Sciatica is a common term for pain that starts in the back or hip and travels down the leg. About 40% of people can suffer from this in their lifetime according to the Harvard Health. True sciatica is the result of the sciatic nerve being compressed. That large nerve runs from the low back and sacrum, through the butt, down the back of the leg to the knee and then to the calf and even foot., This compression can be caused by a number factors but is usually due to low back conditions such as disc herniation, lumbar stenosis or bone spurs.


Many will use the term sciatica to describe all pain radiating in the leg though this would be a misnomer as nerves pinched at different spinal levels will cause pain radiating into different areas of the leg and do not affect the sciatic nerve. The hallmark of sciatica is pain down the back of the leg, not the sides or front of the leg. Treatment for radiating pain into any area of the leg can be very similar to sciatic pain treatment depending on the cause of that pain.

Disc Herniation:

Most sciatic nerve pain is caused by an L5-S1 lumbar disc herniation where pressure is put on the sciatic nerve root from the disc material. A lumbar disc is the structure that sits in-between the vertebra and provides shock absorption and distributes compressive forces through the spine. A disc herniation happens when the softer inner portion of the disc pushes through the tougher outer portion. This protrusion can come into contact with the nerve root which causes the pain radiating down the leg.


Signs and Symptoms: those who’s sciatic nerve pain is caused by a herniated disc will likely have increased pain with sitting or bending over or even with coughing/sneezing. Symptoms generally improve with standing, slight backward bending and walking.


Treatment: With disc herniations we typically encourage low back extension in order to push the herniation back towards the middle of the disc and away from the nerve root. This extension typically starts with just laying on the stomach or propped up with a pillow under the chest. One can then progress to being propped on elbows and eventually pressing into a cobra pose position as tolerated. We often repeat this exercise to “pump” the disc. Extension can also be done in standing. These exercises should be done with limited pain and should result in some reduction in pain intensity or pain centralization. Centralization is when the pain doesn’t travel as far down the leg, or moves up the leg towards the low back. If extension exercises aren’t decreasing or centralizing pain, or are too painful to perform, then some will benefit from lumbar traction. Traction opens up the space around the nerves in the low back which can decrease compression on both the disc and nerve root.

Lumbar Stenosis:

Sciatic symptoms can also be caused by lumbar stenosis or narrowing of the space around the spinal cord or nerve roots in the low back. This narrowing can be caused by loss of lumbar disc height with age, bone spurs encroaching into the nerve space, or arthritis. Lumbar stenosis tends to affect people over the age of 65 but can affect anyone.


Signs and Symptoms: sciatic nerve pain caused by lumbar stenosis presents as pain increasing or radiating further down the leg with standing and walking while pain will generally decrease with sitting, bending forward, or laying down. This is opposite of herniation driven symptoms.


Treatment: Lumbar stenosis is typically treated opposite of a disc herniation focusing on flexion or bending forward such as bringing one or both knees to the chest and repeated forward bends in standing or sitting. All of these exercises should decrease or centralize pain.

Piriformis Syndrome:

This is the major cause of sciatica not specifically related to a condition in the low back. Instead the piriformis, which is a muscle responsible for rotating the hip that sits deep underneath the gluteal muscles, becomes tight or spasms and compresses the nearby static nerve. Although this one muscle gets blamed for the problem, understand that no muscle in the human body works in a vacuum or by itself. There will be biomechanical imbalances noted with one who has been diagnosed with piriformis syndrome.


Signs and Symptoms: Pain or numbness/tingling radiating from the butt into the back of the leg that is worsened with extended sitting, walking or running, and climbing stairs


Treatment: Treatment for piriformis syndrome is typically stretching to the piriformis muscle and treating any other structural or biomechanical imbalances found on evaluation.