Sciatica has a way of making itself impossible to ignore. The electric shooting pain down the back of the leg, the numbness, the feeling that your hip or glute is somehow both painful and dead at the same time. It’s one of the most common reasons people come to see us, and one of the most commonly mismanaged. The core problem: the source of the nerve irritation is almost never properly identified before treatment begins.
What sciatica actually is
Sciatica is a symptom, not a diagnosis. It refers to pain that radiates along the path of the sciatic nerve. The question that determines treatment is: where is the nerve being irritated and why? The most common sources are disc herniation, lumbar stenosis, piriformis involvement, and facet joint inflammation. These are not the same condition. They look similar from the outside but require completely different approaches.
Neural mobilization
The sciatic nerve can become sensitized and restricted in its movement through the tissues it passes through. Neural mobilization exercises work by gently moving the nerve through its range and reducing that sensitization. A sensitized nerve doesn’t respond to strengthening exercises. It responds to gentle, controlled movement that desensitizes it and restores its ability to slide through surrounding tissue.
Why generic core exercises don’t work
Core strengthening exercises are often given without any assessment of what’s actually causing the nerve irritation. If the sciatic nerve is irritated by a disc herniation that’s directionally sensitive, certain movements make it worse and certain movements reduce it. Getting this direction wrong means months of PT with no benefit or active worsening.
What you don’t want to do is throw the “standard” sciatica protocol at it and hope that is addresses the area that is causing the problem. This generally looks like doing one or two things for the lower back, a few things for the hips, resting, and doing a few nerve glides. Going an inch deep and a mile wide is one of the most common reasons why people don’t see success when they put in time and energy into this type of program.
At Land and Sea PT in Oceanside, every session is 1-on-1 with a Doctor of PT for a full 60 minutes. If sciatica has been a recurring or unresolved problem, come in and let us figure out what’s actually driving it.
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Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.