What Is the Best Treatment for Chronic Lower Back Pain? Evidence Based Advice

What Is the Best Treatment for Chronic Lower Back Pain? Evidence Based Advice

by | Jul 14, 2026 | Home Exercises, Injury Prevention, Mobility & Movement

If you’re asking what is the best treatment for chronic lower back pain, the honest answer is that it depends on what’s actually driving your pain, and most people never get that question properly answered. If you’ve had lower back pain for months, you’ve probably already tried the obvious things: rest, over-the-counter anti-inflammatories, a few YouTube stretches, maybe a heat pack on the sofa. And yet here you are, still dealing with it. That experience is more common than you might think. The reason those approaches rarely work isn’t that they’re completely wrong, it’s that they target the symptom rather than whatever is actually driving the pain in the first place.

QUICK ANSWER

The best treatment for chronic lower back pain usually isn’t one single treatment. Current evidence recommends a combination of exercise, physiotherapy, education and active self management. For some people, sports massage, acupuncture or cognitive behavioural therapy may also help, depending on what’s contributing to their pain. The most important step is identifying the underlying cause so treatment can be tailored to you.

 

For most people, treatment includes:

  • A thorough physiotherapy assessment
  • A personalised exercise programme
  • Staying active rather than prolonged rest
  • Education about managing pain
  • Sports massage where muscle tension limits movement
  • Additional treatments such as CBT or acupuncture when appropriate

 

Chronic lower back pain rarely has a single, tidy cause. The most effective treatment approach reflects that complexity. At Body Reset Clinic, every assessment starts with understanding the root cause of why a client’s back pain keeps returning before any treatment decision is made. That principle is simple: treat the problem, not just the pain. It’s what separates short-term relief from lasting recovery.

This article walks through the evidence-based treatment categories for chronic lower back pain, what to try first, how to layer therapies effectively, and the self-management steps that make recovery stick.

 

At a glance: Treatment options for chronic lower back pain

Physiotherapy
Best for identifying the underlying cause of pain and creating a personalised rehabilitation plan.

Exercise
The strongest evidence supports regular, progressive exercise to reduce pain and improve function over the long term.

Sports massage
Can help reduce muscle tension and improve movement, particularly when combined with rehabilitation.

Acupuncture
May provide additional pain relief for some people and is often most effective alongside active treatment.

CBT
Can be beneficial if persistent pain is affecting confidence, sleep or fear of movement.

Steroid injections
Usually only recommended for specific nerve-related conditions rather than general lower back pain.

Surgery
Reserved for a small number of people with serious structural or neurological conditions.

 

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Why does chronic lower back pain keep coming back?

Most people manage back pain reactively. They take anti-inflammatories when it flares, rest until it settles, then return to exactly the same habits that aggravated it in the first place. The pain returns because the underlying dysfunction never gets addressed, whether that’s weak stabilising muscles, restricted hip mobility, or poor movement mechanics through everyday tasks. Sitting, lifting, walking: if the mechanics are off, the load keeps falling in the wrong place.

There’s also a neurological dimension that’s easy to overlook. When pain persists over months or years, the nervous system can become sensitised. Pain signals continue even after the original tissue irritation has resolved, because the brain has learned to treat that region as threatening. This is a well-documented physiological process, not a psychological weakness, and it requires a specific clinical response alongside the physical treatment.

Physiotherapy assessment of chronic non-specific lower back pain commonly identifies a cluster of contributing factors: impaired lumbopelvic control, reduced hip and trunk coordination, and core endurance deficits rather than simple muscle “weakness.” Altered movement patterns develop over time as the body protects itself from pain, and these, too, need addressing.

Psychosocial contributors, including poor sleep, elevated stress, and fear-avoidance behaviour, are also legitimate drivers that a thorough clinician will screen for. Chronic lower back pain is almost never one-dimensional.

 

What is the best treatment for chronic lower back pain? What the evidence says to try first

NICE guideline NG59 is clear on this point. For chronic non-specific lower back pain, the first-line recommendation is exercise, an active self-management approach, and advice to stay active. Bed rest is not recommended. Routine imaging, whether X-ray or MRI, is not recommended for non-specific cases either. The evidence does not support passive, reactive management as a starting point.

