Why Sciatica Isn’t Just a ‘Nerve Problem’ (And How To Treat It)
- Colin O'Banion, DPT
- Mar 4
- 5 min read
Updated: 6 days ago
Who Gets Sciatica?
Sciatica affects a wide range of people, but certain lifestyles and habits make it more common. Here in Boulder, I often see it in our active community—runners, cyclists, hikers, and skiers—who are particularly prone due to repetitive stress on the lower back.
Desk workers, including the many remote professionals in Boulder’s tech and biotech communities, may develop sciatica from prolonged sitting and poor posture.
Middle-aged adults, older individuals, and even pregnant women can also experience sciatic pain due to natural spinal changes or shifts in body mechanics.
Sciatica Is Technically a Nerve Problem—But That’s Not the Whole Story
Sciatica is often described as a “pinched nerve,” but that’s an oversimplification. In reality, all pain is a nerve problem—pain cannot exist without the nervous system processing and transmitting it. However, when it comes to sciatica, the real issue is usually not just the nerve itself, but rather what is irritating it in the first place.
Understanding Sciatica: Why Disc Issues Are the Real Culprit
Here’s the key takeaway: 90% of sciatica cases are actually due to a lumbar disc issue.
More specifically, over 90% of lumbar disc breakdown happens in the posterior part of the disc. When this occurs, the compromised disc can bulge or herniate, pressing against the nerve root as it exits the spinal cord. This leads to pain radiating into the buttocks and down the back of the leg, sometimes even reaching the foot.
So, rather than treating sciatica as just a nerve problem, we need to focus on why the disc is breaking down in the first place.
Why Does Lumbar Disc Breakdown Happen?
Sciatica is rarely the result of a single injury or traumatic event. More often, it develops gradually due to a combination of factors:
Genetics: Some people are naturally more predisposed to disc degeneration.
Lifestyle Habits: Diet, hydration, stress management, and sleep all affect inflammation, pain severity, and healing capacity.
Movement History: Previous injuries, surgeries, and repetitive activities (even from childhood) influence spinal wear and tear.
Posture & Movement Patterns: Chronic sitting, repetitive bending, or dysfunctional movement patterns often play a major role in daily disc irritation.
Eventually, the body reaches a tipping point—something minor, like bending to pick up a sock, might “set off” the pain. But the real cause has been building for years.
How to Fix Sciatica (and Prevent It from Coming Back)
Getting out of pain and preventing future episodes comes down to two key questions:
What needs to be removed?
What needs to be added?
With nearly 20 years of experience as a Doctor of Physical Therapy, I’ve developed a structured evaluation and treatment framework that goes beyond symptom management. At my Boulder office, I take a root-cause approach to sciatica, identifying and addressing the underlying factors contributing to pain.
Step 1: Remove What’s Causing the Pain
Most often, sciatica is aggravated by mechanical factors—certain postures (usually sitting) and repetitive movements that lead to daily irritation and inflammation. The first priority is identifying these triggers and modifying them as quickly as possible. We'll figure this out in a thorough evaluation.
Step 2: Add What Supports Healing
Once we’ve removed the aggravating factors, we need to introduce the right tools to facilitate recovery and healing. This includes:
Mechanical Support: Targeted strengthening, mobility, flexibility, and movement pattern retraining.
Holistic Health Factors: Quality sleep, proper hydration, balanced nutrition, and stress management all play a critical role in reducing inflammation and promoting healing.
Clinical Interventions: We'll draw from tools such as advanced manual therapy, dry needling, shockwave therapy, and interactive neuromuscular stimulation can accelerate recovery and reduce pain quickly.
The Biggest Mistake People Make with Sciatica
One of the most important things to understand about sciatica (and disc issues in general) is that it’s very easy to make it worse. If a clinician doesn’t fully understand disc mechanics, they may prescribe exercises or treatments that further aggravate the issue.
Or a client may perform stretches on their own that feel good in the moment, but are causing more harm than good. I educate clients to "don't scratch the itch."
This is why a thorough evaluation process is crucial. Every treatment plan must be individualized, based on a patient’s specific postures, movement patterns, and lifestyle factors. Imaging (such as an MRI) can be useful in identifying disc breakdown location, but it’s not always necessary for diagnosis and treatment.
Many people assume that chiropractic spinal adjustments for sciatica are the best way to relieve sciatic pain. While chiropractic care can provide short-term relief for sciatica, it often focuses on symptom management rather than addressing the root cause of the issue.
Physical therapy takes a different approach by targeting the underlying disc and movement dysfunctions that contribute to sciatica. Through a combination of hands-on treatment, movement retraining, and advanced techniques like shockwave therapy and dry needling, holistic physical therapy aims to provide long-term solutions instead of temporary fixes.
This is also why you should be cautious about blindly following exercises from YouTube just because an influencer or doctor claims they’ll fix sciatica. They don’t know you or your unique presentation. Even a single session with an experienced clinician can provide critical education on modifying aggravating behaviors and selecting the safest, most effective exercises.
The first goal is to avoid making sciatica worse. The second goal is to actively support healing and long-term recovery.
Take the First Step Toward Comprehensive Care
Sciatica is not just a nerve problem—it’s a disc problem 90% of the time. Understanding this distinction is key to both effective treatment and long-term prevention. If you’re dealing with sciatica, the solution lies in identifying what’s irritating the nerve, removing those triggers, and supporting the body’s healing process with the right interventions.
If you’re tired of short-term symptom relief and want to uncover the root cause of your pain, my holistic evaluation process can help. Together, we’ll create a personalized plan that addresses your body as a whole and leads to long-lasting results.
If you’re in Boulder, CO and struggling with sciatica, don’t settle for generic treatments. Schedule an evaluation today and take the first step toward lasting relief.
How to Connect:
Colin O’Banion, Doctor of Physical Therapy
Colin is a licensed Physical Therapist and founder of Colin O’Banion Physical Therapy in Boulder, Colorado. With 20 years of experience, he specializes in solving complex and chronic pain cases through a root-cause, integrative approach. Colin combines advanced manual therapy, shockwave therapy, dry needling, and movement re-education to help clients return to the activities they love. His one-on-one practice is dedicated to clients seeking lasting solutions when traditional PT has fallen short.
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