Physio assessment and treatment in Miranda and the Sutherland Shire
Overview
Back pain is common, but that doesn’t make it easy to live with. When it flares up, it can affect sleep, work, training, and even basic things like bending to put on shoes. It can also feel unpredictable. One day it’s a dull ache. The next it’s sharp and tight, or it feels like it might seize up again.
If you also have pain into the buttock or leg, pins and needles, or a feeling of weakness, it’s very easy to assume something serious is going on.
Sometimes it’s nerve related sciatica. Other times it’s referred pain from the back. They may feel similar, but the best first steps aren’t always the same.
Most back pain improves, but recovery rarely feels like a straight line. You can have a good day, then a flare-up that makes you question everything. That up and down pattern is common. The key is matching the right approach to the right stage.
Early on, you’re typically in a protection phase, focused on managing symptoms and avoiding further aggravation. Then follows a healing phase, where movement and tolerance start to return, even though the area may still be sensitive. Finally, the recovery phase is where strength and load tolerance determine the long term outcome.
On this page we explain the difference between back pain and sciatica, the symptoms that need a faster check, and what recovery usually looks like.
We also outline the rehab sequence we use at PhysioCentral: restore mobility, rebuild flexibility, then develop strength and load tolerance so you can return to normal life with more confidence.
If you’re in Miranda or elsewhere in the Sutherland Shire and want a clear plan, this will help you understand what to do next.
Contents
- Back pain vs sciatica
- Acute vs chronic back pain (and sciatica)
- What is a red flag?
- Red flags, when to seek urgent care
- Why back pain happens
- Common ways back pain starts
- Do I need a scan?
- The three stages of recovery
- Our rehab sequence
- The tightening phases
- Want more detail on recovery timing?
- What progress should look like
- What your first physio appointment should achieve
- What you can do today
- FAQs
- Book a back pain or sciatica assessment
Back pain vs sciatica, what’s the difference?
Back pain
Back pain usually feels localised. It might be an ache, stiffness, sharp pain, or a spasm. It often changes with bending, lifting, prolonged sitting, rolling in bed, or getting in and out of the car.
Sciatica
Sciatica is commonly used to describe symptoms that travel into the buttock, thigh, calf, or foot. It may include:
- burning, sharp, or electric pain into the leg
- pins and needles or numbness
- symptoms that change with posture (sitting, bending, walking)
- weakness, or the leg feeling unstable
Important note: not all leg pain is true sciatica. Sometimes pain refers into the buttock or thigh without the nerve being the main driver. An assessment helps clarify what you’re dealing with, which means we can choose the right treatment and exercise plan to speed up recovery.
Acute vs chronic back pain (and sciatica)
You’ll often hear back pain described as acute or chronic. This applies to sciatica too.
Acute usually means a new flare-up or a recent episode. It often feels sharp, reactive, and unpredictable. The early goal is to settle symptoms, restore comfortable movement, and avoid repeated aggravation.
Chronic usually means symptoms have been around for longer, or keep coming back. That doesn’t automatically mean the back is damaged. More often it means the area has become sensitive, protective, and deconditioned over time.
The plan is similar, but the focus shifts:
- acute tends to need symptom settling and controlled mobility first
- chronic often needs a longer runway of consistency, then progressive strength and load tolerance to reduce recurrences
Either way, the aim is the same. Get you moving well again, then build strength and habits so you’re less likely to need physio for this again.
We see both acute flare-ups and long term recurring back pain in patients across Miranda and the Sutherland Shire.
What is a red flag?
A red flag is a sign or symptom that suggests your back pain may need urgent medical assessment, rather than the usual physio style management.
Most back pain isn’t dangerous. But certain symptoms can point to a more serious problem, such as significant nerve compression, infection, fracture, or other medical causes. When these red flags are present, the priority is getting the right medical help quickly.
A red flag doesn’t mean something bad is definitely happening. It simply means it’s safer to be checked sooner.
If you’re not sure whether something counts as a red flag, call us or speak with your GP so you’re not guessing.
Red flags, when to seek urgent care
If any of the following symptoms are present, it’s best to seek urgent medical care rather than trying to push through it or self-manage.
Seek urgent medical care if you notice:
- new bladder or bowel changes
- numbness in the groin or saddle region
- rapidly worsening weakness in the leg or foot
- severe pain that’s escalating quickly and not settling at all
- significant pain after major trauma
- fever or feeling very unwell along with severe back pain
If you’re unsure, it’s better to be checked.
Why back pain happens
Back pain rarely stems from just one structure. It typically involves irritation, guarding, and load intolerance.