A large systematic review found that exercise reduces pain by approximately 15 points on a 100-point scale compared with no treatment, with moderate-certainty evidence, a clinically meaningful improvement.

The important word is “exercise” in its broadest sense. Aerobic activity, resistance training, motor control and stabilisation work, yoga, Pilates, and consistent walking have all shown benefit. No single type is consistently superior to the others. The best exercise for your back is the one you’ll actually do consistently and progress over time. That principle matters more than the specific modality. (See evidence that exercise reduces pain in adults with chronic non-specific low back pain.)

 

Why is physiotherapy considered one of the best treatments for chronic lower back pain?

There is a meaningful difference between receiving a printed sheet of generic core exercises and undergoing a proper physiotherapy assessment. A thorough assessment evaluates movement quality, identifies the specific structures contributing to pain, screens for psychosocial factors, and builds a programme around your lifestyle, load demands, and goals. That context is what makes a rehabilitation plan effective rather than generic.

At Body Reset Clinic, the starting point is always understanding why each individual’s back pain persists before any treatment tool is selected. This contrasts sharply with the experience many people have of receiving the same exercises regardless of what’s actually driving their symptoms. A plan built around your specific movement faults and contributing factors will consistently outperform one built around a diagnosis label alone.

Progressive loading is a core principle supported by the evidence and widely recommended in clinical guidelines. The exercise plan must increase in demand over time to build genuine capacity in the tissues and neuromuscular system. A programme that stays at the same level indefinitely provides short-term adaptation but plateaus quickly. Progression, guided by tolerance and clinical reasoning rather than fear of pain, is what drives meaningful long-term change.

Physiotherapy also includes education about movement and pacing. People who’ve lived with back pain for months or years often develop compensatory movement habits that maintain their symptoms without realising it. Understanding how you move through everyday tasks, and learning how to change those patterns, is a core part of what makes supervised rehabilitation valuable. While evidence comparing supervised and unsupervised exercise is mixed, supervision typically adds individual assessment, structured progression, and education that self-directed programmes often lack.

 

How hands-on therapy fills the gaps exercise alone can’t

Even with a well-designed exercise programme, chronically overactive muscles, trigger points, and restricted fascial tissue can limit progress. If the muscles surrounding the hips and lumbar spine are locked in a state of guarding, the body cannot load through the movement patterns the exercise programme is trying to build. This is where sports massage becomes clinically relevant rather than simply relaxing.

Pooled trial data suggest a moderate effect size (SMD approximately 0.75) for sports massage on pain versus inactive controls in chronic low back pain. It’s worth noting that confidence in this evidence is limited, some reviews rate it as low to moderate certainty, and massage works best not as a standalone treatment but as a tool that prepares the soft tissue for more effective rehabilitation. The likely mechanism involves reducing the nervous system’s protective splinting response and improving tissue extensibility enough to allow better quality movement, though the clinical evidence is primarily short-term. For further reading on massage approaches, see this overview of massage therapy for lower back pain.

This is where Body Reset Clinic’s joined-up model makes a practical difference. Rather than seeing a physiotherapist for exercises and a massage therapist separately, with no connection between the two, having both under one roof means the treatment plan is coherent. The sports massage targets the tissue restrictions limiting exercise quality; the physiotherapy builds the strength and movement patterns needed for long-term stability. That combination directly addresses the most common frustration in chronic back pain management: treating the same problem repeatedly without ever resolving it.

 

CBT, acupuncture, and when injections are appropriate

For a significant proportion of people with chronic lower back pain, psychological factors maintain the pain cycle in ways that physical treatment alone won’t resolve. Fear-avoidance behaviour, sleep disruption, and catastrophising are documented neurological and behavioural responses to persistent pain, not character flaws, and they require their own targeted approach. NICE NG59 recommends considering a combined physical and psychological programme incorporating a cognitive behavioural approach when psychosocial barriers are present, or when earlier treatments haven’t achieved sufficient progress.

CBT has moderate-certainty evidence for long-term pain reduction in chronic non-specific lower back pain. Evidence also suggests that CBT combined with physical therapy can outperform physical therapy alone in the short term, though effect sizes vary across trials. The realistic role of CBT is as a component of a broader treatment programme rather than a replacement for physical rehabilitation. If pain catastrophising, sleep disruption, or fear of movement are features of your experience, raising this with your physiotherapist or GP is a sensible next step.

