Understanding sciatica - Everything you need to know about the causes and treatment of sciatica

Added: 2026-05-14

[00:00:00]Are you suffering from sciatica and you need to learn more about it? In this video, I'm going to explain everything you need to know about sciatica so that you can understand it and begin to fix the root problem. So, what is sciatica?

[00:00:12]Well, sciatica is referring to the sciatic nerve and injury to the sciatic nerve. It's kind of a vague diagnosis and you need to know that the nerve is massive. It's actually the biggest nerve that comes out of the spinal cord and it's right here. I put this green strap here to to simulate where the sciatic nerve comes out of. If you think of the pelvis bones here and you look at it, there's this hole right here that's actually covered up by a big ligament on the other side of the hole. So, it's covered up like that and that's where the sciatic nerve pops out. There's a bunch of muscles over this and that nerve runs all the way down the back of the thigh, the back of the knee, down past the heel of the foot and into the toes. It actually fans out and goes to the tips of your toes and there's branches that wrap around the front of the lower leg onto the top of the foot as well. So, sciatica is technically an injury to the sciatic nerve anywhere along its pathway. Now, if we're being really specific, the sciatic nerve by definition is only from this part right here where it exits the pelvis, where it comes out of the pelvis, to the back of the knee because the the nerve continues on but it changes names because it splits in so many different directions.

[00:01:28]But, the way I treat it here in the clinic, if you have problems below your knee, I don't call it something else.

[00:01:34]It's usually sciatica because the root problem's going to be up here and that's where we need to address issues so that you get relief if your calf muscle's giving you problems or some people get problems in their foot as well. Now, this nerve is so massive, it provides lots of innervation to the skin, to the muscles as well and other things that aren't typically talked about. Because it's so massive, it can give a lot of different symptoms. Now, I'm going to cover them with you next. So, if you think that you have sciatica, listen closely. You might need to rewind and and write down things or or turn on the captions here in this video so that you can make sure that you know that this is sciatica or something else. The most classic symptom is buttock pain or pain on the backside of the hip and it may even go into the back of the thigh. If you step into any doctor's office and you tell them that it hurts here and here, the first reflexive thing they're thinking is that sounds like classic sciatica symptoms. But, very often because that nerve goes all the way down into the back of the knee, the calf area, and even the foot, you might get pain in the back of the calf, pain in the bottom of the foot, especially the arch of the foot, and even into your toes. And it's not just pain. Because there's so many different ways that this nerve provides innervation to your body in this area, it can also produce numbness, tingling, cramping, and even muscle twitches where muscles are just twitching like they're flickering it up in your hip, in the back of the thigh, anywhere in the lower leg, on the front or the back, and in the foot as well.

[00:03:06]Now, there's a bunch of branches off the sciatic nerve but one symptom I want to highlight that's kind of unusual but it does show up here in our clinic here and there. There's another branch that's actually not part of the sciatic nerve.

[00:03:19]It's it's a it's called the pudendal nerve. It runs right next to the sciatic nerve though. So, if you have a problem, a root problem that's that's stemming from this area causing your sciatica, you might get pudendal nerve irritation.

[00:03:33]And this is important because the pudendal nerve innervates the groin area, the anus, the vagina, or the penis and scrotum. And so, if you get irritation, if you get pinched in that nerve, it can produce penile pain, scrotal pain, vaginal pain, and anal pain as well. This is an especially difficult situation to deal with if you got that in addition to the leg pain, the butt pain going down your leg, but they're usually rooted in the same problem. The most common presentation of sciatica is it gets worse with movement.

[00:04:04]So, as soon as somebody stands up to get walking somewhere like to walk somewhere in their home or to go somewhere in work or to run an errand, they are feeling really bad. The pain's shooting down their leg or it's in their butt area or on the back of their thigh or knee. And the pain might even be constant where even if they sit down or lie down and find a comfortable position, the pain is still there. It's just less so in very severe cases. Sciatica is usually associated with other conditions like disc herniations in the spine and that's because these nerve roots right here that come out of the lowest part of the back do combine together to form that sciatic nerve that eventually comes out in the back here. So, if you've got a disc herniation or other problems in your low back like degenerative disc disease, um arthritis, stenosis is another common one. Any of those back conditions can be a part of what's causing your sciatica problem. There's another joint nearby called the SI joint where this pelvis bone connects to your tailbone. It's called the sacroiliac joint, SI for short. That joint can also become shifted or stuck and feed into a sciatica problem and that's actually one of the most common problems that I see is an SI joint problem over a lumbar or a lower back problem but they both do happen a good amount. And changes in body like pregnancy or an increase in weight that's kind of sudden that's happens very quickly where the abdomen goes out this direction because it changes the forces on the pelvis and the lower back, that can also contribute to sciatica problems. Now, this tends to affect people as early as their 30s. I have seen cases of people in their 20s getting sciatica but it does seem to happen a little more frequently in people that are even older like 40s, 50s, 60s, and it even affects people in their 70s, 80s, and beyond. It usually affects people that are more sedentary.

