Sciatica: what it actually is, and how osteopathy treats it

Sciatica is a symptom, not a diagnosis. It describes pain that travels from the lower back or buttock down the leg -- often burning, sharp, or accompanied by pins and needles. But calling it "sciatica" doesn't tell you why it's happening.

What actually causes sciatica?

The sciatic nerve is the longest nerve in the body, originating from the L4, L5, S1, S2, and S3 nerve roots in the lumbar spine. It can be irritated at multiple points along its path -- the lumbar spine, the piriformis muscle in the buttock, or further down the leg. Most people assume a disc herniation is the cause, but in clinical practice, muscular compression and joint dysfunction are just as common -- and often more responsive to conservative treatment.

The disc herniation assumption

When a disc herniates, the inner nucleus pulposus can press on an adjacent nerve root, causing the classic radiating leg pain. However, imaging studies consistently show disc herniations in people with no pain at all. The presence of a herniation on MRI does not automatically explain your symptoms. What matters is whether the disc is mechanically irritating the nerve -- and whether that irritation is the primary driver of your pain or one of several contributing factors.

Piriformis syndrome: the underdiagnosed driver

The sciatic nerve passes directly beneath -- and in roughly 10% of people, through -- the piriformis muscle in the deep buttock. Tightness or spasm in the piriformis can compress the nerve and produce sciatica-like symptoms that are indistinguishable from lumbar nerve root compression on clinical presentation alone. This is why a full assessment of the hip, pelvis, and lumbar spine together is essential before attributing sciatica to a disc problem.

How osteopathy treats sciatica

Treatment is directed at finding and addressing the source of irritation -- not just managing the symptom. This typically includes lumbar and sacral joint mobilisation to restore segmental movement, soft tissue work around the piriformis and hip external rotators, neural mobilisation techniques to improve sciatic nerve gliding, and progressive loading to build tissue tolerance and reduce sensitisation. We also assess gait, hip mobility, and sitting posture -- because sustained compression in daily life often perpetuates the problem between sessions.

What to expect from treatment

Most people with sciatica from disc or joint origin improve significantly within 4-6 sessions when the root cause is correctly identified and treated. Piriformis-driven cases often respond faster. If the leg pain is severe, constant, or accompanied by bladder/bowel changes or progressive muscle weakness, urgent imaging and specialist review are indicated -- these are red flag presentations that require medical assessment before hands-on treatment.

Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.