What it is
“Sciatica” technically refers to pain following the path of the sciatic nerve, from the low back through the deep buttock and down the back of the leg. In practice, the term gets used for any low-back-and-leg pain pattern, even when the actual nerve isn’t the source.
That distinction matters, because the source is what determines treatment. Two people with “leg pain that radiates from the back” can need very different things.
What causes it
The most common drivers we see:
- Disc-related root irritation. A lumbar disc bulging or pressing near a nerve root can produce true sciatica: sharp, electric, often worse with bending or sitting.
- Piriformis or deep glute trigger points. A tight, irritable piriformis or glute med can compress or refer along the sciatic nerve, producing a very similar pain pattern without any disc involvement at all.
- Joint-driven referred pain. The lumbar facet joints and SI joint can refer into the glute and posterior thigh in patterns that look like sciatica but aren’t strictly nerve.
- Long sitting, hip mobility loss, and unloaded weakness. Most sciatica we see in active adults responds dramatically to addressing the system, not just the symptomatic level.
What it feels like
- A sharp, electric, or burning pain that runs from the back into the buttock or down the leg
- Pain that’s worse with sitting, bending, or sneezing
- Numbness, tingling, or “pins and needles” in the leg or foot
- Sometimes weakness in the leg or foot (this is more concerning; see red flags)
How we treat it
The first job is figuring out what’s actually driving it. A careful neurological screen plus a movement-based assessment usually clarifies whether we’re dealing with true root involvement, muscular referral, joint referral, or some combination.
Treatment generally involves:
- Position and load relief. Quickly identifying the positions and movements that calm the nerve, and the ones that aggravate it, so you can sleep, sit, and move with less symptom load while we treat the root cause.
- Manual therapy to the lumbar spine, pelvis, and posterior chain.
- Dry needling, particularly effective for piriformis-driven and deep-glute-driven referral patterns.
- Nerve mobilization progressions to restore healthy gliding of the sciatic nerve through the leg.
- Strengthening of the glutes, deep core, and posterior chain. Almost always part of the long-term answer.
When dry needling helps
When a tight piriformis, deep glute, or paraspinal is part of the pattern (which is often), dry needling can produce dramatic and rapid relief. We screen carefully and only needle when the picture supports it.
When to seek help
Sciatica often gets better on its own. The cases that linger, or that involve weakness or numbness, are exactly the ones where early treatment makes the biggest difference. The longer a nerve has been irritated, the longer it takes to fully calm.
Seek immediate medical care for any of the red-flag symptoms above.