Sciatica
The leg pain from your back.
Treated where it actually starts.
Sciatica is a symptom, not a diagnosis. The nerve gets irritated upstream, by a disc, a tight piriformis, a stiff SI joint, or a lumbar facet. Finding which one is what makes treatment work. We evaluate the whole chain, treat the source, and stop guessing.
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The condition
The pain runs down the leg. The cause sits in the back.
Sciatica is irritation of the sciatic nerve, which runs from the lumbar spine through the buttock and down the leg. The classic presentation is sharp, burning, or electric pain that travels below the knee, often with numbness or tingling. What it looks like is consistent. What is causing it varies a lot.
The most common sources are a lumbar disc herniation pressing on the nerve root, piriformis muscle tightness compressing the nerve in the buttock, SI joint dysfunction, or a lumbar facet joint pattern. Less often, spinal stenosis or a vertebral alignment issue. Treatment depends entirely on which one, and that is what an evaluation determines.
How we treat it
Manual therapy first. Then movement that actually decompresses the nerve.
The session begins with hands-on assessment to identify the source, then manual therapy to mobilize the spine, free the nerve where it is restricted, and release the muscles that are guarding around it. This is not generic stretching. It is targeted soft-tissue and joint work specific to where the irritation is coming from.
The home program is small and specific to your pattern. Often it is two or three movements: a nerve glide, a postural correction, and a loading exercise for the structures that need to take more of the work. Most patients feel meaningful change within the first three sessions if the diagnosis is right.
Why it works here
The diagnosis is the work. Not the protocol.
Most sciatica PT runs through a standard protocol regardless of the underlying cause. That works for the cases where the cause matches the protocol. For everyone else, it is months of exercises that do not change the pattern. Here, the evaluation is built to identify the source, and the treatment is built around that finding.
Every session is one clinician, one patient, the full hour. Manual therapy is the majority of the visit. Cases get reassessed each session and the plan is adjusted as the body responds. The goal is to resolve the pattern, not to manage it.
Questions
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Do I need an MRI before starting?
Not usually. The clinical evaluation can identify the source of sciatica in most cases. Imaging is helpful when surgery is being considered or when symptoms include red flags like progressive weakness or bowel/bladder changes. If imaging would change the plan, we will say so.
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My doctor said I need surgery. Should I do PT instead?
PT is the recommended first-line treatment for most cases of sciatica from disc herniation, with research showing similar outcomes to surgery at one year for non-emergency cases. Surgery is appropriate for progressive weakness, intractable pain that has not responded to conservative care, or specific structural patterns. We can work alongside the surgical evaluation if that is the direction.
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I have tried stretching and it has not helped. Why would this be different?
Most generic sciatica stretches assume one cause. If your sciatica is coming from a disc, piriformis stretching can make it worse. If it is from a piriformis pattern, lumbar flexion exercises will not address it. The evaluation determines which pattern is present, and the treatment follows from that.