How We Treat Sciatica: Spine vs Deep Gluteal (Updated 2026)
WRITTEN BY DR RUSSELL JENSEN Principal Chiropractor - Southside Spine and Sport, Bicton WA
AHPRA Registration: CHI0001927257 Practicing chiropractor since 2015.
Trained in Integrative Diagnosis (USA). Special interest in nerve entrapment conditions including sciatica, piriformis syndrome, and deep gluteal nerve compression.
Full profile: southsidespinesport.com.au/meet-our-chiro
How we diagnose and treat sciatica and why the source matters more than the symptom
Sciatica is one of the most searched pain conditions online and one of the most frequently misunderstood. The word gets used by patients to describe pain coming from the back that goes anywhere in the leg. Sciatica is a description of symptoms: pain, tingling, or numbness that travels along the path of the sciatic nerve, typically from the lower back or glute into the back of the leg.
What that description doesn't tell you is where the problem is coming from or how it should be treated.
In this article I'll explain what sciatica actually is, the two most common sources we see in clinic, how we identify which one is driving your symptoms, and the specific treatment approach we use at Southside Spine and Sport that produces results in cases that haven't responded elsewhere.
What is sciatica?
The sciatic nerve is the largest nerve in the body. It originates from nerve roots in the lower lumbar spine (L4, L5) and sacrum (S1, S2, S3), merges into a single nerve in the gluteal region, and travels down the back of the leg to the foot. When any part of this nerve is compressed, tensioned, or irritated, it can produce symptoms anywhere along that path. Like the lower back, glute, back of the thigh, calf or foot.
“Sciatica is not a diagnosis. It is a symptom pattern. It’s pain that follows the sciatic nerve path. The diagnosis is what’s causing it. Getting the diagnosis right is the only way to get the treatment right.”
Common symptoms we see include:
A sharp, burning, or electric pain running from the lower back or glute into the leg
Numbness or tingling in the leg, calf, or foot
Pain that is worse when sitting for extended periods
Pain that eases when walking or lying down
In severe cases, weakness in the leg or foot
The two most common sources of sciatica
1. Disc-related sciatica (compression of nerve roots in the spine)
The most well-known cause. A lumbar disc bulge or herniation compresses one of the nerve roots that forms the sciatic nerve as it exits the spine. This typically produces lower back pain alongside the leg symptoms, and is often aggravated by bending forward, sitting, or activities that increase pressure on the disc.
Disc-related sciatica is what most people (and most clinicians) think of first when sciatica is mentioned. It responds to treatment aimed at reducing disc pressure, restoring spinal mobility, and progressively loading the spine back to full function. Often health professionals will look to rule this in or out first before looking for other, less serious causes.
2. Deep gluteal syndrome sciatica - compression / tension outside the spine
Less well known but far more common than most people realise. It is sometimes called piriformis syndrome. The sciatic nerve travels through the deep gluteal space, where it can be compressed or have its natural movement restricted by the piriformis muscle.
The symptoms can be identical to disc-related sciatica causing leg pain, tingling and numbness but the source is in the gluteal space, not the back. And crucially, treatment aimed at the spine will not fix a problem that originates in the glute.
One distinguishing feature in patients who have a problem with the sciatic nerve in the deep gluteal space is that they are not usually in acute (recently new) pain. Their leg symptoms persist but their back is often fine and just ‘stiff’.
“In my experience, deep gluteal syndrome type sciatica is significantly under-diagnosed. Patients come in having had spinal treatment for months (adjustments, physio, sometimes even injections) without lasting relief, because no one has assessed the nerve at the hip. If spinal treatment isn’t working, its worth investigating causes in the deep gluteal space”
How we tell them apart
Distinguishing disc-related from deep gluteal sciatica requires a proper clinical examination. Not just a description of symptoms, and not just imaging. MRI can show disc pathology, but it doesn't show functional problems, like compression and restriction of the sciatic nerve in the deep gluteal space. A disc bulge on imaging doesn't always mean the disc is what's generating the pain.
In clinic, we use a combination of:
Lumbar provocation tests - to assess whether spinal movement and loading reproduce or change the leg symptoms
Straight leg raise and neural tension tests - to assess the nerve's mobility and identify where along its path it is restricted
Deep gluteal palpation - firm, specific pressure applied along the nerve through the gluteal region to identify regions that may need treatment
FAIR test and piriformis provocation - to assess deep gluteal involvement specifically
The pattern of which tests reproduce symptoms, and where, tells us where the nerve is irritated.
How we treat sciatica at Southside Spine and Sport
Once we've identified the source, treatment is targeted specifically at it.
For disc-related sciatica
We focus on restoring normal movement and load tolerance to the lumbar spine, reducing protective muscle guarding, mobilising the spinal joints, and progressively reintroducing load through a structured rehabilitation program. Uniquely we target adhesions that may have formed in the soft tissues of the spinal joints and muscles as part of most treatment protocols. Learn more about our chiropractic adjustments, adhesion release and rehabilitative exercise here.
For deep gluteal sciatica
This is where our approach differs most significantly from standard chiropractic care and where the Integrative Diagnosis training I did in the United States is helpful.