[00:05:57]They're just not getting a whole lot of activity. Maybe they've got a desk job or for whatever reason they're just not moving around as much. Those people are predisposed to getting sciatica problems but I also do see it a good amount in people that are very active, people that are lifting weights especially and have muscle imbalances that are exposed when they're going to go lift weights or do any sort of running activities. Um this can also happen as a result of an accident like a fall or colliding with somebody else or a bicycle accident or a motor vehicle accident because you can get the bones to become shifted and begin pinching that sciatic nerve right here. Now, extreme cases, like I said, they'll have symptoms constantly.

[00:06:36]They'll just get feel a little bit better if they get into a comfortable position but they'll usually have pain at night. It'll keep them from sleeping and they're miserable because they're not getting rest. They can't find any comfort and they really lose they're debilitated. They lose the ability to do their normal everyday activities because the pain is so intense. But, you can have this in a very mild form as well where you feel maybe just some tightness on one side like on one leg. Um maybe a a a jolt of pain that goes down that goes away pretty quickly. That's a sign that worse sciatica is coming if you don't deal with that root problem to address sciatica before it blows up on you. Now, let's talk about getting x-rays or MRIs for sciatica. If you see a doctor, they'll probably order x-rays and possibly even an MRI. They'll start with an x-ray because that's just the the cheaper, easier thing to do. Many doctor's offices have x-ray machines in them and what they're what they'll be looking at is the spacing between the vertebrae here in your in your lower back and as well as the bone orientation. They they just want to make sure that nothing's broken and nothing is obviously compressing your nerves causing that sciatica problem. If that checks out just fine, then they may request an MRI. And an MRI looks at the softer tissues like the actual disc structure, ligaments, muscles, and it can even visualize nerves. So, they'll be able to see if something's impinged or something's being compressed like your nerves through the MRI imaging.

[00:08:04]However, if you do have a pinched nerve in your lower back, in one of the nerves that could be feeding into your sciatic nerve, it may not be the full picture.

[00:08:14]You need to realize that in sciatica, because it's such a long nerve that goes all the way down into your foot, there's usually multiple places that the nerve is being compressed or stretched or affected somehow and simply affecting the one area that's compressed up here may not resolve your entire sciatica problem. We've seen patients here in the clinic that have a big herniated disc and they go get surgery for it. They do a discectomy surgery where they remove that part of the disc that's pinching the nerve and it kind of helps but not fully. They're still having problems and that's usually because the rest of the sciatica issue has not been addressed because it can't be addressed by surgery. Now, let me tell you about the root problem of sciatica. I've already been mentioning it but I'm going to describe it clearly for you here. In sciatica, there is abnormal compression happening on that sciatic nerve somewhere along the pathway beginning in the lower back. Could be in the pelvis, maybe the hip joint, maybe in the thigh, maybe the back of the knee, could be the muscles anywhere in between. It could be your ankle, in the calf, could be something going on with your foot as well that's improperly tensioning or compressing that sciatic nerve and in order to fix it for the long term so that it's not a recurring problem, it's important to find out where that nerve is potentially being compressed and address it at every single level of the nerve. Otherwise, people have the experience where they do something, they maybe do some stretches or exercises or maybe they'll get an injection or some treatment of some sort and it kind of relieves the sciatica problem maybe enough for them to get back to normal everyday activities, but then here in a few months, maybe 6 months or a year or or maybe a couple of years, it comes back. And that's because it was never fully resolved at every single level of the sciatic nerve. Now, the most common places that I find are trouble areas for the sciatic nerve, there's three. The first one is in the lumbar spine here, in the lower back. There's usually not enough good stability and proper balance of the muscles around the lower back, and that ends up causing too much force at one of these levels down here that irritates the nerve roots, and that's why you start to get some back pain potentially and pain down the leg.

