Sciatica is a pain pattern, not a diagnosis: pain that travels from the lower back or buttock down the leg, usually because a spinal nerve is irritated or compressed. At PHI in Beverly Hills, board-certified physicians Dr. Faisal Lalani and Dr. Nadiv Samimi identify the specific nerve and cause and treat it, and most cases resolve without surgery.
You Know This Pain When You Feel It
Sciatica has a distinctive pattern: pain that starts in your lower back or buttock, then travels down the back of your thigh, sometimes all the way to your foot. It often feels sharp, burning, or electric. Coughing, sneezing, sitting too long, or bending forward can make it dramatically worse.
For some patients it is a constant ache; for others it is intermittent shooting pain that arrives without warning. Either way, sciatica interferes with sleep, work, exercise, and the basic mechanics of daily life. The good news: most cases resolve significantly with the right treatment, and most do not require surgery.
Sciatica Is Actually a Symptom, Not a Diagnosis
This nuance matters because it changes how treatment works. Sciatica is the name for the pain pattern, not the underlying cause. The pain happens when one of the nerves traveling from your lower spine into your leg becomes irritated or compressed, so treating it well requires identifying which nerve is involved and what is irritating it. The most common underlying causes:
- Herniated disc, the most common cause: a disc presses on or inflames a nearby spinal nerve
- Spinal stenosis: the space the nerve travels through narrows with age-related changes
- Foraminal stenosis: the specific opening where the nerve exits the spine narrows
- Piriformis syndrome: a buttock muscle irritates the sciatic nerve as it passes nearby
- Spondylolisthesis: one vertebra slips forward, narrowing the space for the nerve
- Less common causes, including tumors, infections, and post-surgical changes
Identifying the specific cause guides treatment. Epidural injections work best when the irritation comes from inflammation; selective nerve blocks can both confirm the specific nerve and treat the pain; regenerative options may address the underlying disc tissue.
How Sciatica Usually Progresses
Without treatment, many cases of sciatica improve significantly over six to twelve weeks as the disc herniation or inflammation shrinks and nerve sensitivity settles. This natural improvement is real, and many patients can reasonably wait it out for short periods. But waiting is not always the right answer: severe flares can be debilitating, patients who cannot work or sleep suffer real consequences, and for some patients the symptoms become chronic. Earlier treatment often produces faster relief and may prevent the transition to a chronic pain pattern.
When to See Someone
Consider professional evaluation when your sciatica has lasted more than two to four weeks, the pain interferes with sleep, work, or daily function, you have numbness, weakness, or tingling, conservative treatments have not helped, or you want active treatment rather than continued waiting.
Seek prompt evaluation if you experience significant leg or foot weakness, difficulty walking, loss of bladder or bowel control, severe numbness in the groin or inner thighs, or sudden severe pain after a fall or trauma. These can indicate more significant nerve compression that requires urgent attention; call us or go to an emergency department promptly.
How PHI Treats Sciatica
The first step is identifying the specific cause and the specific nerve involved. Your physician evaluates your pain pattern, performs a focused neurological examination, reviews any prior imaging, and sometimes uses diagnostic injections to confirm the source.
For most patients whose sciatica is caused by disc herniation, spinal stenosis, or foraminal narrowing, lumbar epidural steroid injections are typically the first interventional treatment, delivering anti-inflammatory medication directly to the irritated nerve. For patients where the source nerve is unclear, selective nerve root blocks can both diagnose and treat. For chronic or recurrent sciatica that has not responded to standard injections, radiofrequency ablation may be appropriate in selected cases. Regenerative options including PRP, A2M, and exosome therapy may address the underlying disc tissue. For the few situations where surgery is the right answer, PHI coordinates with surgical specialists.
Why PHI for Sciatica
Two board-certified pain physicians
Dr. Faisal Lalani and Dr. Nadiv Samimi both trained in interventional pain at Cedars-Sinai, with extensive experience identifying which nerve is causing your sciatica and matching it to the right treatment.
Diagnostic-first approach
Identifying the specific nerve and cause is the most important step. Many patients arrive having had injections that did not help, often because the injection was not targeting the actual source. We use diagnostic precision to avoid this.
Image-guided technique
PHI physicians perform every injection in our affiliated surgical suite at 455 N Roxbury Drive, Suite B, under image guidance.
Full range of non-surgical treatments
PHI offers epidurals, selective nerve blocks, radiofrequency ablation, and the full regenerative menu, so the right treatment is not limited to what a single-modality practice happens to offer.
Honest framing of surgical necessity
Most sciatica does not require surgery. We tell you straightforwardly whether non-surgical treatment is likely to succeed, where surgical evaluation makes sense, or where both should be discussed.
Concierge, coordinated care
Single-physician continuity from consultation through treatment and return to activity. Patients receive clear guidance and transparent pricing at consultation.
Frequently Asked Questions
Many cases improve significantly over six to twelve weeks. With targeted treatment, relief is often faster, and some patients improve substantially within days of their first epidural injection. Chronic sciatica lasting more than three months often benefits from interventional treatment to prevent further chronicity.
This depends on the underlying cause. Some patients have a single episode and never experience sciatica again; others have recurring episodes related to ongoing disc issues, spinal arthritis, or activity patterns. Treatment addresses current symptoms, while ongoing management of underlying causes affects long-term recurrence.
Brief rest during severe acute flares is reasonable, but extended bed rest typically slows recovery. Gentle continued activity is generally better than complete immobility. Your physician will provide specific guidance for your situation.
The injection does not address the underlying disc or structural cause; it reduces inflammation around the irritated nerve, which often produces meaningful relief. Many patients experience lasting relief because the inflammation cycle is interrupted long enough for natural healing to progress. Others need additional treatment.
The term pinched nerve is informal language for nerve compression or irritation. Sciatica specifically describes nerve irritation in the lower back radiating down the leg. They overlap but are not exactly synonymous, and cervical radiculopathy is a similar pattern in the neck and arm.
Chronic sciatica often becomes an established pain pattern even when the original cause has resolved. A comprehensive evaluation can address both the underlying cause and any chronic pain components that have developed. Treatment options are still meaningful even after years of symptoms.
Most patients with sciatica do not need surgery. The vast majority find meaningful relief through non-surgical approaches including injections, nerve blocks, radiofrequency ablation, and regenerative medicine. Surgery is reserved for specific situations.
Insurance coverage and payment options may vary. All pricing is disclosed at consultation.
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
Treatments We Offer for Sciatica
PHI offers the full range of evidence-based treatments for sciatica. Your physician will recommend the right option, or combination, based on the specific underlying cause, the severity of your symptoms, and your treatment history.
- Epidural Steroid Injections, the usual first interventional step for radiating nerve pain
- Nerve Blocks, selective nerve root blocks that confirm and treat the source nerve
- Radiofrequency Ablation, for chronic or recurrent cases in selected patients
- PRP Therapy
- A2M Therapy
- Exosome Therapy
Schedule Your Sciatica Consultation
A 60-minute consultation will identify the specific cause of your sciatica, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now.