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Sciatica is pain, tingling, or numbness that travels from your low back or buttock down your leg, usually because something is crowding or irritating the sciatic nerve along its path. But sciatica is a symptom, not a diagnosis: the most common culprits physical therapists find are a shifted spinal disc, a tight piriformis muscle deep in your buttock, or a nerve that has lost its ability to glide. Each one needs a different plan, and a physical therapist is a great first stop to find out which one you have.
If you’ve had it, you know it isn’t “just a sore back.” Adele told her Las Vegas audience she had “a wobble” because of “really bad sciatica.” Mike Tyson, a man who made a living taking punches, said that when his sciatica flares up, “I can’t even talk!” Low back pain, which often travels with sciatica, is the single leading cause of disability worldwide according to the World Health Organization. Pain pills simply cannot fix the mechanical cause, so if there’s a rock in your shoe, you still have to take the rock out.
What is sciatica, really?
Your brain, spinal cord, and nerves work as one continuous network, and that network is very sensitive to movement. When a nerve gets squeezed by a disc, a tight muscle, or swollen tissue, or gets overstretched, it lets you know: sharp, burning, shooting pain, pins and needles, or numbness down the back of your leg.
“Sciatica” just describes where it hurts. It doesn’t tell you why.
How common is sciatica?
Very. In our own Mojo Chat cases since 2022, about 1 in 8 were lower back problems, and 7.2% ended up with a sciatica-related diagnosis from one of our physical therapists (12.8% when you include closely related hip and pelvis conditions).
What are the usual suspects behind sciatica?
1. A disc that has shifted. Think of a spinal disc like a jelly donut. Hours of sitting and bending forward push the “jelly” backward, toward the nerves that run down your legs. That can cause pain down one or both legs and make standing tall or bending backward hard. Sometimes the disc shifts to the side instead, and you’ll notice your upper body leaning off to one side of your hips (a “lateral shift”). You can’t stand up straight no matter how hard you try.
2. A tight piriformis. The piriformis is a small muscle deep in the middle of your buttock. When it knots up, it sends pain into the lower buttock and hamstring, and it can even irritate the sciatic nerve that runs right next to it. Common triggers:
3. A nerve that won’t glide. Nerves are meant to slide and glide through the tissues around them as you move. When there is any sort of compartmental pressure anywhere along the nerve, it blocks the nerve from gliding freely. This is why bending forward or straightening your knee sets off symptoms.
4. Inflammation. Any sort of inflammation in an area surrounding a nerve can cause nerve irritation. Nerves are very sensitive to chemical changes in tissue. The good news is that inflammation only lasts 5 to 7 days, so it cannot be the reason for sciatica that lasts longer than a week.
The look-alikes. Irritation at the SI joint (where your spine meets your pelvis) and knots in your glute muscles can feel a lot like sciatica too. In fact, among our cases, the top diagnoses in this group were SI joint irritation (19), piriformis (16), and a backward-shifted lumbar disc (12).
Why does the cause matter so much?
Here’s the twist: the plans for these problems are different, and sometimes opposite.
So grabbing random “sciatica stretches” off YouTube is shooting in the dark. The stretch that fixes your neighbor’s piriformis could irritate your disc. Figure out which suspect you’ve got first.
When is sciatica an emergency?
Go to the ER or get urgent medical care right away if you have:
These signs point to pressure on the spinal cord that needs an orthopedic specialist or neurosurgeon as soon as possible. Until a doctor clears you, avoid heavy lifting, long periods of standing, and intense exercise.
What helps every kind of sciatica?
We went through the self-care, rest, icing, and exercise instructions in our own Mojo Chat treatment plans for every common cause of sciatica: a backward-shifted disc, a forward-shifted disc, a side shift, a tight piriformis, and a nerve that won’t glide. Here is the honest answer. Only a few pieces of advice show up in all of them, and these are the pieces our physical therapists recommend across every common cause of sciatica:
What about ice? It depends. Our disc plans use short ice sessions on the low back, but our piriformis and nerve plans don’t recommend ice at all. Same story for exercises: there isn’t a single exercise that shows up in every plan.
Why do you need a diagnosis for sciatica?
Beyond those basics, you really need to know which cause you have. The specific plans are very different, and some are flat-out opposites. One disc plan has you bending backward and avoiding forward bending; another does the reverse. The nerve plan has you gently flossing the nerve; the piriformis plan works the hip muscles. Pick the wrong one and you can end up undoing your own progress.
The best, easiest way to find out which one you have is Mojo Chat. For $65, you get a real diagnosis from a licensed doctor of physical therapy, from your couch, with no waiting room. Care is delivered by our team of licensed doctors of physical therapy across all 50 states plus D.C.
You’re in Good Hands
At Mojo Health, we get to the root of your leg pain instead of just chasing the symptoms. With our online physical therapy platform, Mojo Chat, you can start recovery from home anytime, 24 hours a day, 7 days a week. Mojo Chat begins with simple questions about your back, hips, and legs, the same questions our physical therapists ask during an in-person visit. Then, you can record a short video to demonstrate exactly where the pain travels and which movements make it better or worse, describe how the pain started, and share any questions or concerns you have.
Our licensed Physical Therapists review everything and provide a clear diagnosis, along with a tailored 14-day treatment plan you can start right away. Mojo Chat guides you step-by-step every day, lets you ask questions of your therapist by text or video, and adjusts your plan as you heal. Our therapists and care team track your progress to make sure you’re improving exactly as expected. And here’s the best part… 86% of users who follow the full 14-day treatment plan report significant to full recovery. For those who need extra support, Mojo Chat seamlessly connects them to top in-person physical therapy clinics nearby.
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