[00:10:39]People that have this kind of sciatica tend to know that they have a back problem. Maybe they know they have a herniated disc already if they've had an MRI, and they've had ongoing backaches and back issues for months, maybe even years or decades. If sciatica now happens in addition to the back problem, usually we need to be looking up here in the back as a source of treating sciatica's root problem. And very often, the root problem is that the back muscles, the ones that run up and down the spine here on the back, are too overdeveloped, they're being used too much, and the abdominal muscles on the front of the body here, they have influence and direct attachments to the lower back, though those are out of balance and the abdominal muscles on the front need to be exercised properly in order to take pressure off the discs, the spine, and ultimately the nerves here that are the roots of the sciatic nerve going down the back of the hip and the leg. The second root problem is that this pelvis bone right here gets shifted. We call this an SI joint problem. When this pelvis bone gets shifted right here because there's a big ligament that covers up the other end of this this hole here, and that's where the sciatic nerve pops out of the pelvis, if this pelvis bone gets shifted this way, this way, or any direction whatsoever, it's going to compress the nerve above, below, on the sides, and that could cause that direct buttock pain. When we see people come in that don't really have much of a back issue, they're pointing down here in this area, they'll literally they'll point this way. They'll say, "It hurts right here, off to the side a bit, not directly in the middle, and it's usually just one-sided." It can go back and forth both sides, but they'll tend to say, "It's usually my right, or it's usually my left. Sometimes my other side will hurt, but typically it's this side."

[00:12:26]When they tell us that, then it's likely an SI joint problem, and it could be that it's stuck. It could also be that it's too loose. There needs to be more investigation on that to determine what type of treatments needed to get this pelvis bone to align properly to take the compression off the sciatic nerve right here. And you could have a combination of a back problem and a pelvis bone SI joint problem and be getting compression of the nerve in these two areas. And the third biggest root problem contributing to the sciatica is muscle imbalances in the hip and pelvis area. Usually glute muscles are not very strong, and muscles on the front of the hips, the the hip flexors and the quad muscles on the front of the thigh, are overly dominant, and when you have muscles that are too strong on the front of the hip here and too weak on the back of the hip here, that sets up the situation where your hip joint doesn't move properly, and then you start getting those SI joint restrictions. And if you can get better glute strength, then you can allow this pelvis bone to stay in position, you allow your hip joint to move better, and that reduces irritation along the back side of the hip joint here so that that sciatic nerve is not being overly stretched or compressed. Now, there's other factors to look at like the way you move, uh the way that you lift weights, the way you walk, if you're a runner or you do some sort of running sport like basketball, soccer, football, any of those, those might be need to looked at the way that you're running or moving in those activities. Jumping sports are also other ones where it could set off sciatica depending on how you're jumping, how you're coming off the ground when you jump, and how you land. Those factors need to be addressed, and then we also need to look at foot muscles at the ankle joint and what's going on in the foot because you could get improper compression of the nerves here in the ankle right here and even in the arch of the foot. Now, let's talk about the common treatment pathway for people suffering from sciatica. If you end up going to your doctor because it's that bad and you you you feel like you need to go see the doctor, your general doctor is going to first issue you medications. They may even tell you to just try over-the-counter medications if you haven't already tried it. If you have tried over-the-counter medications, then they'll prescribe you prescription strength more medications, the stronger stuff. If that doesn't affect it, then they may offer you an injection. Now, something to note here is if it's more your nerve that's the problem, the medications that they're prescribing you, especially if they're nonsteroidal anti-inflammatory drugs, NSAIDs, some examples would be ibuprofen and naproxen, those types of drugs don't tend to affect nerve pain.

[00:15:02]You need to look at a drug like gabapentin, Lyrica is another one. Those drugs directly affect nerve pain. So, you can kind of diagnose yourself if you've already been trying NSAIDs, you're talking about like Aleve, Excedrin, just look at the names of the medications you're taking, and if it doesn't really make a big difference on your on your pain, then you may have more of a nerve problem. And then if you take gabapentin or or Lyrica and you have a a nice big improvement, then your problem is a little bit more nerve-related. So, it's one way to help you diagnose yourself if you've got more of a nerve problem or a joint problem. Now, it's not 100% clear because like I said, you could have disc issues in your back, you could have joint problems, you could have arthritis going on in here, your pelvis might be shifted, your muscles might be spasming as a result of the sciatica, and the NSAIDs will actually help all those symptoms, too. So, it's a widespread diagnosis that is not 100% clear for healthcare professionals even to figure out. Now, hopefully your doctor will send you to physical therapy. I'll talk more about what you'll do there here in a moment, but if physical therapy doesn't work out for you and the medications don't work out, injections didn't work out, then they'll send you to a surgeon to get looked at even further. And they're typically hoping that you'll get better within 1 to 2 months from sciatica, you know, with medications and injections and physical therapy. If you don't meet that 1 to 2 month mark, then usually the doctor will say, "Let's go see the surgeon." And the surgeon's hoping to get you better here in like 3 to 6 months before they start talking about surgical options for you.

[00:16:36]Now, the surgeon is going to try injections first, likely some different ones than you may have had with your general doctor, and they'll maybe even try physical therapy again because there's different kinds of physical therapists. I'll speak more to that here in a moment. They'll try those things first before talking surgery, and if they do talk surgery, it's likely going to be for the spine up here. They'll first look at doing a discectomy, where they take out a chunk of the disc if they find that it's impinging on the nerve. They might also do an osteophyteectomy.

