What we treat · Persistent Sciatica
Sciatica that hasn’t responded to the usual treatments
Leg pain that burns, shoots, or tingles below the knee. You’ve stretched the piriformis, been adjusted, maybe had an epidural. It helped for a while — or not at all. Persistent sciatica has a nervous-system component that most treatment plans never address, and that’s usually the missing piece.
Why does sciatica persist after the disc has healed?
Most disc-related nerve irritation settles within weeks to months. When leg pain persists beyond that, the nerve itself has often become sensitized — it fires with less provocation, and normal movement gets flagged as a threat. Rest and avoidance make sensitized nerves worse, not better.
The way out is graded, progressive loading of the nerve and the movements you’ve been avoiding — dosed carefully enough that the system calms down instead of flaring up.
What does treatment involve?
First, a proper assessment to rule out the small set of cases that need medical referral — progressive weakness, numbness in the saddle area, bladder or bowel changes. Those go to a physician first, and I’ll tell you plainly if that’s you.
For everyone else: a plan that combines nerve-tolerant movement, progressive strength work for the hip and trunk, sleep and stress factors that amplify nerve pain, and a graded return to walking, hiking, running, or riding — whatever the pain took from you.
Common questions
Should I get an MRI first?
Not necessarily. Unless you have red-flag symptoms or surgery is on the table, imaging rarely changes the plan for persistent sciatica — and scary-sounding findings often make fear (and pain) worse.
Is walking good or bad for sciatica?
Usually good — in the right dose. The skill is finding your current tolerance and building from it systematically instead of the boom-bust cycle of overdoing it on good days.
What if I’ve already had surgery?
Post-surgical sciatica responds to the same graded approach. If you’re past the surgical healing window and still have leg symptoms, this is exactly the kind of case I work with.
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