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.
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.
If a PT or Chiro gives you a sheet of exercises for Sciatica, ask them, “would you give me this same list of exercises if it was coming from my back vs my hip?” If the answer is yes, doing those exercises could just as easily make the problem worse as make it better. The reason we consistently get such great results with Sciatic Nerve Pain is because of the specific and personalized program every patient gets as well as the manual work that is needed to reduce pain and symptoms (more on that next).
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.
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.