That burning, shooting pain down your leg has a source — and treating it correctly starts with identifying whether it's coming from the disc, the piriformis, or somewhere else entirely. Dr. Nave finds the driver before building the plan.
You might be dealing with sciatica if you have…
Sharp, shooting pain that travels from the low back or glute down into the thigh, calf, or foot — often following a specific line.
A "dead leg" feeling, tingling in the toes, or areas where sensation is reduced. Often corresponds to an L4, L5, or S1 nerve root.
Difficulty lifting the foot (foot drop), weakness when standing on tiptoes, or the leg feeling like it could give out.
True sciatica is almost always unilateral. Bilateral leg symptoms suggest a different — and often more urgent — source that needs immediate evaluation.
Prolonged hip flexion increases disc pressure and piriformis compression on the sciatic nerve — both classic aggravating positions for sciatica.
Bowel or bladder changes, bilateral leg weakness, or saddle area numbness require emergency evaluation. Call us or go to the ER immediately.
Disc-driven sciatica and piriformis syndrome produce nearly identical symptoms. But the treatment is completely different. Getting this wrong means treating the wrong structure — and wondering why you're not improving.
When a lumbar disc (most commonly L4-L5 or L5-S1) herniates, the displaced nucleus presses against the nerve root as it exits the spinal canal. This produces true radiculopathy — the pain follows a dermatomal pattern corresponding to the compressed root level.
Pattern markers:
Primary Treatment
Flexion Distraction + McKenzie Method. Traction-based decompression to reduce intradiscal pressure and pull the nucleus away from the nerve root, combined with extension-biased exercise to encourage centralization.
The piriformis muscle runs from the sacrum to the femur, and in about 15% of people, the sciatic nerve passes directly through it (rather than beneath it). When the piriformis becomes hypertonic or develops trigger points — from overuse, prolonged sitting, or altered hip mechanics — it can compress the sciatic nerve at the deep gluteal space.
Pattern markers:
Primary Treatment
IASTM / Trigger Point Release + Neural Mobilization. Direct soft tissue work on the piriformis during functional hip positions (FAKTR protocol), combined with sciatic nerve flossing to restore nerve glide and reduce intraneural tension.
Why this differentiation matters: Flexion distraction is the right call for a disc herniation but may not address piriformis syndrome at all. And aggressive stretching of the piriformis can worsen disc-driven sciatica by increasing nerve tension. The orthopedic exam — not assumption — tells us which protocol to use.
Regardless of source, sciatica recovery follows the same structural logic — decompress, reduce inflammation, stabilize. The tools are different depending on which source drove the nerve irritation.
Reduce the mechanical load on the sciatic nerve root — whether that's disc pressure through flexion distraction, or piriformis compression through direct soft tissue work.
Neural flossing and nerve glide techniques to restore normal sliding motion of the sciatic nerve along its pathway, reducing adhesions and intraneural tension from chronic compression.
Core stabilization, hip strengthening, and movement pattern retraining to remove the mechanical loads that caused the compression in the first place — so it doesn't come back.
The vast majority of sciatica is manageable with conservative care. But certain findings indicate spinal cord or cauda equina involvement — a surgical emergency.
Go to the ER immediately if you have:
Call us same-day if you have:
Sciatica always has an upstream source. Most commonly:
Low Back Pain — Causes & Treatment
Disc herniation, facet syndrome, SI joint, Lower Cross Syndrome
Book a 60-minute structural evaluation in Overland Park. We'll identify whether your sciatica is disc-driven, piriformis-driven, or something else — and build a plan specific to that source.
Quality Life Chiropractic · 7102 College Blvd, Overland Park, KS 66210 · (913) 488-3233