Shooting pain down the leg. Can't sit at your desk. Can't sleep on your side. Sciatica disrupts almost everything — and the right diagnosis is the first step back to normal.
Conservative-first treatment at LAOSS — surgery only when truly needed.
Sciatica isn't a diagnosis on its own — it's a symptom of an underlying problem in the lower spine. The sciatic nerve is the longest nerve in the body. It's actually a bundle of nerve roots that exit the lumbar spine at the L4, L5, and S1 levels, merge in the pelvis, and travel down through the buttock, the back of the thigh, the calf, and into the foot. When any of those roots get pinched or irritated where they leave the spine, you feel it everywhere that nerve travels.
Most commonly, the culprit is a lumbar disc herniation — the soft inner gel of a spinal disc pushes out through a tear in the tough outer wall and presses on a nerve root. Other common causes include spinal stenosis (narrowing of the canal where the nerves live, often age-related), spondylolisthesis (one vertebra slipping forward on the one below), and occasionally piriformis syndrome, where a muscle deep in the buttock irritates the nerve below the spine.
The good news: most sciatica gets better. In study after study, roughly 80–90% of patients with a herniated disc and sciatic pain improve within 6 to 12 weeks with conservative care — physical therapy, anti-inflammatories, posture changes, and time. Our job at LAOSS is to confirm what's actually causing your pain, get you on the right non-surgical track quickly, and recognize the smaller subset of patients who genuinely need a procedure to recover.
This condition is an irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas. Sciatica may result from a variety of problems with the bones and tissues of the lumbar spinal column.
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Five lumbar vertebrae stack in the lower back, each separated by a shock-absorbing disc. Behind those discs, a spinal canal carries the cord and the nerve roots that branch out to the legs. Where each root exits, it has to pass through a narrow tunnel called the foramen. A bulging disc, a bone spur, or a thickened ligament inside that tunnel can press the root — and that pressure is what you feel as a streak of pain down the leg. Which root is pinched determines exactly where the pain travels: L5 lights up the side of the calf and the top of the foot; S1 follows the back of the calf into the heel and the little toe.
Sciatica is a clinical diagnosis first — most of the answers come from your story and a careful exam, not the MRI machine. At LAOSS we start by mapping where exactly the pain travels, what triggers it, and what makes it ease. The distribution of your symptoms usually tells us which nerve root is involved before we image anything.
The physical exam is targeted and brief. We test the strength of specific muscle groups (heel walk for L5, toe walk for S1), check reflexes at the knee and ankle, map the area where you feel numbness, and perform straight-leg raise and slump tests that reproduce nerve tension. If those exam findings match a clear pattern and your symptoms are recent, we often start treatment the same day without further imaging — disc-related sciatica usually doesn't need an MRI in the first few weeks.
We do image when something doesn't fit, when red flags are present, or when conservative care isn't working. X-rays (available on-site at most offices) check alignment, fractures, and spondylolisthesis. MRI is the gold standard for visualizing disc herniations, stenosis, and which root is being compressed — we order it when symptoms persist past 6 weeks, when weakness is progressing, or when we're considering an injection or surgery. The goal is always the same: enough information to choose the right treatment, without unnecessary delay.
Most patients with sciatica never need surgery. Our pathway starts with the least-invasive option that fits your situation and escalates only when symptoms or imaging demand it. Conservative care does the heavy lifting; procedures are reserved for the cases that genuinely need them.
Non-surgical options designed to calm nerve irritation, restore movement, and let the disc heal on its own.
Minimally invasive decompression performed by board-certified spine surgeons — reserved for patients who haven't responded to conservative care or who have progressing weakness.
Sciatica care is judgment-heavy. Knowing when to wait, when to inject, and when to operate — and matching the right level to the right surgery — is what separates good outcomes from frustrating ones.
We move stepwise — start with the least-invasive option that fits your situation, and escalate only when it doesn't work.
If most of these match your situation, an evaluation with a sciatica specialist is the next step.
These signs typically point toward an in-person evaluation with a spine or pain-management specialist.
Your first visit is built to give you an answer the same day, not just another referral.
Sciatica recovery rarely runs in a straight line — flares and plateaus are normal. A clear plan with measurable milestones makes the path predictable.
The first two weeks are about reducing inflammation around the nerve root and keeping you moving in safe positions.
Targeted physical therapy rebuilds core stability, hip strength, and confidence in the spine.
Once function returns, the focus shifts to keeping it — and catching any flare early before it spirals.
We talk through the risks and benefits of every option — injection or surgery — at your visit. Informed consent is a conversation, not a form.
Every spine procedure carries a small set of standard risks. We screen, prepare, and monitor for them on every patient.
Some risks are tied specifically to working near a nerve root. We discuss these in detail so you can weigh them against the benefits.
At LAOSS you'll find personalized, accessible spine care led by board-certified pain management physicians and orthopedic spine surgeons. Our pain management team handles the vast majority of sciatica cases non-surgically — physical therapy coordination, targeted medication, and image-guided epidural injections — while our spine surgeons step in for the smaller share of patients who need a microdiscectomy or decompression. The two groups work side by side, which means you don't get bounced between offices when your treatment plan evolves.
Best ortho experience I've had. The whole team treats you like a person, not a number. Front desk, MAs, doctor — everyone is professional and kind.
Book a visit with a sciatica specialist at any of our eight Los Angeles–area offices. Most patients leave their first visit with a diagnosis and a clear plan.
