What You Need To Know About Sciatica



Sciatica is a common problem for many people, and presents itself as varying levels of pain that radiate along the route of the sciatic nerve. Pain typically originates around the lower back, through the hip and buttocks, and down the leg. Generally, the pain is isolated to one side of the body. Many cases of sciatica are mild, and with treatment from an efficient rehabilitation center, they can be resolved in a few weeks. However, long-lasting sciatica pain may require the need for chronic sciatica treatment or pinched nerve treatment, depending on the cause and severity of the issue.

Types of Sciatica

There are two types of sciatica, spinal and extraspinal. Spinal sciatica is a pain referred to the leg caused by spinal nerve root compression. Extraspinal sciatica is caused by compression of the sciatic nerve within or below the sub gluteal space.



Spinal sciatica is typically caused by a herniated disc or arthritic spinal facet joints. Extraspinal sciatica is caused by different types of hip muscle hypertrophy, bone spurs, variations in nerve gliding, fascial tightness, fibrous bands or abnormal movement around the hip and thigh.


At NY Dynamic Neuromuscular Rehabilitation, we understand how sciatica pain, especially chronic sciatica pain, can affect our patients’ overall quality of life. It can also develop into more serious problems if not addressed through proper chronic sciatica treatment. Chronic sciatica not only causes permanent nerve damage, but may also result in reduced strength in the affected leg, numbness or loss of feeling, and in more serious cases can even contribute to bladder or bowel control issues.

A variety of problems contribute to the development of sciatica, and understanding the cause of sciatica pain is essential for providing the right treatment, such as pinched nerve treatment or piriformis syndrome therapy. The causes can be broken down into three main types: sciatica from spinal pathology (diseases that affect the spine), sciatica from external factors like irritation or compression, and sciatic-like conditions that, while not directly affecting the sciatic nerve, produce similar symptoms.

Sciatica caused by spinal pathology typically revolves around herniated or bulging discs and pinched nerves. A herniated or bulging disc often places pressure on a nerve, pinching it and causing pain. The pain originates from the nerve root, causing radicular pain, or radiating to the lower extremities along the path of the nerve root. Pinched nerve treatment is necessary to reduce pressure and relieve the pain. Other pathologies include ligamentum flavum hypertrophy (inflammation or thickening of the ligaments supporting the spine) and spondylolisthesis (slipped vertebra).

There are several external factors that can contribute to sciatica, but one of the most common is piriformis syndrome. The piriformis is a flat muscle located near the hip joint in the gluteal region. Piriformis syndrome develops when this muscle places pressure on the sciatic nerve, which we can address through piriformis syndrome therapy. Other external spinal factors include obturator syndrome and ischial tunnel syndrome.

Sciatic-like conditions vary, from sacroiliac joint dysfunction and side effects from hernias, to more uncommon causes like infections or tumors. With so many potential causes of sciatic pain, it has never been more important to work with highly experienced physical therapy and chiropractic professionals to get an accurate diagnosis for sciatic nerve physical therapy.



Depending on the type of sciatica, proper diagnosis may require multiple images modalities such as MRI, ultrasonography and ultrasound guided nerve blocks.

Explore more advanced diagnostic tools available only at NYDNRehab:


Non-invasive treatment in NYDNRehab

Many providers of sciatica physical therapy focus on a mixture of physical therapy exercises and prescription medications to treat pain, along with more invasive treatment procedures like surgery. While these procedures can be successfully used in sciatic nerve physical therapy, we expand on these options with more non-invasive approaches in both physical therapy and advanced chiropractic care. Many of our treatments are typically found only in research facilities and military hospitals, such as the C.A.R.E.N. system.

Our clinic features the first private C.A.R.E.N. system in the United States. C.A.R.E.N, or Computer Assisted Rehabilitation Environment, is a virtual reality environment that uses a multi-sensory experience for treatment, and to record important data about spinal stability, posture, balance and back pain. The device uses a computer operated platform with six degrees of freedom, projection screen, motion capture, motion base and special D-Flow and human modeling software to create real-time repeatable situations and environments. These features allow for precise and advanced physical therapy that cannot be duplicated by any other method. The results are fast and effective, and can be used for anything from enhancing athletic ability to treating back pain and sciatica.


Dynamic neuromuscular stabilization is a strategy that combines treatments and exercises to help restore strength, stability and healthy posture for sciatic nerve pain therapy. With the breakthrough scientific basis of DNS, our clinic is often able to treat cases where others have failed. This is largely due to the individualized nature of DNS, which combines chiropractic and physiotherapy to target the movement control centers of the brain. Targeting these centers helps correct issues like poor posture and body alignment that can contribute to the development of sciatica.

Our clinic is one of the few in New York that utilizes extracorporeal shock wave therapy (ESWT). With ESWT, we can activate the body’s natural self-healing abilities through high frequency sound waves that accelerate cell growth and tissue repair while reversing chronic inflammation.

To determine which chronic sciatica treatment method will be most successful, it is essential to start with a proper diagnosis. The professionals at our New York clinic have years of experience treating sciatica, using their clinical experience to match nerve pain symptoms with diagnostic results. Our clinic offers advanced diagnostic techniques such as diagnostic musculoskeletal ultrasound, that gives us a detailed look at the nerve conflicts inside the spinal discs, and in the pelvic and hip areas. Electromyography and nerve conduction may also be used to record electrical activity and identify possible nerve pain causes for later sciatic nerve pain therapy.

With the associated risks of nerve damage, sciatica requires both effective and prompt treatment to reduce potential side effects. At our clinic, we provide options beyond the traditional physical therapy services of medical clinics. With our state-of-the-art diagnostic and treatment equipment and our experienced professional staff, we provide individual treatment options that not only address spinal and nerve problems, but also work to prevent future pain and nerve damage. This is all done while using noninvasive approaches through our sciatica physical therapy programs. Our services will ensure you receive individual patient care and faster results, leading to a better quality of life post-treatment.

Ultrasound Guided Injections at NYDNRehab

Sometimes conservative sciatica treatment is not enough. In severe cases of sciatica, we use ultrasound guided nerve hydrodissection in conjunction with nerve blocks and ultrasound guided dry needling.


Whether you’re confined at home or on the go, NYDNRehab TeleHealth services provide a convenient way to receive ongoing professional physical therapy and chiropractic treatment at home, in the office or while traveling. With TeleHealth, you never need to miss a therapy session or lose hard-earned gains in treatment.

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About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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