Sciatica Relief: What Actually Works (And What Doesn't)

8 min read • February 2026 • By Dr. Garrett Hewstan

The pain starts in your lower back or hip and shoots down the back of your leg. Sometimes it's a sharp, electric jolt. Sometimes it's a constant burning ache. Sitting makes it worse. Driving is miserable. You've Googled "sciatica relief" at 2am because you can't sleep.

Sciatica is one of the most searched pain conditions on the internet — and one of the most poorly treated. Most people cycle through painkillers, stretching routines, and maybe a cortisone injection without ever addressing why the nerve is being compressed in the first place.

Here's what's actually going on, and what to do about it.

What Sciatica Actually Is (And Isn't)

Sciatica isn't a diagnosis — it's a symptom. It means your sciatic nerve, which runs from your lower back through your hip and down each leg, is being irritated or compressed somewhere along its path.

The pain you feel in your leg isn't a leg problem. It's a signal that something upstream — in your spine or hip — is pressing on the nerve. Treating the leg pain without finding and fixing the compression is why most sciatica treatments provide temporary relief at best.

The Four Most Common Causes

1. Disc Compression

This is the one everyone knows about. A bulging or herniated disc in your lower back presses on the nerve root where it exits the spine. But here's what most people miss: the disc didn't herniate randomly. Years of spinal compression — from sitting, poor movement patterns, and weak supporting muscles — created the conditions for the disc to fail. The herniation is the consequence, not the cause.

2. Piriformis Syndrome

The piriformis is a small muscle deep in your hip. The sciatic nerve runs directly beneath it — and in about 15-20% of people, the nerve actually runs through the muscle. When the piriformis tightens (from sitting, hip imbalance, or overuse), it can clamp down on the nerve and create identical symptoms to a disc herniation. This is frequently misdiagnosed and treated with the wrong approach.

3. Spinal Stenosis

As the spaces in your spine narrow over time — from compression, arthritis, or bone spurs — the nerves get squeezed. This is more common in people over 50 and tends to get worse with standing and walking, better with sitting or bending forward.

4. General Compression and Deconditioning

This is the most common and most overlooked cause. Years of sitting have compressed your lower spine, tightened your hip flexors, weakened your glutes and core, and created a body that's structurally predisposed to sciatic nerve irritation. There may not be one dramatic event — just a gradual buildup of compression and dysfunction until the nerve has no room left.

Why Common Treatments Fail

Painkillers and Anti-Inflammatories

These turn down the pain signal but don't change anything structurally. The nerve is still compressed. The inflammation will return as soon as the medication wears off because the cause is still there. Useful for getting through acute flare-ups, but not a solution.

Generic Stretching Routines

The internet is full of "5 stretches for sciatica" lists. The problem: if your sciatica is from disc compression, certain stretches can make it significantly worse by pushing the disc further into the nerve. And if your muscles are tight because they're protecting an unstable area, stretching removes that protection. Without knowing the cause, stretching is a gamble.

Cortisone Injections

Cortisone reduces inflammation around the nerve, which can provide significant relief — sometimes for weeks or months. But inflammation is the body's response to compression. If the compression doesn't change, the inflammation comes back. Many people find themselves getting repeated injections with diminishing returns.

Bed Rest

This is one of the worst things you can do for sciatica, despite it feeling logical when you're in pain. Prolonged rest increases spinal compression (lying down still compresses, just differently), weakens the muscles that should be supporting your spine, and tightens the hip flexors — all of which make the nerve compression worse over time.

What Actually Works for Lasting Sciatica Relief

Step 1: Identify the Specific Cause

Is it a disc? Piriformis? General compression? The treatment for each is different — sometimes opposite. A proper assessment identifies exactly where and why the nerve is being compressed. This single step is what separates people who recover quickly from people who struggle with sciatica for years.

