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 at all about which structure is producing that pain, and that gap is where most sciatica treatment goes wrong.
At least three different structures generate leg pain that feels identical from the outside. Each responds to a different treatment. Establishing which one is yours is the first job, and it is a job that can be finished rather than managed indefinitely.
When leg pain is called sciatica, the generator is usually one of these:
Two of these are frequently active at once. That is not an unusual presentation; it is the normal state of a leg that has hurt for years, and it is precisely why one injection aimed at one structure produces 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 presentations are uncommon. They are also 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 appears on scans of people with no pain whatsoever. What settles the question is a physical examination that provokes and localizes the pain, followed where needed by a diagnostic block: a small, precisely placed injection of local anesthetic under fluoroscopic guidance.
If numbing that structure removes the pain, that structure was generating it. If it does not, that is not a failure — it has eliminated a suspect, which is information the next step depends on. 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 generator, not the label. A compressed nerve root inflamed at the exit is treated at the root — see why an inflamed nerve root burns and what an epidural steroid injection actually does. Nerve entrapment in the deep gluteal space is treated where the entrapment is, with steroid, anesthetic or botulinum toxin depending on what the block established. Stenosis that has not responded to conservative care has its own minimally invasive options. Scar tissue after previous surgery has another.
The treatments themselves are set out under sciatica and radicular pain treatment. The order matters. This practice leads with the least invasive step that can answer the question, and escalates only on evidence.
Patients arrive having had the right procedure performed correctly, with relief that 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 lower the threshold at which a nerve fires and keep it sensitized after the mechanical problem has been addressed. Sarcopenic wasting — the quiet loss of the muscle that stabilizes the pelvis and lumbar spine — 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 arrives with a year of pain are not soft factors layered on top of the biology. They drive it.
This practice treats those drivers alongside the structural problem rather than referring them out and hoping. Behavioral work is delivered in-house by a licensed, pain-trained clinician, not handed over at discharge. The injection is not the treatment; it is what makes the treatment possible.
For most sciatica, surgery is not the treatment, and that is a statement about the condition rather than about surgery. Pain generated by the piriformis, the cluneal nerves, the SI joint or a sensitized nervous system has no structural lesion for a surgeon to correct.
Where there is a compressive lesion producing progressive neurological deficit, or stenosis that has exhausted every less invasive option, 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 reserved 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 returned or never resolved, that has identifiable causes of its own — see why your leg still burns after a back surgery that worked.
An interventional pain physician can establish which structure is generating the leg pain, which is the step most often skipped. Surgeons correct structural problems that need structural correction; primary care manages the early weeks well. The distinction matters because the three common generators need three different treatments. See the three structures that actually generate leg pain.
Not necessarily. Bulging discs are common on the scans of people with no symptoms at all, so the image cannot settle it by itself. A selective nerve root block can, by numbing the suspected root and observing what happens to the pain. Read what a selective nerve root block proves.
The one aimed at the structure actually producing it, which is why the diagnostic step comes first. A root that is inflamed responds to treatment at the root; a nerve entrapped in the buttock does not, no matter how well the epidural is performed. See what an epidural steroid injection actually does.
Often yes, and the location is a useful clue rather than a contradiction. Buttock-dominant pain that worsens with sitting points toward the deep gluteal space or the hip rather than a lumbar disc. See when sciatica is not a disc.
Movement is generally part of the treatment rather than a risk to it, though the right amount depends on which structure is involved — stenosis and disc pain behave differently on their feet. See what the evidence shows about walking.
Most acute leg pain improves within a few weeks. Pain lasting longer than about six weeks without a clear trajectory toward resolution is worth a specialist opinion, as is any pain that returned after treatment. Read what waiting for pain treatment does to your body.
That is not the direction of this practice. The work is aimed at treating the generator directly and reducing medication burden — many patients come specifically to get off medication that stopped helping. See whether pain medication can make pain worse.
No. You do not need a referral to be evaluated here, and you do not need to be an existing patient. Some insurance plans require one for their own reasons, which is worth checking with your carrier. Same-day appointments are available for acute pain.
Yes. The practice is licensed in Missouri and Illinois, with offices on Woodson Road in St. Louis and on Natural Bridge Road in Bridgeton, and sees patients from across the Metro East including Edwardsville and Maryville.
Call (314) 481-5000 or request an appointment. See all conditions we treat.
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