Red flags — when to skip PT
Loss of bowel or bladder control, progressive weakness in the leg, foot drop, or saddle anesthesia means an ER visit — these can indicate cauda equina syndrome. Everything else belongs in PT first.
Conditions We Treat
Sciatica Physical Therapy in Washington DC and Bethesda
Sciatica is leg pain — often with numbness or tingling — caused by nerve irritation in the lower back. The term gets used loosely, but the mechanism matters. Most cases respond to conservative care within 6–12 weeks. No injection or surgery needed for the vast majority of patients.
What's actually happening
Most sciatica is mechanical, not damaged tissue. Common drivers include disc herniation pressing on a nerve root, lumbar stenosis narrowing the nerve canal, piriformis syndrome where a deep hip muscle compresses the sciatic nerve, and SI joint dysfunction referring pain into the leg.
Evaluation
Sixty-minute evaluation. Neuro screen (reflexes, dermatome sensation, myotome strength), straight-leg raise and slump tests, McKenzie directional preference assessment, hip and SI joint screen. We usually identify a clear position that centralizes your symptoms — that's the foundation of the home program.
Treatment approach
Directional preference exercises (McKenzie-style work that centralizes symptoms), neural mobilization and sciatic nerve glides, manual therapy for piriformis and deep hip rotators, dry needling for gluteal and piriformis trigger points, gluteal and core strengthening, and clear guidance on what positions to avoid in the acute phase.
When PT alone isn't enough
If you're not progressing after 6–8 weeks of consistent PT, or if you have significant weakness, we'll be honest about when an injection or surgical consult makes sense. Most patients never need either.
Costs, insurance, locations
Medicare, CareFirst, Aetna, UnitedHealthcare, Tricare. Self-pay $150. Capitol Hill, Bethesda, and in-home. Same-week evaluations.
Ready to start?
Same-week evaluations at Capitol Hill, Bethesda, and in-home throughout the DMV.
Book a Sciatica EvaluationFrequently asked questions
How is sciatica different from regular back pain?
Sciatica has a nerve component — pain (often with numbness or tingling) travels down the leg, usually past the knee. Regular back pain stays local to the back and may refer briefly into the buttock or thigh but doesn't follow a nerve distribution.
Will PT make my sciatica worse before it gets better?
Not usually. We test for directional preference at evaluation and pick exercises that should reduce, not worsen, the leg pain. If something flares it, we change it.
How long does sciatica typically take to resolve with PT?
Most cases resolve in 6–12 weeks of consistent care. Severe disc herniations or stenosis cases may take longer.
Do I need an MRI before starting PT?
Almost never. Imaging changes the treatment plan in only a small fraction of cases. Most patients improve without ever needing an MRI.
Is dry needling safe with sciatica?
Yes — we frequently needle piriformis and gluteal trigger points when they're contributing to nerve irritation. It can provide significant relief.
Should I get a cortisone injection or try PT first?
PT first is the recommended starting point. Injections are reasonable when PT alone isn't moving the needle, or when pain is preventing you from doing the rehab work.
What if my sciatica is from spinal stenosis?
Stenosis-driven sciatica responds to PT — the approach focuses on flexion-biased movement, hip mobility, and aerobic conditioning. Most patients meaningfully reduce symptoms without surgery.
Can I exercise with sciatica?
Yes, with modifications. Complete rest usually makes it worse. We'll help you keep moving in ways that don't aggravate the nerve.