Sciatica
Sciatica is a symptom, not a diagnosis. The real question is what’s compressing or irritating the nerve — and where.
Sciatica is a symptom. The source is the answer.
Sciatica describes pain that travels along the path of the sciatic nerve — from the low back or buttock down the back of the leg, sometimes to the foot. It is often sharp, burning, or electric, and may come with numbness, tingling, or weakness.
But sciatica is a description of where the pain travels, not an explanation of why. The same leg pain can be caused by a herniated disc pressing a nerve root, by spinal stenosis narrowing the canal, by a piriformis muscle compressing the nerve in the buttock, or by an inflamed sacroiliac joint referring pain down the leg. Each requires a different treatment.
Treating sciatica without identifying its source is guesswork. We identify the exact structure irritating the nerve and treat that — which is why our patients often improve after other approaches have failed.
There is a further complication worth understanding: sciatica that persists long enough stops being purely a compression problem. The nervous system amplifies, and pain continues even after the disc has resorbed and the nerve is no longer pinched. Patients in this position are frequently told their imaging looks better and their pain therefore should be gone. Their pain is real; the mechanism has simply changed.
This is why timing matters. A nerve compressed for weeks behaves differently from one compressed for years, and treatment aimed only at the disc will not address what the nervous system has learned in the interim.
Sciatica tells us the nerve is unhappy. It doesn’t tell us why. Finding out why is the entire job.
What can cause sciatica
Below are the conditions we most commonly identify and treat. Many patients have more than one contributing source at the same time — which is precisely why careful diagnosis matters.
Spinal Causes of Sciatica
Lumbar Disc Herniation
The most common cause. Disc material protrudes and chemically irritates or physically compresses a lumbar nerve root, most often L4-L5 or L5-S1, producing pain that radiates in that nerve’s specific distribution down the leg.
Lumbar Spinal Stenosis
Narrowing of the spinal canal compresses nerve roots. The hallmark is leg pain and heaviness with walking or standing that eases with sitting or leaning forward — neurogenic claudication.
Foraminal Stenosis
Narrowing specifically of the opening where a nerve root exits the spine, often from bone spurs or disc height loss. It can compress a single nerve root and produce classic radicular pain.
Spondylolisthesis
A vertebra slipping forward on another can narrow the canal and foramen, compressing nerve roots and producing sciatic symptoms alongside axial back pain.
Non-Spinal Causes of Sciatica
Piriformis Syndrome
The sciatic nerve passes beneath (or, in some people, through) the piriformis muscle deep in the buttock. When that muscle is tight or inflamed, it can compress the nerve directly, producing sciatica with no spinal cause at all.
Sacroiliac Joint Dysfunction
An inflamed SI joint can refer pain into the buttock and down the leg in a pattern that mimics true sciatica. It is one of the most commonly missed causes of leg pain.
Deep Gluteal Syndrome
Entrapment of the sciatic nerve in the deep gluteal space by muscle, scar tissue, or fibrous bands — a distinct cause that will not respond to spinal injections.
Peripheral Nerve Entrapment
Compression of the peroneal or tibial nerve further down the leg can cause symptoms that resemble sciatica but originate far from the spine.
Other Contributors
Post-Traumatic & Post-Surgical Nerve Irritation
Scar tissue, adhesions, or altered mechanics after injury or spine surgery can tether or irritate nerve roots, producing persistent radicular pain.
Vascular Claudication
Reduced arterial blood flow to the legs can cause exertional leg pain that mimics neurogenic claudication. Distinguishing the two is essential — the treatments have nothing in common.
Central Sensitization
Long-standing sciatica can outlast its original cause as the nervous system amplifies pain signaling. Pain persists even after the compression is relieved, requiring a different treatment approach entirely.
Inflammatory & Other Causes
Rarely, radicular leg pain reflects infection, tumor, or inflammatory disease. Thorough evaluation is designed to identify these rather than assume a mechanical cause.
Contributing Factors & Perpetuating Causes
Movement Dysfunction & Postural Load
Prolonged sitting, repeated flexion, and poor lifting mechanics load the disc precisely where it is most vulnerable. Correcting these patterns is part of the treatment, not an optional extra.
Core Weakness & Deconditioning
The spine relies on the surrounding musculature for load-sharing. Weakness transfers load to the disc and joints, which is why rehabilitation is essential to preventing recurrence.
Metabolic Health, Weight & Inflammation
Systemic inflammation and mechanical load both influence disc health and nerve sensitivity. Our team includes a double board-certified internal and obesity medicine physician who consults on weight, GLP-1 therapy, and nutrition.