And the main source of pain is the protective muscle spasm that is triggered by any of the main drivers. Such as these…
Common drivers include:
- disc irritation, which can contribute to local pain and sometimes leg symptoms
- joint irritation, including facet joints and surrounding structures
- protective muscle guarding and spasm, which is the body’s way of protecting the area
- stiffness elsewhere (hips or upper back not moving well, so the low back takes the load)
- a spike in load (lifting, long drives, gardening, sudden training increases)
- recovery factors (poor sleep, stress, reduced movement, fear of flare-ups)
The goal isn’t guessing. The goal is to identify the main driver and match the right plan to it.
Common ways back pain starts
Back pain often feels like it came out of nowhere, but there’s usually a trigger or a build up.
Common patterns we see include:
- desk and sitting build up, gradually increasing stiffness, then a flare-up after a long day at the computer
- lifting and twisting, picking up a child, laundry basket, gym lift, or an awkward lift from the car boot
- long car trips, prolonged sitting, followed by a sharp catch when you stand up or bend
- gardening and housework, repeated bending, reaching, and time on the floor
- running and sport changes, a jump in training load, speed work, hills, or a change in routine
- a simple movement that catches, like bending to tie shoes, rolling in bed, or stepping the wrong way when you’re already stiff
Knowing how it started helps guide what to do first and what to avoid temporarily.
Do I need a scan?
Most people with a new episode of back pain don’t need imaging straight away.
Scans can be useful when:
- the red flags listed above are present
- there’s significant or worsening weakness
- symptoms aren’t improving as expected over time
- the results will change the treatment plan
A common trap is over-interpreting scan findings. Many people without pain have disc bulges or age-related changes on imaging. That doesn’t automatically mean those findings are the reason for your pain.
If imaging is appropriate, we’ll recommend it, and your GP will guide that process.
The three stages of recovery
We use a simple framework across the clinic because it helps people understand why symptoms change.
These stages are the plain-English version of the body’s healing phases (inflammatory, proliferative, remodelling), so you can match the right action to the right stage.
Stage 1: Protection phase
This is the injury or flare-up stage. Things feel sensitive and unpredictable. The goal is to settle symptoms and reduce repeated flare-ups.
What helps most here:
- reducing obvious triggers, often bending, heavy lifting, and prolonged sitting
- gentle movement in small doses
- settling strategies that don’t spike symptoms
Stage 2: Healing phase
Symptoms start to settle, but the area can still feel stiff or vulnerable. This is where people often do too much because they feel better, then flare up again.
The goal here:
- restore movement options
- reintroduce load gradually
- rebuild confidence without provoking the nervous system
Stage 3: Recovery phase
This is where durability is built. You may feel mostly fine day to day, but still get reminders with certain loads or positions.
The goal here:
- build strength and endurance
- return to work, sport, and training with fewer flare-ups
- reduce recurrence risk
Our rehab sequence
This is the practical approach we use day to day: restore Mobility, then Flexibility, then Strength. It fits inside the recovery stages above, and the timing matters.
1) Mobility
Mobility restores movement through the spine, hips, and pelvis so the irritated area isn’t forced to do all the work.
Early mobility work should feel:
- gentle
- controlled
- repeatable
- calming, not like you’re testing the back
As you reintroduce movement, symptoms may briefly worsen before they settle and start improving again. That doesn’t automatically mean damage. It usually means the area is sensitive and needs a controlled, gradual return to normal movement.
For sciatica-type presentations, mobility can also include positions and movements that reduce nerve sensitivity.
Many people find symptoms ease with gentle, repetitive mobility work, not long periods of rest. Rest can make tissues feel tighter, and you might feel worse when you get up after lying down too long.
2) Flexibility
Flexibility is the next step once the area is less reactive. It helps reduce the tight and guarded feeling that can stick around even when pain is dropping.
This is also where people often notice stiffness shifting around or a tightening sensation returning for a few days. That’s common and usually responds well when flexibility work is timed correctly.
3) Strength
Strength is the preventative long game. It’s how you stop living cautiously around your back.
Weak muscles can be easier to strain, and they often tighten to protect joints. That tightening can restrict movement, compress sensitive structures, and irritate nerves.
Before we begin strengthening, we need to make sure you’ve got enough mobility and flexibility. If we start strength work too early, tight and weak muscles can overstrain and tighten further, sometimes even going into spasm.
Put simply, we need to loosen up the tight bits before we strengthen the weak bits. Otherwise the tight bits often just get tighter.
Strength work isn’t just working on your core. It often includes:
- trunk endurance and control
- hip strength
- leg strength and capacity
- lifting patterns and confidence under load
- work and sport specific conditioning
If strength starts too early, symptoms can flare again and people lose trust in the process. Timing matters.
The tightening phases
Many people notice a tightening sensation at a few predictable points.
Days 7 to 10: Scar tissue formation
As the initial inflammation settles, scar tissue begins to form early in healing. As it forms, it can tighten, and people often feel more tightness and less pain.
This usually responds well to the right mobility work and a sensible, gradual increase in activity.
