Low Back Pain & Sciatica

Lumbar Disc Herniation

A disc herniation occurs when the nucleus pushes through the annulus wall, typically posterolaterally toward the nerve root. The disc material creates both mechanical compression and a chemical inflammatory response on the adjacent nerve root — producing the characteristic combination of local back pain and radiating leg symptoms. The level of herniation predicts the pattern:

• L3–L4 (L4 nerve root) — anterior thigh, inner knee, medial lower leg; quadriceps weakness; reduced knee reflex
• L4–L5 (L5 nerve root) — outer calf, top of foot, big toe; great toe and ankle dorsiflexion weakness
• L5–S1 (S1 nerve root) — back of calf and heel, outer foot, little toe; calf weakness; reduced Achilles reflex

The majority of lumbar disc herniations resolve with conservative care. Mechanical traction, manual therapy, directional preference exercises (McKenzie-based), and neural mobilization reduce compression on the nerve root and facilitate resolution of disc material — most patients avoid surgery with appropriate PT.

Sciatica and Lumbar Radiculopathy

Sciatica refers specifically to pain that travels down the leg along the path of the sciatic nerve — from the buttock down the posterior thigh, into the calf, and potentially to the foot. True sciatica results from irritation or compression of a lumbar nerve root (radiculopathy) — most commonly from disc herniation or foraminal stenosis. Symptoms range from a sharp, shooting pain to burning, numbness, tingling, or weakness in the leg. Sitting typically aggravates symptoms; walking or lying down often relieves them.

Not all leg pain is sciatica. Referred pain from lumbar facet joints, SI joint dysfunction, or piriformis syndrome can all mimic radiculopathy but require very different treatment. Accurate diagnosis at Healing Star PT ensures you receive the right treatment from day one.

Facet Joint Syndrome

The lumbar facet joints guide movement and share load between vertebrae. Facet joint syndrome is a common but often underdiagnosed cause of low back pain — typically producing localized pain near the spine that is worse with extension and rotation, relieved by flexion or sitting, and may refer into the buttock or posterior thigh (but rarely below the knee). Facet-mediated pain is highly responsive to Maitland manual therapy — targeted joint mobilization restores normal mechanics and rapidly reduces pain.

Sacroiliac Joint Dysfunction

The sacroiliac (SI) joint connects the sacrum to the pelvis and transmits load between the spine and lower extremities. SI joint dysfunction produces pain at the SI joint region (often directly over the PSIS — the bony prominence at the top of the pelvis), sometimes radiating into the buttock, groin, or posterior thigh. It is commonly aggravated by prolonged sitting, transitional movements, and single-leg activities. Pregnancy, asymmetrical loading activities, and leg length discrepancies are common contributing factors. Joint mobilization, soft tissue treatment, and targeted stabilization of the SI region are highly effective.

Lumbar Spinal Stenosis

Lumbar stenosis occurs when the spinal canal or nerve root canals narrow — typically from a combination of disc bulging, facet joint arthritic overgrowth, and ligamentum flavum thickening. The hallmark symptom is neurogenic claudication: leg heaviness, aching, or cramping that develops with walking and is relieved by sitting or forward bending (which opens the spinal canal). Unlike vascular claudication, symptoms come on with ambulation and are not related to pulse or circulation. Physical therapy — including lumbar flexion exercises, manual therapy, and mechanical traction — effectively manages the majority of stenosis cases without surgery.

Degenerative Disc Disease

As discs lose hydration and height with age, the intervertebral space narrows and load distribution changes — increasing stress on facet joints and potentially producing pain with sustained postures. DDD is one of the most over-relayed imaging findings in medicine: it is extremely common in asymptomatic people over 40. Our role is to identify whether the degenerative findings are actually responsible for your pain and address them with manual therapy, targeted exercise, and load management education.

Muscle Strain and Myofascial Pain

Acute lumbar muscle strain from lifting, twisting, or sudden movement is the most common cause of sudden-onset back pain. While most acute strains resolve in days to weeks, inadequately treated strains can develop into chronic myofascial pain with persistent trigger points in the quadratus lumborum, erector spinae, and gluteal musculature. Dry needling combined with manual therapy and progressive loading exercise resolves these patterns effectively.