Acupuncture occupies a useful middle ground. Cochrane review evidence supports acupuncture for medium-term pain relief, roughly three to twelve months, in chronic lower back pain, with moderate-certainty ratings for some outcomes. It works best when used alongside active rehabilitation rather than as a passive standalone treatment. If acupuncture reduces pain enough to allow better quality movement and exercise engagement, it has done its job.

Epidural steroid injections are not appropriate for general non-specific lower back pain. They are indicated for nerve root pathology: lumbar radicular pain (pain radiating along the nerve pathway), disc herniation with nerve compression, or spinal stenosis producing neurogenic symptoms. When those conditions are present and conservative treatment over four to six weeks hasn’t provided sufficient relief, injection can reduce pain for weeks to several months and support engagement with rehabilitation.

Surgery remains a last resort, appropriate when there is persistent or progressive neurological deficit, structural compression confirmed on imaging, or suspected serious pathology such as malignancy or cauda equina compromise (a rare but serious condition affecting the nerve bundle at the base of the spine).

 

What can you do at home for chronic lower back pain?

The most durable outcomes in chronic lower back pain come from building a consistent movement habit over time, not from any single treatment episode. This doesn’t require a gym membership or a complex programme. Walking, swimming, or home-based strengthening can all deliver meaningful benefit when progressed gradually. The principle of graded activity, starting at a manageable level and increasing load steadily, guided by planned progression rather than moment-to-moment pain levels, is the foundation of long-term self-management.

One of the most common patterns in chronic back pain is what clinicians call the boom-bust cycle: overdoing activity on good days, then collapsing into rest on bad days. Pacing means keeping activity levels more consistent, making decisions about movement based on a planned weekly progression rather than how the back feels on any given morning. This approach reduces the peaks and troughs that maintain sensitisation and disrupts the reactive management pattern that keeps most people stuck.

Sleep quality and stress levels are worth addressing directly as part of recovery. The research on sleep hygiene as a standalone intervention for back pain is limited, but both poor sleep and elevated stress are known to lower pain thresholds and slow tissue recovery. Managing these factors won’t replace physical rehabilitation, but ignoring them creates an uphill environment for recovery.

 

Where to start if you’re ready to address this properly

The best treatment for chronic lower back pain isn’t one intervention. It’s a coherent approach that identifies what’s actually driving your pain and builds a plan around that. The evidence is consistent: exercise and physiotherapy first, with hands-on therapy to address the tissue restrictions that limit exercise quality, CBT or acupuncture as useful adjuncts when indicated, and injections only when specific nerve-root pathology is present and conservative management hasn’t delivered enough relief.

Self-management is not a consolation prize when treatment ends. It’s the foundation that makes recovery lasting rather than temporary. Understanding how to pace your activity, progress your loading, and manage the factors that either support or undermine recovery is as important as any hands-on treatment you receive.

If you’ve been living with chronic lower back pain and the reactive approach hasn’t worked, a root-cause assessment is the logical starting point. At Body Reset Clinic in Hartley Wintney, Hampshire, that’s exactly what an initial assessment provides: a thorough understanding of why your pain persists and a personalised plan that combines physiotherapy and sports massage to address it directly. Book an initial assessment and find out what’s actually driving your back pain (learn more about What is a Body Reset?).

 

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Frequently asked questions about the best treatment for chronic lower back pain

For further detail, see our FAQs about our Sports Injury Service

What is the best treatment for chronic lower back pain according to NICE guidelines?

NICE guideline NG59 recommends exercise and active self-management as the first-line approach for chronic non-specific lower back pain. A combined physical and psychological programme should be considered when psychosocial factors are contributing. Bed rest and routine imaging are not recommended.

How long does it take for physiotherapy to help chronic lower back pain?

This varies depending on how long pain has been present, what’s driving it, and how consistently the programme is followed. Most people begin to notice meaningful improvement within six to twelve weeks of a well-structured, progressive rehabilitation programme. Longer-standing pain with central sensitisation may take longer to respond.

