People who book an appointment for sciatica often expect the session to focus on their back or the painful leg. Many are surprised when the clinician taps their knees with a reflex hammer, touches their feet with cotton wool or asks them to push against resistance. These checks form part of a neurological examination, and they are a standard part of physiotherapy for sciatica. Each one gives information about the nerves running from the lower back to the legs, which helps guide decisions about care.
Testing Reflexes
Reflex tests check the pathway between a tendon, the spinal cord and the muscle that responds. The clinician compares both sides of the body, and the results can point to details such as these:
- Whether the knee reflex is reduced, which may suggest involvement of a nerve root in the upper lumbar spine.
- Whether the ankle reflex is reduced or absent, which is often linked to the S1 nerve root.
- Whether reflexes are unusually brisk, which may point to a problem higher up in the spinal cord.
- Whether findings are on one side only or on both sides.
- How reflexes compare with earlier visits, if the person has been assessed before.
Testing Sensation
Sensation testing maps the areas of skin where feeling has changed. Each nerve root supplies a particular strip of skin, known as a dermatome, so the clinician may check for the following:
- Areas of numbness or reduced feeling on the thigh, shin or foot.
- Pins and needles or burning that follows a specific pattern down the leg.
- Differences between light touch and sharp sensations in the same area.
- Changes in feeling around the inner thighs or buttocks, which need urgent attention.
Testing Muscle Strength
Strength testing looks for weakness in muscles supplied by particular nerve roots, and any weakness found can shape sciatica treatment plans from the first session. Asking the person to hold positions against resistance helps the clinician check movements like these:
- Lifting the foot and big toe upwards, which relies mainly on the L5 nerve root.
- Rising onto the toes, which tests the calf muscles supplied by S1.
- Straightening the knee against resistance.
- Lifting the leg sideways to assess the hip muscles.
- Walking on the heels and then on the toes to show weakness during movement.
Comparing the Three Sets of Findings
No single test gives the full picture, so results are read together alongside the person’s history. Decisions about care usually depend on how these findings line up, as the following points show:
- Matching changes in reflexes, sensation and strength can suggest which nerve root is most likely affected.
- Pain with normal neurological findings may suggest irritation rather than ongoing nerve compression.
- Mixed results may lead the clinician to consider other sources, such as the hip or sacroiliac joint.
- Nerve tension tests, such as the straight leg raise, are often added to support the findings.
Tracking Change Over Time
The first assessment also gives a starting point for measuring progress. Repeating the same checks at later visits helps in ways like these:
- Showing whether strength and sensation are returning as symptoms settle.
- Flagging any decline that may need medical review.
- Guiding when exercises can be progressed or activity increased.
When Findings Call for Medical Review
Some results suggest the problem may need input from a doctor. Clinicians usually advise prompt medical attention when these signs appear:
- Weakness that is getting worse, such as foot drop or frequent tripping.
- Numbness in the saddle area around the groin and buttocks.
- New problems controlling the bladder or bowel.
- Symptoms in both legs at the same time.
What the Checks Add Up To
Reflex, sensation and strength tests may seem unrelated to back or leg pain at first, but together they show how the nerves are functioning. Anyone unsure about their results can ask the clinician to explain what each test showed and how it shapes the plan.
Schedule a sciatica assessment with us at The Movement Laboratory and let us help you move with ease.