Fear-Avoidance & Protective Behavior
Understandable protection of a painful back leads to stiffness, weakness, and a nervous system increasingly primed for threat. Carefully graded movement reverses this.
When sciatica is an emergency
Seek immediate care — call 911 or go to an emergency room — if leg pain occurs with: loss of bowel or bladder control; numbness in the groin or inner thighs; rapidly progressive leg weakness or foot drop; or severe pain after major trauma. These can signal cauda equina syndrome, which requires emergency treatment. This page is educational and is not a substitute for evaluation.
Diagnosis is a procedure, not a guess
Imaging alone rarely provides the answer. Findings of degeneration are extraordinarily common in people with no pain whatsoever — so an abnormal image doesn’t prove we’ve found the culprit. Conversely, some of the most treatable causes may not appear on imaging at all.
So we build the diagnosis from several converging sources:
01 — A genuinely thorough history and physical examination
Which dermatome the pain follows, which reflexes and muscles are affected, and what provokes or relieves symptoms. The pattern itself localizes the problem — and it’s why our visits are longer than the industry norm.
02 — Correlated imaging
MRI interpreted against your symptoms and exam. Nearly everyone over forty has disc changes on MRI. The finding only matters if it explains your pain in your distribution.
03 — Virtual MSK Movement Assessment
Objective, wearable-free measurement of how you actually move — revealing compensation patterns, strength deficits, and functional limits that imaging cannot show.
04 — Diagnostic nerve blocks
Selective nerve root blocks can confirm precisely which nerve root is generating your pain — invaluable when imaging shows changes at several levels and we need to know which one actually matters.
This is the difference between treating a picture and treating a patient. We confirm the source before committing you to a therapeutic procedure.
Precise, non-opioid, physician-performed care
Once we know the source, treatment can be targeted. Every procedure is performed personally by Dr. Joshi, using low-dose imaging, non-opioid sedation when appropriate, and hand-selected medications and products. We do not delegate procedures, and we do not use opioids as a treatment strategy.
Lumbar Transforaminal Epidural Steroid Injection
The most targeted treatment for a compressed lumbar nerve root, delivering anti-inflammatory medication directly to the affected root to reduce inflammation and relieve leg pain.
Dr. Joshi pioneered the use of a blunt needle for lumbar transforaminal epidural injections — reducing the risk of catastrophic intravascular and intraneural injury. A sharp needle can inadvertently enter a vessel or nerve; a blunt needle is far less likely to. It is one of several first-in-the-world techniques he has contributed to the field.
Selective Nerve Root Blocks
Both diagnostic and therapeutic: by anesthetizing one specific nerve root, we confirm it is the source of your leg pain and often provide immediate relief.
Caudal & Interlaminar Epidural Injections
Alternative epidural approaches selected for your specific anatomy and pathology, particularly useful in multi-level disease or post-surgical anatomy.
Piriformis & Deep Gluteal Injections
When the nerve is being compressed in the buttock rather than the spine, image-guided injection of the piriformis or deep gluteal space treats the actual source — something no spinal injection will ever accomplish.
Sacroiliac Joint Injections
For SI-mediated leg pain, targeted injection both confirms the diagnosis and treats it. This is why accurate diagnosis matters: an SI joint problem treated as a disc problem never resolves.
Radiofrequency Ablation
Where appropriate and confirmed by diagnostic blocks, ablation can provide durable relief. We use smaller-gauge needles and lower-temperature, tissue-sparing lesions.
Regenerative Medicine & Orthobiologics
For appropriate candidates, PRP and orthobiologic approaches aim to support tissue repair rather than merely suppress inflammation — physician-performed, with candid discussion of what evidence supports today.
Ketamine Infusion Therapy
When sciatic pain has outlasted its original cause and the nervous system has become sensitized, ketamine infusions can reduce that amplified pain response.
Rehabilitation & Movement Retraining
Nerve pain resolves fastest when the mechanics that provoked it are corrected. Our multi-disciplinary team builds rehabilitation into every plan.
Treating Coexisting Facet or SI Joint Pain
Many patients with sciatica also have a facet joint or sacroiliac joint contributing to their pain. Treating only the nerve leaves a substantial portion of the pain in place — which is why diagnosis must be comprehensive rather than satisfied by the first finding.
Metabolic & Whole-Person Optimization
Weight, inflammation, sleep, and metabolic health influence both disc health and pain sensitivity. Our multi-disciplinary team addresses these alongside interventional care.
What We Decline to Do
We do not rush toward surgery or spinal cord stimulator implantation. We do not order unnecessary imaging. We do not prescribe opioids as a treatment strategy. What a practice refuses to do tells you as much as what it offers.