Is surgery ever the best option for chronic lower back pain?

Surgery is appropriate only in specific circumstances: persistent or progressive neurological deficit, structural compression confirmed on imaging, or serious pathology such as cauda equina syndrome. For the vast majority of people with chronic non-specific lower back pain, conservative management, exercise, physiotherapy, and where relevant CBT or acupuncture, remains the evidence-based approach.

Sciatica Treatment Options: From Home Care to Surgery

Sciatica Treatment Options: From Home Care to Surgery

by | Jun 19, 2026 | Home Exercises, Treatments

It often starts with a single sharp moment. You’re midway through a morning run, reaching for something under your desk, or simply standing up from the sofa, and suddenly there’s a burning, shooting pain that travels from your lower back or buttock all the way down the back of your leg, prompting you to consider your Sciatica Treatment Options. Some people describe it as electric. Others say it feels like a hot wire. Either way, it stops you in your tracks.

What makes sciatica particularly disorienting is that most people aren’t sure what they’re dealing with. Is it a back problem? A hip problem? A nerve? The answer is usually all three in some combination, and that confusion makes it genuinely hard to know where to start. Sciatica is one of the most common pain conditions seen in clinical practice, often left too long or managed with painkillers that address the symptom but nothing beneath it. Understanding your sciatica treatment options early makes a real difference to how quickly and completely you recover.

At Body Reset Clinic (see What is a Body Reset?), sciatica is one of the conditions we assess most often, and the first thing we tell every client is that understanding what’s driving the pain makes all the difference to choosing the right path forward. This article lays out the main sciatica treatment options clearly, explains what the evidence actually supports, and helps you make a more informed decision about what to do next.

 

What sciatica actually is and what causes it

The sciatic nerve is the largest nerve in the body. It originates from the lower lumbar spine, passes through the buttock, and runs down the back of each leg all the way to the foot. When that nerve is compressed, irritated, or inflamed at any point along its path, the result is the distinctive shooting pain, tingling, or numbness that most people recognise as sciatica. It’s worth knowing, though, that sciatica is a symptom rather than a standalone diagnosis. The underlying cause varies considerably, and that variation matters enormously when it comes to choosing the right treatment.

The most common drivers include lumbar disc herniation, spinal stenosis, and piriformis syndrome, though other causes exist. A herniated disc occurs when the soft inner material of a spinal disc pushes outward and presses against a nearby nerve root. Spinal stenosis involves a gradual narrowing of the spinal canal, typically related to age-related changes, which squeezes the nerves within it. Piriformis syndrome is different: it happens when a deep muscle in the buttock becomes tight or irritated and compresses the sciatic nerve from the outside. Prolonged sitting and previous injury may contribute across all three conditions, while age is a particularly significant factor in spinal stenosis.

The classic presentation of sciatica is one-sided leg pain that travels below the knee, often more intense than the back pain itself. If you’re experiencing pain, numbness, or weakness in both legs simultaneously, or if you notice any change in bladder or bowel function, that’s a different situation entirely and requires urgent attention (more on that below).

 

Immediate self-care: what to do in the first few days

When sciatica flares up acutely, the instinct for many people is either to push through it or take to their bed completely. Neither approach is ideal. The evidence consistently shows that gentle, continued movement is more effective than bed rest for nerve-related pain. Light walking, regular position changes, and avoiding long periods of sustained sitting all help keep the nerve from becoming further sensitised and maintain circulation to the affected area.

Ice and heat

Ice and heat each have a role, but they work differently. Ice is most useful in the first 48 to 72 hours when there’s acute inflammation present, apply for up to 20 minutes at a time with a cloth between the ice pack and your skin. Heat works better when the pain feels more like deep muscle stiffness or tension rather than sharp, inflamed pain. Many people find that alternating between both gives better relief once the most acute phase has settled, though this is largely a matter of personal preference rather than a hard-and-fast rule. Neither will resolve the underlying cause, but both can take the edge off enough to move more freely.

Stretches

Specific stretches can also help during the early days, particularly those targeting the piriformis and hip flexors. A simple figure-four stretch, lying on your back with one ankle crossed over the opposite knee, gently stretches the deep gluteal muscles that often tighten around the irritated nerve. If self-care doesn’t produce meaningful improvement within two to three weeks, or if pain worsens or spreads, it’s time to move beyond home management.