[00:17:07]That's when they take away bone spurs.

[00:17:09]If they do an X-ray or an MRI and they find that there's chunks of bone growing towards the nerves in the area, they might do an osteophyteectomy, where they take that chunk off. And in in a more extreme case, they'll do a spinal fusion, where they put rods and pins in there and they're connecting the two bones in the spine that are causing problems so that they don't move excessively and pinch the nerves that lead into the sciatic nerve. Now, another option that isn't typically recommended by doctors, but patients often seek this out because it's beneficial, is chiropractic care. Now, if you've got stuck joints, like stuck joints here in your lower back and SI joints that are stuck, chiropractors very often can free those up very successfully for you and take pressure off nerves. But if you have muscle imbalances, weaknesses, or looseness in certain joints here in your lower back, your your pelvis area, then chiropractic adjustments may actually become harmful for you at that point. We have patients here in the clinic all the time that have they report to us they have the experience that I started going to chiropractic for my sciatica problem, I actually felt better, I was improving, and then there came a point where I kept going for treatments, and it actually started to hurt me when they went to when I went to treatment and they did their adjustment techniques. And I read that as there were some joints that were stuck initially, and the chiropractor successfully freed those up, that's awesome, but then there's joints that are loose as well, and now they started to aggravate the nerves by overstretching already loose joints. So, if you have that experience, you need to stop going to the chiropractor or stop getting adjustments, talk to your chiropractor, and see what next steps need to happen. Likely there's some muscle imbalance that needs to be addressed, and there's specific exercises that need to be done, specific muscles, to improve your situation further. Now, if you end up going to physical therapy for your sciatica problem, as you might have been referred to by your doctor, then you need to be sure that you find a physical therapist that specializes in treating people with sciatica and other non-surgical conditions. You see, most PTs specialize in helping people right after surgery.

[00:19:11]We call those post-operative cases.

[00:19:14]People that have just had like a hip replacement, a spinal fusion in their back, or a knee replacement, or something like that, and they're excellent at that. Physical therapists, by and large, are very, very good at helping somebody recover right after a surgery. But if you're dealing with sciatica and you haven't had surgery yet, then that may not be the best therapist to see. You may you're not going to have full certainty that they'll be able to handle your problem appropriately to get that sciatica problem away as fast as possible. But physical therapists and most people in the healthcare field are usually genuinely trying to do good by you.

[00:19:45]They're they're do-gooders. They want to help with what they know, but they may not always know the best things to help sciatica. So, you'll often see them doing exercises uh like these. They'll do straight leg raises for sciatica where they'll pick up the leg this way.

[00:20:01]They'll do bird dogs.

[00:20:03]And these are not good where they pick up one arm and one leg and you might hold it or you might alternate back and forth.

[00:20:10]And they might also have you do back extension exercises like these where you lay on your stomach and you pick up your your hands and your feet like so.

[00:20:18]And there's other versions of these exercises like there's some where you're standing, you're leaning backwards repeatedly like this in order to try to reduce the sciatica symptoms, but these exercises tend to make the problem worse over time. And so, some therapists may also offer stretches and there's a lot of these on the internet where they'll stretch the hamstring. They'll have you put that leg with sciatica up on a a chair or a stool or bench or something and reach towards your toes to stretch this area out.

[00:20:46]They'll do figure four stretches where you put one leg on top of the other and try you're trying to stretch this part out. Bring your leg in this way.

[00:20:55]>> [snorts] >> Or they'll have you bring your knee to your chest to get a stretch in this area where the sciatic nerve is going. They may even have you hold on to a strap and pull your leg up like this, very much like the strap that I used to demonstrate the sciatic nerve on the skeleton and put a stretch through your leg this way. And another common one is a cobra stretch where you lay face down and you're pressing up this way to get some back extension going. They may also have you do hip exercises like marching where you're picking up your legs, you may do this lying down.

[00:21:24]All these exercises are not very specific towards addressing the root problem of sciatica that I've just mentioned. You need to get exercises focused on getting your abdominals stronger, your glutes stronger, and possibly your foot muscles stronger.

[00:21:39]Now, I've got a playlist of videos for sciatica problems. There's exercises and stretches that I actually think are going to help you out. They're linked in the description below. Find that playlist for sciatica problems so you can begin to address that root problem.

[00:21:52]I hope this video was helpful for you.

[00:21:53]Please give it a thumbs up if you thought it was. Share with somebody who's suffering from sciatica so they can begin to understand what's going on and please subscribe to our channel so that you don't miss out on any of the helpful videos we post each and every week. Thanks so much. I'll see you in the next video. Bye-bye.