What we treat · Back Pain and Sciatica
Sciatica that hasn’t responded to the usual treatments
It burns, or it shoots, or it goes numb somewhere below the knee — and it has outlasted everything you threw at it. You stretched the piriformis. You got adjusted. Maybe there was an epidural that worked for six weeks, or didn’t work at all. Sciatica that lasts is a different problem from sciatica that starts. Most plans are still treating the first one.
Jamie Atlas — Pain & Performance Specialist · 5× 5280 Top of the Town winner · 9NEWS Fitness Expert
“I have a herniated L4/L5 and my sciatic pain feels like a screwdriver in my back”
— KendraYour results may vary.
Play video: Client testimonial — Kendra, two years of shooting sciatic pain resolved “The doctor told me my spondylolisthesis back pain could only be cured with surgery”
— TonyYour results may vary.
Play video: Client testimonial — Tony, two weeks of severe back pain down to 1 out of 10 Why is it still there after the disc settled?
Because by now the disc is probably not the thing driving it. The nerve got sensitive, and sensitivity outlasts irritation.
Most disc-related nerve pain settles within weeks to a few months. When leg symptoms carry on past that, what has usually changed is the threshold — the nerve fires at provocations it used to ignore, and ordinary movement gets flagged as something to protect you from.
Which is why the standard advice quietly makes it worse. Rest, avoid, wait it out: all of it lowers the threshold further. A sensitized nerve gets its tolerance back the same way everything else does, by being asked for a bit more than it did yesterday and no more than it can take.
What has to be ruled out first?
A short list, and it matters. A small number of these belong with a physician before they belong with me.
Progressive weakness in the leg. Numbness in the saddle area. Any change in bladder or bowel control. Those get referred, immediately and without hedging.
Everything else — which is the overwhelming majority — is exactly the kind of case this work is built for. Part of the first session is establishing which of the two you are, and I will tell you plainly rather than start a plan I don’t believe in.
What does the work look like?
Less dramatic than what you have already tried, and considerably more durable. We stop chasing the leg and start rebuilding what feeds it.
The plan works on four things at once:
- movement the nerve tolerates, dosed so it calms rather than flares
- progressive strength for the hip, trunk and leg
- the sleep and stress load that amplify nerve pain more than most people expect
- a graded return to whatever the pain took — walking, hiking, riding, standing through a workday
It is probably not one tight muscle, and it is probably not something a stretch was ever going to reach. Nerve pain is slower to turn around than back pain and it does turn around. Most people are in the six to eight session range.
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.
Why can it change this fast?
Pain is produced by your nervous system, not simply reported by your tissues. When pain outlasts healing, what usually keeps it going is a protection response — guarding, avoiding certain movements, a system that has learned to read ordinary load as danger. That's a learned pattern, and patterns can shift quickly when you give the system genuinely new information. Fast change proves the pain is changeable. Making it hold is the work that follows, and for most people that's six to eight sessions.
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