The Truth About Sciatica

"Sciatica" gets used to describe any pain that travels down the leg — but it isn't a diagnosis. The sciatic nerve is formed by five nerve roots in the lower lumbar spine (L4 through S3) and runs through the posterior hip before descending into the thigh. Pain along that path can come from three completely different places, each with a different fix.

The least common is a compressed disc. When a disc at L4–L5 or L5–S1 presses on a nerve root, the result is sharp, electric pain that traces a specific line down the leg — often with numbness or weakness in the foot. Far more often, what clients call sciatica is either the sciatic nerve being compressed by a tight piriformis muscle in the deep posterior hip, or referred pain from trigger points in the gluteus medius and minimus — muscles that reliably send aching discomfort into the back of the thigh and calf. These muscular causes look like sciatica but come with no weakness, no numbness, no neurological signs at all.

The distinction matters because the treatment is completely different for each. A compressed disc needs movement that unloads the nerve root. Piriformis compression needs soft tissue release of the deep hip rotators and nerve mobilization through the hip. Gluteal trigger points respond to direct compression and targeted stretching. Movement testing and palpation in the first session almost always tell us which one we're looking at — and from there, the work has a clear target.