Weeks 3 to 4: Scar tissue maturing
As healing continues and tissue adapts, stiffness can return as scar tissue matures. Scar tissue can tighten as it becomes more organised. This is often when flexibility becomes a bigger focus.
Weeks 6 to 8: Muscle strengthening
As you build strength more confidently, weak muscles can tighten as a precursor to getting stronger. This isn’t automatically a setback. The key is load progression that matches your capacity.
These phases can sound annoying, but they become much easier to manage once you expect them. They’re also a normal part of recovery.
A full recovery includes improving any deficits you may have had before your injury or flare-up, especially if you’ve had chronic or recurring back pain. Our goal isn’t only to help you recover quickly, it’s also to reduce the chance of this happening again.
Want more detail on recovery timing?
If you want to go deeper, these pages explain the healing stages and treatment timing in more detail:
- The healing process of soft tissue injuries and the tightening phases in recovery
- Understanding injury recovery, a simple guide to healing phases and treatment timing
- The injury recovery process, healing phases and treatment timing
What progress should look like
A good recovery pattern often looks like:
- fewer severe flare-ups
- shorter flare-ups when they happen
- more movements and positions that feel safe
- improved walking tolerance and day to day function
- improved sleep, or less disruption from pain
If you’re trending in that direction overall, you’re generally on track even if you have an occasional rough day.
What your first physio appointment should achieve
Most people want 3 things on day one:
- relief!
- reassurance that they aren’t doing damage
- a plan they can start immediately
A good assessment typically includes:
- a clear history of how it started and what changes symptoms
- movement testing (what’s stiff, what’s sensitive, what’s protective)
- nerve screening when leg symptoms are present
- strength and control checks (hips, trunk, legs)
- a simple explanation in plain English
- a home plan matched to your stage (protection, healing, or recovery)
You should leave knowing what to do today and this week, not just what’s wrong.
What you can do today
General starting points that help many people:
- Keep moving in small doses. Short walks and frequent position changes are often better than long rests.
- Avoid long holds in one posture. Sitting still tends to stiffen and sensitise.
- Reduce spikes in load. Avoid testing heavy lifting during a flare-up.
- Use heat if it helps, especially for stiffness and guarding.
- Pick one or two simple exercises. Small and consistent usually beats big and occasional.
If you’ve got leg pain, pins and needles, or weakness, get assessed sooner so you’re not guessing your way through it.
FAQs
Urgent and when to get checked
What are the red flags I should not ignore?
Red flags are uncommon, but important. If you notice any of the red flag symptoms listed above (bladder or bowel changes, groin or saddle numbness, rapidly worsening weakness, severe escalating pain, fever with severe back pain, or major trauma), seek urgent medical care.
How long should I wait before getting it checked?
If it’s severe, recurrent, or limiting work, sleep, or normal activity, it’s worth getting assessed early. If you’ve got leg symptoms, especially pins and needles or weakness, the sooner the better.
When should I get imaging for back pain?
Imaging is usually most useful when the red flags listed above are present, when there’s significant or worsening weakness, or when symptoms aren’t improving as expected over time. Scans aren’t always helpful early because they often show changes that don’t match pain.
Understanding what is going on
What is the difference between sciatica and referred pain?
Sciatica is nerve related pain that can travel into the buttock, leg, calf, or foot, sometimes with pins and needles, numbness, or weakness. Referred pain can also travel into the buttock or thigh, but the nerve isn’t the main driver. They can feel similar, so an assessment helps clarify which one you’re dealing with.
Is sciatica always caused by a disc bulge?
No. A disc can be involved, but sciatica type symptoms can also be influenced by nerve sensitivity, inflammation, joint irritation, and protective muscle guarding. What matters most is what’s driving your symptoms right now.
Does a disc bulge mean I will need surgery?
Usually not. Many people have disc changes on scans and don’t have pain. Even when a disc is contributing to symptoms, most cases improve with the right progression of movement and loading.
Does a disc bulge mean I will always have back pain?
No. Disc changes are common, even in people without pain. Symptoms are often influenced by sensitivity, inflammation, and protective muscle guarding, not just what shows up on a scan.
Can sciatica cause calf pain or foot pain?
Yes. Sciatica symptoms can travel into the calf, ankle, or foot depending on which nerve roots are irritated. It’s often described as burning, electric, or sharp, and may come with pins and needles.
What to do right now
Should I rest completely or keep moving?
A blend is usually best. A short rest can help settle an acute flare-up, but complete rest for days often increases stiffness and sensitivity. Gentle movement in small doses usually supports recovery.
Is walking good for back pain and sciatica?
Often, yes. Walking is one of the simplest ways to keep things moving without long periods of compression. Start small and build gradually. A good starting point is 10 minutes. You’re often better off doing three 10-minute walks than one 30-minute walk.