Step 2: Decompress the Nerve Pathway

Whatever is compressing the nerve needs space. For disc-related sciatica, specific spinal decompression exercises create space between vertebrae and allow the disc to retract away from the nerve. For piriformis-related sciatica, targeted hip work releases the muscle's grip on the nerve. The approach depends entirely on the cause — which is why Step 1 matters so much.

Step 3: Restore Hip and Spinal Mobility

Your hips and lower spine have likely lost significant range of motion from years of sitting and guarding. Once the acute compression is addressed, restoring mobility prevents the nerve from being re-compressed. This isn't aggressive stretching — it's gradual, guided mobilization that respects your body's pace of healing.

Step 4: Rebuild the Support System

Weak glutes, dormant deep stabilizers, and a deconditioned posterior chain created the conditions for your sciatica in the first place. Rebuilding this support system is what prevents sciatica from coming back. Most people skip this step because once the pain stops, they think they're fixed. This is why sciatica recurs.

Step 5: Daily Maintenance Practice

Sciatica doesn't come from a single event — it comes from accumulated patterns. A 15-20 minute daily practice that maintains decompression, mobility, and strength keeps the nerve pathway clear and prevents the conditions that led to compression from rebuilding.

Warning Signs: When to Seek Immediate Help

Most sciatica, while painful, is not dangerous. However, seek immediate medical attention if you experience:

• Sudden severe weakness in your leg or foot — difficulty lifting your foot or walking
• Loss of bladder or bowel control — this is a medical emergency called cauda equina syndrome
• Numbness in the groin or inner thigh area — another sign of serious nerve compression
• Progressive neurological symptoms — increasing numbness, weakness, or loss of reflexes

These symptoms suggest severe nerve compression that may require immediate medical intervention.

FAQ: Sciatica Relief

How long does sciatica take to heal?

Acute sciatica often resolves within 4-6 weeks. However, if the underlying cause isn't addressed, sciatica frequently becomes chronic or recurrent. With proper treatment targeting the root cause, most people experience significant relief within 1-4 sessions and full resolution within 4-8 weeks.

Is it better to rest or move with sciatica?

Movement is almost always better than rest for sciatica. Prolonged bed rest actually worsens sciatica by increasing spinal compression, weakening supporting muscles, and tightening hip flexors. The key is the right kind of movement — gentle decompression and walking are helpful, while heavy lifting and aggressive stretching can make things worse.

Can sciatica be caused by something other than a herniated disc?

Yes. While herniated discs get the most attention, sciatica is frequently caused by piriformis syndrome, spinal stenosis, general spinal compression from prolonged sitting, or sacroiliac joint dysfunction. Identifying the actual cause is essential because each requires a different treatment approach.

Should I see a doctor or try to treat sciatica at home?

Seek immediate medical attention if you have sudden severe weakness in your leg, loss of bladder or bowel control, or numbness in the groin area. For typical sciatica, starting with a practitioner who can identify the specific cause is more effective than generic home remedies, which often treat symptoms without addressing the underlying issue.

Why does my sciatica keep coming back?

Recurring sciatica almost always means the root cause was never addressed. Pain medications, muscle relaxants, and even cortisone injections treat the symptoms but don't fix the compression, tightness, or weakness that's irritating the nerve. Until the structural issue is resolved — and you have a daily practice to maintain the correction — the nerve will continue to be compressed and the pain will return.

Key Takeaways

• Sciatica is a symptom, not a diagnosis — the pain in your leg is caused by nerve compression somewhere in your back or hip
• Four common causes require different treatments: disc compression, piriformis syndrome, spinal stenosis, and general deconditioning
• Most treatments fail because they target symptoms — painkillers, generic stretching, and cortisone don't fix the structural compression
• Bed rest makes sciatica worse — movement (the right kind) is essential for recovery
• Identifying the specific cause is the critical first step — without it, treatment is guesswork
• Lasting relief requires a complete approach: decompress, mobilize, strengthen, and maintain daily