We don't rush to implant
A spinal cord stimulator is a legitimate tool for the right patient at the right time. But it’s an implant, and we treat it as a genuine last resort — not an early default reached for after a couple of quick attempts. First we find the root cause, address it, and rehabilitate it. Only when the better options are truly exhausted do we consider going there.
The same procedure is not the same procedure
Two practices can list the same procedure on a website and deliver profoundly different experiences, risks, and outcomes. Here is what changes when the details are done right.
Performed personally by Dr. Joshi
Never delegated to a technician, resident, or rotating staff. You’re treated by the physician who developed and teaches the technique — and in image-guided procedures, the difference between physicians is measured in millimeters.
Dramatically less radiation
Pulsed, low-dose imaging and a few precisely targeted spot images instead of continuous live X-ray. Based on our own procedural dose data, this reduces radiation exposure by at least 50% — and often far more — versus conventional continuous fluoroscopy, with no compromise in accuracy. For conditions treated repeatedly over years, that difference compounds.
Non-opioid sedation
When sedation is used, we use ketamine-based sedation, not fentanyl. Opioid sedation exposes you to unnecessary opioids, can complicate workplace drug testing, and can actually increase pain sensitivity. Ketamine can do the opposite.
Smaller needles, tissue-sparing lesions
Precision means we don’t need to be destructive to be effective — smaller-gauge needles and lower-temperature, longer-duration ablation that spares the healthy tissue around the target.
We actually numb you first
Thorough local anesthesia of skin and underlying tissue before the procedure begins. It takes an extra minute. We take it.
Independent, and obsessive about quality
Nearly four out of five U.S. physicians now answer to a corporate owner. We’re physician-owned, so our only incentive is your outcome. What a practice refuses to do tells you as much as what it offers.
Sciatica, answered
No — and assuming so is a common and costly mistake. Sciatica can arise from spinal stenosis, foraminal narrowing, spondylolisthesis, piriformis syndrome, deep gluteal entrapment, or a sacroiliac joint. Several of these will never respond to a spinal injection, which is why finding the true source comes first.
Many episodes improve within weeks. But pain that persists, worsens, or comes with weakness or numbness deserves evaluation rather than waiting. Prolonged nerve compression can cause lasting changes, and persistent pain risks central sensitization.
Dr. Joshi personally performs every procedure using a blunt-needle technique he pioneered for lumbar transforaminal epidurals, dramatically reduced radiation exposure, non-opioid sedation, and hand-selected medications. Notably, we decline to perform transforaminal epidurals in the cervical and thoracic spine, where we consider the risk unacceptable.
Most patients with sciatica never need surgery. Interventional treatments combined with rehabilitation resolve the majority of cases. Surgery is considered only for specific indications such as progressive weakness or genuinely intractable symptoms after appropriate care — and we do not rush toward implants or operations.
Because the nerve that supplies your leg begins in your spine. Compression or inflammation at the nerve root produces pain along that nerve’s entire path. Your leg hurts, but the leg isn’t the problem — which is exactly why treating the leg accomplishes nothing.
It can, particularly if the underlying mechanics are never corrected. That’s why we don’t stop at pain relief — we rehabilitate the movement patterns and strength deficits that set the problem up in the first place.
In most cases, yes — and prolonged bed rest is actively harmful. Movement within tolerance maintains circulation, prevents deconditioning, and reduces the nervous system’s threat response. The important exceptions are progressive weakness or the emergency red flags described above, which require immediate evaluation.
Frequently, yes. Many herniations resorb over months as the body reabsorbs the extruded material. The purpose of interventional treatment is to control inflammation and pain during that window, preserve function, and prevent the nervous system from becoming sensitized while healing occurs.
Because pain that persists long enough changes the nervous system. The original compression may be resolved while the amplified signaling remains. This is real, it is common, and it is treatable — but it requires a different approach than another epidural aimed at a disc that has already healed.
Leg pain, heaviness, or weakness that comes on with walking or standing and eases when you sit or lean forward. It is the hallmark of lumbar spinal stenosis, and it is distinct from vascular claudication, which arises from reduced blood flow. Distinguishing the two matters enormously, because the treatments have nothing in common.
Find out what's actually causing your pain.
A precise diagnosis is the beginning of a real solution. Let’s find your pain generator — and treat it.
This page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor does it create a physician-patient relationship. Individual results vary, and no specific outcome is promised or guaranteed. Radiation-reduction figures reflect National Pain Centers’ own procedural dose data compared with conventional continuous-fluoroscopy technique. Certain regenerative therapies are considered emerging or investigational and are not FDA-approved for all uses. Always consult a qualified physician regarding your medical condition. If you are experiencing a medical emergency, call 911.