Is sitting bad for sciatica?
Sitting is a common aggravator for nerve sensitive presentations because it holds the spine in one position and can increase sensitivity. Many people also find sitting aggravates disc related pain. If sitting worsens symptoms, aim for shorter sitting blocks, frequent position changes, and a gradual return to tolerance.
How can I drive or sit in the car without flaring sciatica?
Bring the seat closer so your knee bends a little more, which can reduce tension through the sciatic nerve. Set the backrest roughly in the 95 to 110 degree range and use a small lumbar support if it helps. On longer trips, stop every 60 to 90 minutes to stand and walk.
Is heat or ice better for back pain?
Both can help. Heat is often useful for stiffness and muscle guarding. Ice can help if things feel inflamed or irritated. The best option is the one that gives you relief without making symptoms worse afterwards.
Should I stretch my back if it hurts?
Not initially. When the back is in spasm, aggressive stretching often makes it tighten further. Early on, gentle repetitive mobility work is usually a better first step than long, strong stretches.
What is the best sleeping position for sciatica?
Most people do best on their side or on their back. Side sleeping often feels better with a pillow between the knees. Back sleeping often feels better with a pillow under the knees. Stomach sleeping commonly irritates symptoms during a flare-up.
Why is my back pain worse in the morning?
Morning pain is often a mix of stiffness from being still for hours and sensitivity when you first start moving. Sleep position can contribute too. A simple option is lying on your back with knees bent and gently rocking your knees side to side for 2 minutes before you get up.
Why does sciatica feel worse at night?
It can feel worse because you’re still for longer, positions can compress sensitive areas, and poor sleep increases pain sensitivity. If night symptoms are a pattern, it’s often worth adjusting your daytime movement plan and your sleep setup.
Why does my back or sciatica hurt when I cough or sneeze?
Coughing and sneezing briefly increase pressure through the spine. If the area is irritated, that split second can trigger sharp pain or a quick zap into the leg. If it’s happening frequently, it’s worth getting assessed so your plan can be adjusted.
Exercise, gym, and rehab
Can I go to the gym with back pain?
Often yes, but your plan usually needs modifying. Early on, avoid repeated flare-ups by reducing spikes in load and avoiding movements that consistently aggravate symptoms. As things settle, strength work becomes a key part of preventing recurrence. Remember the order: Mobility first, then Flexibility, then Strength.
What exercises are best for sciatica?
There isn’t one best exercise for everyone. Some people respond well to extension based movements, others to flexion tolerance work, nerve mobility, or hip and trunk control. The right exercise is the one that improves symptoms or function without flaring you over the next 24 hours.
Will stretching fix sciatica?
Stretching too early often irritates sciatica. If stretching gives short term relief but you pay for it later that day or the next morning, it’s probably too much or the wrong type. Early on, gentle mobility usually beats long, hard stretches.
Treatment choices people ask about
Does massage help back pain or sciatica?
Massage can help, especially for muscle guarding and that tight, protective feeling. It usually works best as part of a plan, not as the whole plan. The long term win tends to come from the right mobility first, then flexibility, then strength and load tolerance.
Timeframes and progress
How long does back pain usually take to settle?
Many episodes improve over days to weeks, but it depends on the driver, your day to day loads, and how reactive things are. A mild strain often settles within 3 to 4 weeks. A more significant soft tissue strain can take 6 to 8 weeks to heal, and longer again to rebuild full strength.
Why did my back feel better, then flare again?
This is common. Flare-ups can come from load spikes, prolonged sitting, poor sleep, stress, or progressing strength too early. It can also happen during predictable tightening phases as tissue adapts. A flare-up isn’t automatically damage, but it is a signal to adjust your plan.
Is numbness or pins and needles normal with sciatica, and when should I worry?
Pins and needles can happen with nerve irritation. What matters is the trend. If it’s improving overall, that’s reassuring. If numbness is spreading, weakness is worsening, or you’re losing control in the foot or ankle, that needs prompt assessment. If you have bladder or bowel changes or groin numbness, seek urgent medical care.
How do I know if I am making progress?
Look for trends, not perfect days. Good signs include fewer severe flare-ups, shorter flare-ups, more time between flare-ups, improved walking tolerance, more comfortable sitting and bending, better sleep, and more confidence with daily tasks. Recovery is often cyclical. As you reintroduce movement and then strength, you might feel a small flare, then things settle again as the body adapts.
Book a back pain or sciatica assessment
If you want a clear diagnosis and a plan you can follow, our physiotherapists at PhysioCentral can help you work through the right stage at the right time.
We focus on the sequence that gets you better as quickly as possible, and keeps you better for the long run:
- restore mobility
- improve flexibility
- develop strength and confidence
The goal isn’t just to settle this flare-up. It’s to build the strength and habits that help stop it coming back, so you can stay active and confident long term.