We work directly around the nerve and the structures affecting it in the deep gluteal space. Here's specifically what that involves:
We locate the adhesions along the nerve using specific palpation. Once we have a stable contact on the adhesion affecting the sciatic nerve we apply compression and we move the leg (bending the hip forward with the knee straight) which slowly applies a tensioning force on the nerve and the adhesion, breaking the adhesion up. Typically this is done 4-7 times in a single session, if done right.
The effect of this is to mobilise the nerve at the hip, freeing it from the structures it may be adhered to.
“This technique must be applied for the right problem, by someone with the right training, with the right level of specificity. It is not something to attempt at home. When it’s applied correctly to the right diagnosis, the change in symptoms can be rapid and significant. When it’s applied to the wrong structure, or imprecisely, it achieves nothing or can make pain worse.”
This is the treatment approach that produced results for patients who had tried everything else and understanding why it works makes it easier to understand why those other treatments didn't.
Shockwave therapy
Sometimes we use shockwave therapy alongside or in place of manual treatment as part of a treatment plan and to stimulate healing in the surrounding connective tissue.
As with all our services, Radial Shockwave is included in our standard consultation fee at no additional cost. Learn more about our shockwave therapy
When to seek urgent care
“Most sciatica, while painful and debilitating, is not a medical emergency. However, the following symptoms require urgent medical attention”
Loss of bladder or bowel control
Numbness in the groin or inner thigh (saddle anaesthesia)
Progressive leg weakness - not just pain, but genuine inability to lift the leg or foot
Sciatica that began after a significant trauma such as a fall or accident
Rapidly worsening symptoms over hours or days
These can indicate cauda equina syndrome. A serious spinal emergency that requires immediate medical management. Do not wait for a chiropractic or physiotherapy appointment if these symptoms are present.
How long does sciatica take to resolve?
This depends almost entirely on two things: how long it has been present, and whether the right source has been identified and treated.
For disc-related sciatica identified and treated early, most patients see meaningful improvement within 2-8 weeks. Full recovery typically takes 3-4 months including the rehabilitation phase.
For deep gluteal sciatica most patients see meaningful improvement within 1-6 sessions.
The single biggest factor in how quickly you recover is getting an accurate, tissue specific diagnosis.
Related conditions worth knowing about
If you're experiencing gluteal or leg pain, the following conditions are worth being aware of as they are frequently confused with sciatica:
Piriformis syndrome - deep gluteal muscle irritation compressing the sciatic nerve
Cluneal nerve pain - a commonly missed nerve entrapment at the pelvic rim that mimics sciatica
Disc pain - lumbar disc pathology that may or may not be generating nerve symptoms
Frequently asked questions
What is sciatica?
Sciatica is pain, tingling, or numbness that follows the path of the sciatic nerve from the lower back or gluteal region into the leg. It is a symptom pattern, not a diagnosis - the diagnosis is what is causing the nerve to be irritated, which must be identified before treatment can be properly targeted.
Can sciatica come from the glute rather than the spine?
Yes. Deep gluteal syndrome type sciatica occurs when the sciatic nerve is compressed in the gluteal region by structures such as the piriformis muscle rather than in the spine. Symptoms can be identical to disc-related sciatica. Treatment is completely different and must target the compression site in the glute, not the spine.
How do I know if my sciatica is from my spine or my glute?
Disc-related sciatica typically involves lower back pain alongside leg symptoms, and is aggravated by bending forward and sitting. Deep gluteal sciatica tends to produce more localised gluteal pain with leg referral and may not involve lower back pain at all. A clinical examination with specific provocation testing is needed to distinguish them.
What is the best treatment for sciatica?
Treatment depends entirely on the source. Disc-related sciatica requires treatment aimed at the spine; mobilisation, neural mobilisation, and progressive loading. Deep gluteal sciatica requires targeted soft tissue therapy to the sciatic nerve through the gluteal region or with shockwave therapy. Treating the wrong source produces no lasting improvement.
How long does sciatica take to resolve?
Disc-related sciatica identified early typically improves meaningfully within 2-8 weeks, with full recovery in 2-4 months. Deep gluteal sciatica varies but usually we see improvement within 1-6 sessions. Early accurate diagnosis is the most important factor.
Can sciatica go away without treatment?
Mild cases sometimes resolve within a few weeks with rest and activity modification. Cases involving significant nerve pain, weakness, or symptoms persisting beyond 6 weeks are unlikely to fully resolve without targeted treatment. Cauda equina symptoms (loss of bladder or bowel control) require immediate emergency care.
“If you have leg pain, tingling, or numbness that hasn’t responded to treatment — or you’re not sure whether what you have is disc-related or coming from the glute — a proper clinical assessment will give you a clear answer and a plan that actually addresses the right structure.”
Book an appointment online or send us a message if you'd prefer to ask a question first.
We're based in Bicton and see patients from across Perth's southern suburbs, including Fremantle, Melville, East Fremantle, Cockburn, and surrounding areas.
Reviewed and updated by Dr Russell Jensen, Principal Chiropractor (AHPRA: CHI0001927257), Southside Spine and Sport, May 2026.
Originally published November 2021. This article is for general information only and does not constitute medical advice. Always consult a qualified health professional for diagnosis and treatment of sciatica.
