Sciatica isn't really a diagnosis. It's a description of a symptom — pain that originates in the lower back or buttock and radiates down the leg along the path of the sciatic nerve. That distinction matters, because the cause of sciatica determines the treatment, and "sciatica" itself can come from at least half a dozen different sources.
The good news: most cases of sciatica resolve within 6 to 12 weeks with the right conservative care. The frustrating news: a lot of patients spend months chasing the pain in the wrong direction because the root cause hasn't been identified.
What's actually happening
The sciatic nerve is the largest nerve in the body. It forms in the lower back from nerve roots exiting the lumbar spine, runs through the buttock, and travels down the back of the leg, branching to supply most of the leg's muscles and sensation. When any part of that nerve gets compressed, irritated, or chemically inflamed, you feel it as leg pain — even though the source of the problem is usually upstream.
The most common drivers I see in clinic include:
- Lumbar disc herniation — a disc bulge pressing on a nerve root as it exits the spine. This is the textbook cause, but it's only one of several.
- Spinal stenosis — narrowing of the spinal canal, more common as we age, which crowds the nerve roots.
- Piriformis syndrome — when the piriformis muscle deep in the buttock irritates the sciatic nerve as it passes through (or sometimes through) the muscle.
- SI joint dysfunction — the sacroiliac joint can refer pain along similar pathways and is often confused with true sciatica.
- Facet joint irritation in the lower lumbar spine can produce radiating buttock and leg pain that mimics sciatica.
Telling these apart requires a proper assessment — orthopedic testing, neurological screen, palpation, and movement evaluation. The treatment differs significantly depending on which is driving the pain.
What sciatica feels like — and what it doesn't
True sciatica typically presents as sharp, shooting, or electric pain that travels in a continuous line from the lower back or buttock down the back or side of the leg. It often gets worse with sitting, coughing, or sneezing, and may be associated with:
- Numbness or tingling in specific parts of the leg or foot
- Weakness in muscles supplied by the affected nerve root
- Worsening pain with certain positions (often forward bending or sitting)
What's usually not sciatica: vague aching across the whole leg, pain that stops at the buttock, or pain that's the same in both legs. Those patterns point to other causes that need different treatment.
How we treat sciatica
The first step is identifying the source. Once we know whether we're dealing with a disc, a piriformis, an SI joint, or something else, the plan can be targeted.
For disc-related sciatica, the priorities are calming nerve irritation and reducing the mechanical pressure. Flexion-distraction and spinal decompression techniques can be highly effective. Neural mobilization ("nerve flossing") helps restore nerve glide. Acupuncture has strong evidence for radicular pain and helps modulate the heightened pain sensitivity that often accompanies it.
For piriformis-driven sciatica, the muscle itself needs work — ART, dry needling, and Graston Technique on the piriformis and deep external rotators are particularly effective. Strengthening the glutes and addressing the movement patterns that overload the piriformis prevents recurrence.
For SI joint involvement, restoring SI joint mobility through chiropractic adjustment, addressing the surrounding pelvic muscles, and strengthening the deep stabilizers are the foundation.
Across all presentations, movement matters. Bed rest beyond a day or two actually slows sciatica recovery. Gentle walking, targeted nerve glides, and position-specific exercises (the right ones, identified by assessment) consistently outperform passive rest.
What you can do today
While waiting for an appointment or starting treatment:
- Avoid prolonged sitting. If your job is sedentary, stand up every 20-30 minutes and walk for a minute.
- Try gentle nerve glides. Lying on your back, hold the thigh of the affected leg and gently straighten and bend the knee, like pumping. Do 10 reps, 2-3 times a day. Stop if it sharply increases symptoms.
- Use heat for muscle-driven pain, ice for sharp acute irritation. Most chronic sciatica responds better to heat.
- Stay moving, but modify load. Walking is generally safe and often helpful.
When sciatica needs urgent attention
Most sciatica is not an emergency, but a few signs warrant immediate medical attention:
- Loss of bladder or bowel control
- Numbness in the saddle area (between the legs)
- Rapidly progressive weakness in the leg
These could indicate cauda equina syndrome — a rare but serious condition that requires urgent imaging and possible surgery.
The takeaway
Most sciatica resolves with the right conservative care, but "the right care" depends on what's actually causing your pain. If you've been dealing with leg pain that radiates from your back or buttock, get assessed properly. The earlier we identify the source, the faster you're out of pain — and the lower the chance it becomes chronic.