 

Sciatica treatment options with the strongest evidence

Of all the non-surgical approaches to sciatic nerve pain, exercise-based physiotherapy has the strongest and most consistent evidence base. Most people with sciatica improve significantly within a few weeks to a few months with appropriate management, and a structured physiotherapy programme is among the interventions most likely to support that recovery. The key is that the programme needs to be tailored to the specific cause: disc herniation typically responds well to extension-based exercises and nerve gliding techniques, while piriformis-driven pain responds better to deep gluteal stretching and hip strengthening. A physiotherapist will identify which pattern fits and build accordingly.

Manual therapy and soft tissue work are most effective when used alongside exercise rather than in place of it. The evidence isn’t strong enough to support spinal manipulation as a stand-alone treatment for sciatica, but as part of a combined approach it can meaningfully reduce pain and improve movement, particularly when muscle tension in the gluteal and lumbar region is contributing to nerve irritation. For piriformis-related presentations, targeted soft tissue release to the hip and buttock region may help reduce muscle tension around the nerve, though evidence for direct effects on nerve compression is still developing.

Medications have a role in symptom management, but they’re not where long-term resolution comes from. NSAIDs are typically the first choice for short-term relief, though the evidence for their effectiveness in sciatica is mixed and gastrointestinal side effects are a genuine consideration with regular use. For pain with a strong neuropathic character, nerve pain agents such as gabapentin or pregabalin are sometimes prescribed. Opioids are reserved for severe, short-term situations only. Medications manage symptoms; they don’t address the root cause of nerve compression or irritation.

 

When sciatica treatment options include injections or surgery

Epidural steroid injections (ESIs) deliver anti-inflammatory medication directly around the affected nerve root. For sciatica driven by lumbar disc herniation, they can be useful in the short term, reducing pain enough to allow someone to engage in rehabilitation who would otherwise struggle to move at all. It’s worth noting, though, that the benefit is often modest and variable: research suggests relief may last up to three to six months in some cases, but by 12 months outcomes are generally similar to conservative care alone. ESIs are best understood as a potential bridge to rehabilitation rather than a solution in themselves. For patient-facing information about the procedure see this overview of epidural shots.

The risks associated with ESIs are mostly minor: temporary injection-site pain, headache, flushing, or transient numbness are the most common. More serious complications, including dural puncture or nerve damage, are uncommon but real. Repeated injections carry cumulative risks related to steroid exposure, including effects on blood sugar and bone density, which is why they’re used selectively rather than routinely.

Surgery is indicated in a relatively small proportion of cases. For disc herniation, the standard procedure is a microdiscectomy, and it does deliver faster pain relief than prolonged conservative care in the short term. By one to two years, however, outcomes tend to converge between those who had surgery and those who continued with conservative management. Surgery is appropriate when symptoms persist despite six to twelve weeks of structured conservative treatment. Earlier surgical referral is warranted when there is progressive neurological weakness or signs of cauda equina syndrome. For spinal stenosis, decompression surgery is considered when claudication remains function-limiting despite non-surgical management. Claudication is the pattern of leg pain and heaviness triggered by walking and relieved by sitting. Complications from spinal surgery are uncommon but include bleeding, infection, and nerve injury, so the decision should be made carefully and with full information.

 

How physiotherapy and hands-on therapy work together for sciatic nerve pain

No single treatment reliably resolves sciatica for every person. The conditions that cause it are varied, the way each person’s nervous system responds differs, and the lifestyle factors that keep symptoms going are individual. The most effective treatment plans combine structured exercise progression, targeted manual therapy, and education about how to manage load and movement day-to-day. This is particularly true when sciatica involves both nerve irritation and surrounding muscle tension, which is the pattern seen in most clinical presentations.

