San Francisco Sciatica Doctors
Sciatica Is a Symptom. Finding the Cause Is the Key.
Sciatica describes pain that travels along the path of the sciatic nerve, typically from the low back or buttock into the leg.
It may be severe and disabling, or it may present more subtly as aching, burning, tingling, numbness, or a pulling sensation extending down the leg.
But sciatica is not the diagnosis.
What is irritating the nerve—and where?
At Physicians’ Back Institute, identifying the cause is the first step toward effective treatment.
Not All Sciatica Comes From the Same Place
The sciatic nerve begins with nerve roots in the lower spine and travels through the pelvis and buttock before continuing down the leg.
Irritation can therefore occur at different points along its course.
Possible causes include disc herniation, spinal stenosis, degenerative changes or spondylolisthesis, pelvic or soft-tissue restrictions, and piriformis or surrounding muscular dysfunction.
Because the causes differ, the treatment must differ as well.
Treating “sciatica” without determining its source can lead to treatment of the wrong structure.
“I can’t say enough positive things about my experience being treated by Dr. Robert Minkowsky. He offers a very unique experience in San Francisco for those with back pain. I first saw him in 2010 for sciatica. After successfully treating that problem. I was pain free for several years but then developed nerve pains in my legs and shoulder due to scoliosis and stenosis. Physical therapy proved ineffective. Through a combination of treatments from Dr. Minkowsky, and following through on his recommended exercise program, I have been able to avoid surgery and regain my life. I would highly recommend Dr. Minkowsky to anyone suffering from back injuries whether from a sudden injury or due to long-term structural issues.”
What Sciatica Can Feel Like
Sciatica may cause pain extending from the low back or buttock down the back or side of the leg. Symptoms can include sharp, burning, or electric pain; tingling; numbness; pulling or tightness; pain aggravated by sitting, standing, walking, bending, or lifting; and weakness in the leg or foot.
The pattern and behavior of these symptoms provide important diagnostic clues.
Why the Examination Matters
MRI can be very useful when evaluating sciatica, particularly when disc herniation, stenosis, or another spinal condition is suspected. But imaging alone does not tell us everything.
We combine imaging when appropriate with a detailed history, neurologic examination, assessment of spinal and pelvic mechanics, muscle function, and hands-on osteopathic evaluation.
This helps us determine not simply that a patient has leg pain, but where along the nerve pathway the problem may be occurring and what is contributing to it.
The Whole Nerve Matters
A nerve is not an isolated structure. It must move and glide through muscles, fascia, and other tissues as the body moves.
For that reason, symptoms in the leg may be influenced by the spine, pelvis, buttock, or tissues along the course of the nerve.
Our examination therefore does not stop at the low back or at the place where the patient feels pain.
We evaluate the entire pathway.
Treatment Is Based on the Cause
There is no single treatment for sciatica.
Depending on the diagnosis and stage of the condition, treatment may include osteopathic manual treatment, rehabilitation, therapeutic exercise, changes in posture and ergonomics, appropriate medication, or selected injection procedures.
Exercise must also be individualized. A movement that is useful for chronic nerve restriction may aggravate an acutely inflamed nerve.
That is why we prefer to determine what is happening before simply prescribing “sciatica stretches.”
The right treatment depends on the right diagnosis.
When Sciatica Needs Urgent Evaluation
New or progressive weakness, significant loss of sensation, loss of bladder or bowel control, numbness in the groin or saddle region, fever or systemic illness associated with severe back pain, or other rapidly worsening neurologic symptoms require prompt medical evaluation.
Finding the Cause. Restoring Function.
Robert Minkowsky, MD, and Irène Minkowsky, MD, are board-certified medical doctors with extensive postgraduate training in osteopathy and decades of experience evaluating spine, nerve, and musculoskeletal problems.
If you have sciatica, our goal is not simply to treat the pain traveling down your leg.
We want to determine why the nerve is irritated and address the factors contributing to it.
