Few pain experiences stop people in their tracks the way sciatica does. That burning, electric sensation that starts in the low back and shoots through the glute and down the back of the leg is hard to ignore and easy to mismanage. Most people either push through it and make it worse, or rest completely and wonder why nothing changes.

Sciatica is one of the most treatable conditions we see at DSM. It’s also one of the most misunderstood. Here is what is actually going on.

What Sciatica Actually Is

Sciatica isn’t a diagnosis. It’s a symptom. It describes pain that follows the path of the sciatic nerve, which runs from the lumbar spine through the glute and down the back of the leg, sometimes all the way into the foot. The nerve itself is the longest in the body.

The term tells you where the pain is going. It doesn’t tell you why. That distinction matters because the treatment depends entirely on what is compressing or irritating the nerve.

What’s Causing the Compression

The most common causes:

  • Disc herniation or bulge. A disc in the lumbar spine pushes into the space where the nerve exits. This is the most common cause and often responds very well to conservative care, including spinal decompression therapy.
  • Piriformis syndrome. The piriformis muscle, which sits deep in the glute, can compress the sciatic nerve when tight or inflamed. Common in runners and people who sit for extended periods.
  • Spinal stenosis. Narrowing of the spinal canal puts pressure on nerve roots. More common in older adults but can occur at any age.
  • Sacroiliac joint dysfunction. The joint connecting the sacrum to the pelvis can refer pain along the sciatic distribution and mimic true sciatica.

    • Understanding the cause changes everything about the treatment approach. Treating a piriformis problem the same way you treat a disc herniation won’t get results.

    The image shows a physical therapist administering sciatica treatment to a patient lying face down on a treatment table. The therapist's hands are focused on the patient's lower back, aiming to reduce nerve pain and improve mobility. This therapya is part of a comprehensive approach to managing sciatic nerve pain through specialized physical therapy techniques.

    Why Rest and Stretching Fall Short

    Rest can calm nerve irritation temporarily. But the disc mechanics or muscle dysfunction driving the problem stay exactly where they are. When you go back to your normal routine, the compression returns and so does the pain.

    Stretching the piriformis and hamstrings is a popular recommendation and it can feel relieving in the moment. But stretching doesn’t address nerve sensitivity, disc mechanics, or the muscular imbalances driving the problem. Temporary relief isn’t the same as resolution.

    What We Do at Dynamic Sports Medicine

    We start with a clinical assessment to identify the specific driver of your sciatica. That assessment shapes the entire treatment plan.

    For disc-related sciatica, spinal decompression therapy is one of the most effective tools we use. It creates negative intradiscal pressure that takes load off the nerve and supports disc rehydration. Paired with core stability work and movement coaching, this addresses both the acute compression and the pattern that created it.

    For piriformis-driven sciatica, dry needling into the piriformis and surrounding musculature combined with targeted soft tissue work and hip mobility training gets faster and more lasting results than stretching alone.

    In most cases, we keep people training with modifications. Stopping activity entirely is rarely necessary and often counterproductive.