated nerve. We find positions and movements that ease your leg pain, adjust how you sit, sleep and work, and keep you moving within what the nerve tolerates. Bed rest doesn’t speed recovery [5]. Hands-on treatment such as joint mobilisation and soft tissue work is part of standard physiotherapy for sciatica [2], and NICE says to consider it only as part of a package that includes exercise [1]. We use it to make moving easier while the nerve settles. Our manual therapy page explains what that involves. NICE advises against traction, back belts and corsets, ultrasound and TENS for sciatica [1].
Get the nerve moving
As the pain settles, we add nerve mobility exercises, often called nerve glides or sliders. They move the sciatic nerve gently through its range without stretching it hard. A systematic review found neural mobilisation reduced pain and disability in chronic low back pain, though the authors noted the evidence is still limited [11]. We pair this with a graded walking plan, building your time on your feet in steps you can recover from.
Build the strength
This is where most of the long-term work happens. Our physios also work on the gym floor, so you can move from the treatment room to supervised exercise in the same building, often in the same session when it’s appropriate. We build trunk and hip strength first, then progress to squats, hip hinges, carries and the lifting patterns your work or sport needs. NICE guidance supports exercise programmes (biomechanical, aerobic, mind-body or a combination) for people with a flare-up of low back pain with or without sciatica [1]. Two of our physiotherapists are also qualified strength and conditioning specialists, which helps when the goal is heavy lifting or sport.
Worth knowing: trials of individual physio techniques for sciatica are mixed and mostly low quality, so no single technique has been proven to fix it [12]. We stick to what guidelines support, which is staying active and progressive exercise, with hands-on care as a short-term add-on [1].
Scans, injections and surgery
These are decisions for your doctor, and we don’t provide them. We’ll refer you when they’re worth discussing. NICE suggests considering an epidural injection of local anaesthetic and steroid for acute, severe sciatica, and surgery to decompress the nerve when non-surgical care hasn’t improved pain or function and the scan matches your symptoms [1].
Surgery can speed things up. In a large Dutch trial of people with 6 to 12 weeks of severe sciatica, early surgery relieved leg pain faster than continued conservative care. But after one year, about 95% in both groups felt recovered [8], and at five years there were no significant differences between the groups [9]. In the conservative group, 39% had surgery within the first year [8], rising to 46% by five years [9]. For many people without red flags, a period of good conservative care is a reasonable first option.
How long it takes and how many sessions
Sciatica usually gets better in a few weeks to a few months, though it can last longer [2]. In a Dutch trial of people whose sciatica was severe enough to consider bed rest, 87% reported improvement after 12 weeks, whether they rested in bed or not [5].
Not everyone gets there quickly. In a UK study of people seeing their family doctor with sciatica or back-related leg pain, average leg pain fell from about 5 out of 10 to under 3 out of 10 by four months. By 12 months, 55% had improved their disability score by at least 30% [6]. In that study, having had leg pain for longer and believing the problem would last a long time were both linked to less improvement [6]. That’s one reason we explain what’s happening and agree a plan at your first visit.
Session numbers vary. In the same UK study, people with milder or improving symptoms had up to two physiotherapy sessions, while those with more troublesome pain had a course of three or more [6]. Your physio will give you a plan after the first session, with an estimate for your case, and review it as you progress. If you’re not improving as expected, we’ll tell you and refer you to a doctor.
What you can do at home
- Keep moving. Carry on with your normal activities as much as you can. Moving may hurt, but it isn’t harmful and can help you get better faster [2]. Bed rest doesn’t help [5].
- Break up sitting and lying. Avoid sitting or lying down for long periods [2]. Change position often and use the positions that ease your leg pain.
- Start gentle exercise early. Anything that gets you moving can help [2]. Short, regular walks are an easy place to start, adding time as your leg settles.
- Try heat. A heat pack on the painful area can ease symptoms [2].
- Ask about pain relief. Talk to a pharmacist or doctor. Paracetamol is unlikely to help, and it’s not clear how much anti-inflammatories such as ibuprofen help with sciatica [2].
- Know your red flags. Numbness around your genitals or bottom, new bladder, bowel or sexual problems, or weakness in both legs means going to an emergency department straight away [4][2].
Your physiotherapist will set specific exercises after assessing you, because the right starting point depends on what eases and aggravates your symptoms.
Cost and insurance
Your first consultation is free. Treatment sessions start from ฿1,600. If you have health insurance, you can claim with your insurer, and we’ll supply the documents your provider asks for. It’s worth checking your policy’s physiotherapy cover before you start. See our insurance claims page for how claiming works.
Your physiotherapists
Your knee is treated by one of our licensed physiotherapists: Boom Namsak, who is both a physiotherapist and a strength coach, Gino Udomthanakij, or Som Benjaprasertsri. They all work in English and Thai, and they all coach the gym-floor part of your rehab themselves.
Common questions
Is sciatica the same as a slipped disc?
Not exactly: sciatica describes the symptoms, and a slipped disc is the most common cause of them. Sciatica means pain, tingling or numbness travelling down the leg from an irritated nerve root in the lower back. A slipped disc (also called a herniated disc or HNP) pressing on that root is behind most cases, but spinal stenosis, a slipped vertebra and, less often, nerve irritation deep in the buttock can cause similar symptoms. Your physio assesses which is most likely.
