Short answer
Sciatica means pain running down the leg along the sciatic nerve, most often from an irritated nerve root in the lower back, such as from a disc herniation. Piriformis syndrome, where the nerve is irritated in the buttock, is less common and is diagnosed after spinal causes are ruled out1. Most sciatica improves without surgery, and physical therapy speeds recovery with directional exercises, nerve mobility and graded activity2.
Answered by Dr. Manan Patel, PT, DPT, TPS, Certified Vestibular Specialist and Therapeutic Pain Specialist. Updated October 18, 2026.
How do sciatica and piriformis syndrome feel different?
- Lumbar radiculopathy (true sciatica): leg pain often worse than back pain, below the knee, with possible numbness, tingling or weakness, often affected by bending, sitting or coughing
- Piriformis syndrome: deep buttock pain, worse with prolonged sitting, tenderness over the piriformis muscle and pain with hip rotation1
How do you test for the source of leg pain?
We examine the back and hip, test nerve tension, reflexes, strength and sensation, and look for a directional preference: movements, such as repeated back bending, that pull pain out of the leg toward the back, called centralization. Warning signs such as loss of bladder or bowel control, numbness in the saddle area or rapidly worsening weakness need emergency care.
What does non-surgical treatment involve?
Treatment includes directional preference (McKenzie-style) exercises when centralization is found, nerve mobility (nerve flossing) dosed to avoid flare-ups, hip and core strengthening and a graded return to sitting, driving and lifting3. Many herniated discs shrink over time4. Imaging is usually not needed unless warning signs are present or surgery is being considered.
Where can I get sciatica physical therapy in Alpharetta or Cumming?
We treat sciatica and lumbar radiculopathy at our Cumming and Alpharetta clinics for patients from Johns Creek, Milton, Roswell, Suwanee and Forsyth County. Dr. Patel's training as a Therapeutic Pain Specialist adds pain neuroscience education, which helps calm an irritated, protective nervous system.
Where can I get help in Alpharetta, Cumming and nearby?
Dr. Manan Patel, PT, DPT, TPS and our team of physical therapists see patients from Alpharetta, Johns Creek, Milton, Roswell, Cumming, Suwanee, Sugar Hill, Buford, Duluth and Forsyth County at two North Atlanta clinics. Every visit is 60 minutes, one-on-one, and urgent appointments are available within 48 hours. We are in-network with Traditional Medicare, BCBS / Anthem and Tricare, and offer a $129 rate per visit for self-pay and out-of-network plans. Not sure where to start? Take the free symptom self-check, or visit our Alpharetta clinic or Cumming clinic page.
Cumming clinic
Off GA-400 Exit 13 on Peachtree Parkway
Cumming, GA 30041
Alpharetta clinic
Inside Georgia Brain & Spine Physical Therapy
Alpharetta, GA 30022
Related care
Related questions
- How can you stop radiating arm pain, numbness and tingling from a pinched nerve in the neck without surgery?Cervical radiculopathy is irritation of a nerve root in the neck, usually from a disc herniation or narrowing around…2 min read · Patient question
- Back and neck pain after 40: what do degenerative disc disease, stenosis and facet arthritis really mean?These terms describe age-related changes that show up on most spine scans after 40, including in people with no pain…2 min read · Patient question
- What is a safe roadmap to recovery after spine surgery (ACDF, microdiscectomy, laminectomy or fusion)?Recovery follows phases set by your surgeon's protocol: protecting the surgery early, then restoring movement, then…2 min read · Patient question
- All concussion, spine and pain questionsBrowse every question in this topic.
References
- Hopayian K, et al. The clinical features of the piriformis syndrome: a systematic review. European Spine Journal. 2010.
- National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management (NG59). 2016, updated 2020.
- George SZ, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021.
- Chiu CC, et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation. 2015.
This answer is general education, not a diagnosis or a substitute for an examination. If you have new or worsening symptoms, contact your doctor. Call 911 for sudden severe dizziness with trouble speaking, weakness, numbness, double vision or a severe headache.
