Sciatica — pain that radiates from the lower back down the leg along the path of the sciatic nerve — is one of the most common and misunderstood conditions in neuromusculoskeletal care. Accurate diagnosis is essential before any treatment begins. Dr. Andrew Bishara evaluates and manages sciatica and lumbar radiculopathy at his Sugar Land, TX clinic, serving Fort Bend County.
The term “sciatica” describes pain that follows the distribution of the sciatic nerve — the largest nerve in the body, formed from lumbar and sacral nerve roots that travel through the buttock and down the back of the leg, sometimes reaching the foot.
True sciatica is most often caused by compression or irritation of a lumbar nerve root — typically from a disc herniation, disc bulge, or foraminal narrowing at L4–L5 or L5–S1. This is more precisely called lumbar radiculopathy. Other causes include spinal stenosis, spondylolisthesis, or piriformis syndrome (compression of the sciatic nerve by the piriformis muscle).
Distinguishing between these causes requires a thorough clinical examination — not just symptom reporting — because each has a different prognosis, treatment approach, and referral pathway.
Burning, electric, or shooting pain that travels from the lower back or buttock into the thigh, calf, and sometimes the foot.
Altered sensation, pins and needles, or numbness along the sciatic nerve distribution — often one-sided.
Weakness in the foot, ankle, or leg that may cause a foot drop or difficulty walking — a sign of significant nerve root compromise.
Pain that worsens when sitting, coughing, sneezing, or bending forward — characteristic of disc-related nerve compression.
Sciatica typically affects one leg. Bilateral symptoms may indicate a different or more serious underlying cause requiring additional evaluation.
Though not always present, low back pain or stiffness commonly accompanies sciatic nerve symptoms.
Sciatica cannot be accurately diagnosed from symptoms alone. A thorough neuromusculoskeletal examination is essential to identify the specific cause, level, and severity of nerve involvement.
Specific orthopedic tests including straight leg raise (SLR), Bragard’s, femoral nerve stretch, slump test, and others help identify nerve root tension, disc involvement, and the likely anatomical level of compression.
Deep tendon reflexes, dermatomal sensation testing, and myotomal strength testing help determine whether a specific nerve root is compromised and to what degree.
When lumbar disc herniation, spinal stenosis, or other structural pathology is suspected based on examination findings, MRI of the lumbar spine is coordinated. X-rays may also be obtained to assess alignment and bony pathology.
We systematically rule out conditions that mimic sciatica — including piriformis syndrome, vascular claudication, sacroiliac joint dysfunction, facet referral, and lumbar instability — before establishing a diagnosis.
Once an accurate diagnosis is established, a targeted care plan is developed. Treatment is guided by clinical findings — not a one-size-fits-all protocol.
Treatment begins only after diagnosis is confirmed. The approach depends on the specific cause, nerve level, and severity — not just the symptom pattern.
Chiropractic adjustments, soft tissue therapy, and rehabilitative approaches targeting the specific structural cause of nerve compression and irritation.
Symptom response, neurological changes, and functional improvement are tracked at each visit. Treatment is adjusted based on objective findings, not assumptions.
When conservative care is insufficient or neurological deficits are progressing, prompt referral to pain management, neurology, or spine surgery is coordinated without delay.
Get an accurate diagnosis first. Dr. Bishara evaluates sciatica and lumbar radiculopathy in Sugar Land, TX — no referral required.
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