How long does sciatica last?
Sciatica usually gets better within a few weeks to a few months, though it can last longer and can come back. Recovery varies a lot. Some people improve noticeably within a couple of weeks, while others have symptoms that go up and down for months. We set a plan after your first session based on what you can do, and refer you to a doctor if you’re not improving as expected.
Can I exercise or go to the gym with sciatica?
Yes, staying active is recommended, but you may need to change what you do for a while. Bed rest doesn’t speed recovery, and gentle movement such as walking can help. Heavy lifting, long periods of sitting or movements that sharpen your leg pain may need scaling back early on. Your physio will show you what to modify for now and how to build back up to full training on our gym floor.
Do I need an MRI for sciatica?
Usually not at first. Sciatica is diagnosed from your symptoms and a clinical examination, and NICE advises against routine imaging. Disc bulges and protrusions also show up on scans in many people with no pain, so a scan on its own can mislead. Imaging is considered if symptoms last beyond about three months, if weakness is getting worse, or if surgery is being discussed. We don’t do scans at the clinic, but we’ll refer you to a doctor if you need one.
Can a slipped disc heal without surgery?
Yes, in many cases the disc material that has pushed out shrinks back on its own. A 2015 systematic review of repeat scans found the more pronounced types of herniation, extrusions and sequestrations, were the most likely to regress, and some resolved completely. Symptoms can settle as this happens. Rehab focuses on calming the nerve and rebuilding your strength and confidence in the meantime.
Will I need surgery for sciatica?
Most people with sciatica improve without surgery. Surgery is a decision for your doctor and can be considered when severe leg pain hasn’t improved after six to eight weeks of conservative care, or urgently if there are signs of cauda equina syndrome. In a large Dutch trial, early surgery eased leg pain faster, but outcomes were similar to conservative care at one year and at five years.
Could my pain be piriformis syndrome instead?
It’s possible, but a slipped disc is the more common cause of sciatica. Piriformis syndrome is one of several conditions grouped as deep gluteal syndrome, where the sciatic nerve is irritated in the buttock, away from the spine. The symptoms can look very similar, so the spine needs to be checked first. Your physio will assess both areas and refer you for further tests if the picture isn’t clear.
What is cauda equina syndrome?
Cauda equina syndrome is a rare emergency where the nerves at the bottom of the spinal canal are compressed, most often by a large disc prolapse. Warning signs include numbness around the genitals, inner thighs or bottom, new bladder or bowel problems, new sexual problems, and sciatica or weakness in both legs. If you notice any of these, go to a hospital emergency department straight away. Treating it before symptoms become severe can reduce the risk of permanent disability.
References
Show 14 references
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. Published 2016, last updated July 2026. www.nice.org.uk/guidance/ng59
- NHS. Sciatica. NHS website. Page last reviewed 3 December 2024. www.nhs.uk/conditions/sciatica/
- Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019;367:l6273. doi.org/10.1136/bmj.l6273
- Getting It Right First Time (GIRFT), NHS England. Spinal Surgery: National Suspected Cauda Equina Syndrome (CES) Pathway. February 2023, updated March 2026. gettingitrightfirsttime.co.uk/wp-content/uploads/2026/04/National-Susp
- Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA. Lack of effectiveness of bed rest for sciatica. N Engl J Med. 1999;340(6):418-423. doi.org/10.1056/NEJM199902113400602
- Konstantinou K, Dunn KM, Ogollah R, Lewis M, van der Windt D, Hay EM, et al. Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. Spine J. 2018;18(6):1030-1040. doi.org/10.1016/j.spinee.2017.10.071
- Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-195. doi.org/10.1177/0269215514540919
- Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-2256. doi.org/10.1056/NEJMoa064039
- Lequin MB, Verbaan D, Jacobs WC, Brand R, Bouma GJ, Vandertop WP, et al. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open. 2013;3(5):e002534. doi.org/10.1136/bmjopen-2012-002534
- Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi.org/10.3174/ajnr.A4173
- Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017;47(9):593-615. doi.org/10.2519/jospt.2017.7117
- Dove L, Jones G, Kelsey LA, Cairns MC, Schmid AB. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J. 2023;32(2):517-533. doi.org/10.1007/s00586-022-07356-y
- Shiri R, Euro U, Heliövaara M, Hirvensalo M, Husgafvel-Pursiainen K, Karppinen J, et al. Lifestyle risk factors increase the risk of hospitalization for sciatica: findings of four prospective cohort studies. Am J Med. 2017;130(12):1408-1414.e6. doi.org/10.1016/j.amjmed.2017.06.027
- Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH. Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J. 2020;102-B(5):556-567. doi.org/10.1302/0301-620X.102B5.BJJ-2019-1212.R1
Free first consultation
Book a knee assessment
Aspire Physio Bangkok is at Jasmine Building, 2nd Floor, Sukhumvit Road, Soi 23, a short walk from Asok BTS and Sukhumvit MRT. We’re open Monday to Friday 7am to 8pm, and Saturday and Sunday 8am to 4pm. Bookings are required in advance. Book your free first consultation through our contact page or call 082-281-8009.