Sciatic pain is memorable. A line of burning or electric pain running from the buttock down the back of the thigh, sometimes all the way past the knee. It can make sitting unbearable, driving miserable, and sleep a negotiation.
The instinct is to treat the leg. The leg is where it hurts, after all. But the leg is usually just the messenger.
What sciatica actually describes
Sciatica is not a diagnosis so much as a description. It means the sciatic nerve, the largest nerve in the body, is being irritated somewhere along its path. The symptoms show up downstream of wherever that irritation is happening.
That irritation can come from the spine itself, which is a medical issue and needs a physician. But a very common source sits higher up and is entirely muscular: the deep rotators of the hip, particularly the piriformis, which lies directly over the path of the nerve.
When those muscles are tight and shortened, they can compress the nerve underneath them. The nerve complains. You feel it in your leg.
Why sitting makes it worse
The deep hip rotators are in a shortened position when you sit. Sit for eight hours a day, five days a week, and those muscles adapt to that length. They get short, they get dense, and they stop releasing.
Add a long drive, a desk, and a wallet in the back pocket, and you have a set of muscles clamped down over a nerve for most of your waking hours. The pain tends to be worst after sitting and better after walking, which is a useful clue that the problem is muscular rather than structural.
What treatment involves
Working on the leg does very little if the compression is at the hip. So we work where the problem is.
That means the glutes, the deep rotators underneath them, and the low back and hamstrings that share the load. This is deeper, slower work. The deep rotators sit under a thick layer of muscle, and reaching them takes patience and sustained pressure rather than speed.
We also look at how you are actually moving. If one hip is doing more work than the other, releasing the tight side without addressing why it got tight means you will be back in three months with the same thing.
How long it takes
Acute sciatic pain that started recently often responds quickly, sometimes within a couple of sessions. Pain you have carried for a year or more usually takes a more sustained plan, because the tissue has had a long time to adapt and the nervous system has become very good at protecting the area.
Between sessions, the most useful thing you can do is interrupt the sitting. Not a gym programme, just standing up and walking for a few minutes every hour. That alone changes the loading pattern more than most people expect.
When it is not muscular
Some sciatic pain is structural, coming from a disc or from narrowing in the spine. Signs that warrant a physician first include weakness in the leg or foot, numbness that is spreading, pain following a significant fall or accident, and any change in bladder or bowel control, which is urgent.
If you are not sure which kind you have, come in and we will assess it. If it looks structural, we will tell you and point you toward the right person rather than work on something that needs imaging.