Sciatica is a description of where the pain travels, not a diagnosis of what is causing it. Something is irritating the sciatic nerve or the roots that form it, and effective treatment depends entirely on identifying which structure. At Remix Medical in Houston, our board-certified pain physicians work that out before treating it.
What is Sciatica?
Sciatica is radiating pain along the path of the sciatic nerve — from the lower back through the buttock and down the back of one leg. The sciatic nerve is the largest in the body, formed from the L4 through S3 nerve roots.
The pain is typically one-sided and often described as burning, sharp, or electric rather than the dull ache of ordinary back pain. It frequently worsens with sitting, coughing, or sneezing, all of which raise pressure on the nerve.
Because sciatica is a symptom, the useful clinical question is always what is compressing the nerve.
What Causes Sciatica
1. Herniated Lumbar Disc
The leading cause. Displaced disc material presses on a nerve root before it joins the sciatic nerve.
2. Spinal Stenosis
Age-related narrowing of the spinal canal compresses the nerve roots, classically producing leg pain that eases with sitting or leaning forward.
3. Degenerative Disc Disease
Loss of disc height narrows the openings the nerve roots pass through.
4. Piriformis Syndrome
The piriformis muscle deep in the buttock can spasm and compress the sciatic nerve directly, producing pain that mimics true radiculopathy.
5. Spondylolisthesis
One vertebra slipping forward on another can narrow the space available to the nerve.
6. Trauma, Tumor, or Infection
Rare, but important to exclude when the presentation is atypical.
How Remix Medical Can Help
Evaluation starts with a physical examination designed to identify which nerve root is involved — straight leg raise, reflexes, strength testing, and sensory mapping. Imaging is reserved for severe, progressive, or persistent symptoms, because degenerative findings are common in people without pain and don't always explain the problem.
Most sciatica from a disc herniation improves over weeks, since herniations frequently shrink on their own. Treatment is aimed at controlling pain well enough to stay active while that happens.
| Approach | What it involves |
|---|---|
| Staying active + physical therapy | Movement retraining and nerve mobilization — more effective than bed rest |
| Medication management | Anti-inflammatories and nerve-pain agents targeting the radicular component |
| Epidural steroid injections | Image-guided anti-inflammatory medication placed at the compressed nerve root |
| Selective nerve root blocks | Confirm which root is generating the pain and provide therapeutic relief |
| Piriformis and trigger point injections | For the muscular contributors when examination points to them |
| Surgical referral | Reserved for weakness from nerve compression, or pain that fails everything else |