Sciatica is a symptom, not a diagnosis. The word describes pain that travels from the low back or buttock down the leg. It says nothing about which structure is causing that pain. That gap is where most sciatica treatment goes wrong.
At least three different structures cause leg pain that feels the same from the outside. Each needs a different treatment. Finding out which one is yours is the first job. It is a job that can be finished, not managed forever.
When leg pain is called sciatica, the source is usually one of these:
Two of these are often active at once. That is not unusual. It is the normal state of a leg that has hurt for years. And it is exactly why one injection aimed at one structure brings partial relief and then stalls.
Go to an emergency department, or call 911, if leg or back pain comes with any of the following:
These cases are uncommon. But they are the ones where hours matter.
Imaging alone cannot do this. A bulging disc on an MRI is a finding, not a verdict. The same finding shows up on scans of people with no pain at all. What settles the question is a physical exam that brings on and pinpoints the pain. When needed, it is followed by a diagnostic block. That is a small, precise shot of numbing drug under live X-ray.
If numbing that structure removes the pain, that structure was causing it. If it does not, that is not a failure. It has ruled out a suspect, and the next step depends on that. See why an injection that does not work is still information and what fluoroscopy actually shows, image by image.
Treatment is chosen to match the source, not the label. A pinched nerve root inflamed where it exits is treated at the root — see why an inflamed nerve root burns and what an epidural steroid injection actually does. A nerve trapped in the deep gluteal space is treated where it is trapped. That means steroid, anesthetic or botulinum toxin depending on what the block established. Stenosis that has not responded to conservative (non-surgical) care has its own minimally invasive options. Scar tissue after past surgery has another.
The treatments themselves are laid out under sciatica and radicular pain treatment. The order matters. This practice starts with the least invasive step that can answer the question. It steps up only on evidence.
Patients arrive having had the right procedure done correctly. But the relief lasted weeks instead of months. That pattern is usually not a technical failure. It is a nerve sitting in an inflamed body.
Insulin resistance and metabolic inflammation make a nerve fire more easily. They keep it sensitized after the mechanical problem has been treated. Sarcopenic wasting — the quiet loss of the muscle that steadies the pelvis and low back — removes the support the treated segment needs to stay quiet. And a job that keeps someone seated for nine hours, a sleep debt that never clears, and the isolation that comes with a year of pain are not soft factors stacked on top of the biology. They drive it.
This practice treats those drivers along with the structural problem. We do not refer them out and hope. Behavior work is done in-house by a licensed clinician trained in pain, not handed off at discharge. The injection is not the treatment. It is what makes the treatment possible.
For most sciatica, surgery is not the treatment. That is a statement about the condition, not about surgery. Pain from the piriformis, the cluneal nerves, the SI joint or a sensitized nervous system has no structural flaw for a surgeon to fix.
Sometimes a pinched nerve is causing nerve loss that keeps getting worse. Or stenosis has failed every less invasive option. Then surgery is the right answer, and this practice performs it. Dr. Gurpreet Singh Padda, MD, MBA, MHP is a licensed physician and surgeon with surgical privileges. Surgery is saved for when it is the answer, not used as the next step on a list.
If you have already had spine surgery and the leg pain came back or never went away, that has its own causes we can find. See why your leg still burns after a back surgery that worked.
Some leg pain called sciatica comes from the hip or sacroiliac joint, not a nerve root. When that joint is confirmed as the source, an image-guided intra-articular injection of PRP injections is a treatment option. Outer hip pain is often hip bursitis, which is really a gluteal tendon problem. See all orthobiologic treatment options.
An interventional pain doctor can find which structure is causing the leg pain. That is the step most often skipped. Surgeons fix structural problems that need structural repair. Primary care handles the early weeks well. The difference matters, because the three common sources need three different treatments. See the three structures that actually generate leg pain.
Not always. Bulging discs are common on the scans of people with no symptoms at all. So the image cannot settle it alone. A selective nerve root block can. It numbs the suspected root and watches what happens to the pain. Read what a selective nerve root block proves.
The one aimed at the structure actually causing it. That is why the diagnosis comes first. An inflamed root responds to treatment at the root. A nerve trapped in the buttock does not, no matter how well the epidural is done. See what an epidural steroid injection actually does.
Often yes, and the location is a useful clue, not a contradiction. Pain mostly in the buttock that gets worse with sitting points toward the deep gluteal space or the hip, not a low back disc. See when sciatica is not a disc.
Movement is usually part of the treatment, not a risk to it. But the right amount depends on which structure is involved. Stenosis and disc pain act differently when you are on your feet. See what the evidence shows about walking.
Most sudden leg pain improves within a few weeks. Pain that lasts longer than about six weeks without clearly getting better is worth a specialist’s opinion. So is any pain that came back after treatment. Read what waiting for pain treatment does to your body.
That is not the direction of this practice. The work aims to treat the source directly and cut the medicine load. Many patients come just to get off medicine that stopped helping. See whether pain medication can make pain worse.
No. You do not need a referral to be seen here, and you do not need to be a current patient. Some insurance plans require one for their own reasons, so check with your carrier. Same-day appointments are available for sudden pain.
Yes. The practice is licensed in Missouri and Illinois. It has offices on Woodson Road in St. Louis and on Natural Bridge Road. It sees patients from across the Metro East, including Edwardsville and Maryville.
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