The sciatic nerve runs from your lower back down through the buttock and into the leg. When it gets irritated or compressed anywhere along that path, you get pain that follows the nerve — usually starting in the low back or buttock and shooting down to the calf or foot. That's sciatica. But the question is always: what's irritating the nerve?
What causes sciatica
Disc herniation is the most common cause. A disc in the lumbar spine bulges or ruptures and presses on a nerve root. The pain pattern depends on which level (L4-L5 or L5-S1 are the most common).
Piriformis syndrome happens when the piriformis muscle in the buttock becomes tight or inflamed and compresses the sciatic nerve as it passes underneath (or, in some people, through) the muscle. This is more common in runners and people who sit a lot.
Spinal stenosis is narrowing of the spinal canal, usually from age-related arthritis. Pain is often worse with standing or walking, better with sitting or bending forward.
Sacroiliac (SI) joint dysfunction can mimic sciatica. The pain pattern looks similar but the cause is the joint, not the nerve.
Spondylolisthesis is when one vertebra slips forward on another, sometimes pinching nerves.
Each of these needs different treatment. That's why diagnosis comes first.
How Dr. Ngo diagnoses sciatica
Detailed history — when did it start, what makes it better or worse, exactly where the pain travels. Physical exam including straight leg raise, slump test, and other neurological testing. Reflexes, strength, sensation in the leg.
Most cases can be diagnosed clinically. When MRI is needed — usually to confirm a suspected disc herniation or rule out something more serious — we order it.
We don't guess. We don't 'treat sciatica' generically. We figure out what's causing yours and treat that.
Treatment
For disc-related sciatica: spinal decompression, specific adjustments, soft tissue work, McKenzie-method exercises, and progressive rehab.
For piriformis syndrome: targeted soft tissue therapy on the piriformis and deep gluteal muscles, hip mobility work, specific stretches, and adjustments to the SI joint and lumbar spine to address contributing factors.
For SI joint dysfunction: SI-specific adjustments, supportive belt if needed during acute phase, glute strengthening.
For stenosis: flexion-bias exercises, posture correction, gentle decompression, often combined with referral for nerve-root injection if conservative care isn't enough.
Most patients see meaningful improvement within 4-6 weeks. Stubborn cases take longer.
When to be concerned
Most sciatica resolves with proper treatment. But certain symptoms are red flags that need immediate attention: loss of bowel or bladder control, numbness in the saddle area (between your legs), progressive weakness in the leg, or sudden severe pain after trauma.
If you have any of these, don't wait — go to an ER. We screen for these on the first visit and refer immediately if anything concerning shows up.
Frequently asked questions
How long does sciatica last?
It depends on the cause. Acute disc-related sciatica typically improves significantly within 4-6 weeks of proper treatment, with full resolution often by 12 weeks. Piriformis syndrome can resolve faster — sometimes within 2-3 weeks. Stenosis-related sciatica is more chronic and usually managed rather than 'cured.' Without treatment, sciatica can persist for months or become chronic.
Can I just stretch it out?
Sometimes — depends on the cause. Piriformis-related sciatica often responds to specific stretches. Disc-related sciatica can get worse with the wrong stretches (forward bending, for instance, often aggravates lumbar disc problems). Don't guess. Get diagnosed first, then we'll teach you what to stretch and what to avoid.
Does sitting make sciatica worse?
For most causes, yes — especially if sitting was a contributing factor in the first place. Pressure on the lumbar discs is highest when sitting, particularly when slouched. Get up every 30-45 minutes if possible. A lumbar support and proper chair height help.
Should I rest or stay active with sciatica?
Stay as active as your symptoms allow. Bed rest beyond a day or two actually makes most cases worse. Walk if you can. Avoid the specific movements that flare your pain. We'll guide you on what's safe.
Will heat or ice help?
Ice helps in the acute phase (first few days) when there's inflammation. Heat helps later when the issue is muscle tension and tightness. If you're not sure which phase you're in, alternating both is usually safe.