At Body Reset Clinic, a specialist assessment is always the starting point. We identify the root cause of sciatic nerve irritation first, then build a treatment plan that addresses it directly. For many clients, that plan combines physiotherapy-led exercise progression with soft tissue release to the gluteal and lumbar region and, where relevant, sports massage to reduce muscle tension that’s compressing or aggravating the nerve. Because we offer physiotherapy and sports massage under one roof, clients don’t need to piece together a referral pathway or coordinate between separate practitioners. The plan is joined-up from the first appointment, and continuity of care is maintained throughout, which is particularly valuable for a condition where consistent, progressive treatment tends to produce the best outcomes. For further reading and updates on what we publish clinically, see The Body Reset Clinic Blog Pages.

 

When to seek specialist help and what recovery really looks like

Some symptoms require urgent attention and should not be managed at home. Seek immediate emergency care if sciatica is accompanied by loss of bladder or bowel control, numbness in the inner thighs, groin, or saddle area, or rapidly worsening weakness in the legs. These are potential signs of cauda equina syndrome, a serious neurological emergency that requires surgical decompression without delay. This condition is rare, but knowing the warning signs is critical, see this summary of the seven warning signs of cauda equina syndrome.

For non-emergency situations, prompt professional assessment is still worthwhile if pain is worsening after two to three weeks of self-care, if symptoms followed a significant trauma, or if there are any neurological changes such as foot drop or increasing numbness. Waiting it out with painkillers alone risks allowing the underlying problem to become more established and harder to treat.

Recovery from sciatica is rarely linear: there are better days and harder ones, and progress isn’t always immediately obvious. What matters is whether the overall trajectory is moving in the right direction. Recurrence may be more likely when the underlying movement patterns, strength deficits, and lifestyle factors aren’t addressed, which is why professional guidance extends beyond the acute phase and into a period of consolidation and prevention.

 

Getting the right help sooner makes recovery faster

Sciatica has a well-established range of treatment options, and the right choice depends on what’s causing it, how long it’s been present, and how severe it is. The good news is that the vast majority of people don’t need injections or surgery. When it comes to sciatica treatment options, exercise-based physiotherapy combined with targeted hands-on treatment is the most evidence-backed starting point, and the approach most likely to produce lasting relief rather than temporary suppression of symptoms.

The most important thing is not to leave it to manage itself indefinitely. Getting a proper assessment early means the right treatment begins sooner, and the risk of the problem becoming chronic drops considerably. A structured plan built around the actual cause of your pain is always more effective than generic advice or trial-and-error self-management.

If sciatic nerve pain is stopping you from moving, training, or getting through the workday comfortably, a specialist assessment at Body Reset Clinic will identify exactly what’s driving it and build a plan to address it properly. Get in touch to book your assessment, appointments are available early mornings, evenings, and Saturdays to fit around your schedule, and take the first step towards lasting relief. For more practical details see our FAQs, or contact us with any questions.

 

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FAQs

 

What is the most effective treatment for sciatica?

Most people improve with conservative treatment. Exercise-based physiotherapy has the strongest evidence for reducing sciatic nerve pain and improving function. The best treatment depends on the underlying cause, which may include a disc herniation, spinal stenosis, or piriformis syndrome.

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Can sciatica go away on its own?

Yes. Many cases of sciatica improve within a few weeks without surgery. Gentle movement, appropriate exercises, and avoiding prolonged sitting can help support recovery. However, persistent or worsening symptoms should be assessed by a healthcare professional.

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Is walking good for sciatica?

In many cases, yes. Gentle walking can help reduce stiffness, improve circulation, and prevent the nerve from becoming more sensitive. The key is to stay within a comfortable range and avoid activities that significantly worsen symptoms.

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When should I see a physiotherapist for sciatica?

Consider seeing a physiotherapist if symptoms have not improved after two to three weeks of self-care, if pain is worsening, or if numbness, tingling, or weakness are affecting daily activities.

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Do I need surgery for sciatica?

Most people do not require surgery. Surgery is usually considered when symptoms persist despite several weeks of structured treatment, or when there is significant nerve compression causing weakness or other neurological symptoms.

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How long does sciatica take to heal?

Recovery varies depending on the cause and severity. Many people see significant improvement within six to twelve weeks, although some cases can take longer. Early assessment and appropriate treatment may help speed recovery.

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Can sports massage help sciatica?

Sports massage may help reduce muscle tension around the lower back, hip, and gluteal region that can contribute to discomfort. It is often most effective when combined with a structured rehabilitation programme rather than used as a standalone treatment.