Direct answer: Sciatica — pain radiating down the leg along the path of the sciatic nerve — is usually assumed to come from a herniated disc, and often it does. But a meaningful share of cases have a different origin entirely: fibrous adhesion around the piriformis muscle and lumbar fascia in the deep gluteal space, physically entrapping or irritating the sciatic nerve as it passes through or near the piriformis. This distinction matters because disc-focused treatment won't resolve nerve irritation that's actually mechanical and tissue-based. At Novo Soft Tissue in the Denver Tech Center, an exam — not imaging alone — determines which pattern fits.
By the time someone reaches out about sciatica that hasn't resolved, they've often already had spine imaging that shows only mild, age-typical disc changes that don't clearly explain pain of this severity, along with a course of physical therapy aimed at the low back rather than the deep gluteal region specifically.
The piriformis muscle sits deep in the gluteal space, and the sciatic nerve runs directly beneath it — or in some people, through it — on its way down the leg. When adhesion forms in and around the piriformis and surrounding lumbar and gluteal fascia, it can physically compress or irritate the nerve, producing pain, tingling, or numbness that follows the sciatic distribution, but that's triggered more by hip rotation and prolonged sitting than by spinal loading or bending — one of the clearer signs pointing away from a disc-driven cause.
Manual adhesion release is the primary tool for freeing the piriformis and surrounding deep gluteal tissue directly, sometimes paired with radial ESWT depending on how deep and how extensive the adhesion is on exam.
A 2005 study in the Journal of Neurosurgery: Spine (Filler et al.) followed 239 sciatica patients whose standard treatment had already failed, and found that two-thirds of that group were ultimately re-diagnosed with piriformis syndrome rather than a disc-related cause, confirmed with MR neurography imaging. A 2025 systematic review in BMC Surgery pooling 212 patients found that a meaningful share of sciatica is non-discogenic, and that nearly half of piriformis-syndrome cases show no identifiable structural abnormality on standard imaging — one reason this cause is frequently missed or misattributed to the spine. Shockwave therapy for piriformis-related entrapment specifically is a newer area, with early case reports showing reduced pain and reduced sciatic nerve swelling, though larger trials are still limited compared to more established conditions.
A new-patient comprehensive exam is $270 and includes a full history, physical examination, and an explanation of the diagnosis; no treatment is performed on the first visit. Follow-up visits are $90 for a single-region treatment. $180 for focused shockwave treatment. Novo Soft Tissue does not bill insurance directly, but accepts cash, check, major credit cards, HSA, and FSA, and provides documentation you can submit for possible reimbursement.
Request an appointment to have sciatica evaluated for a piriformis/adhesion-related cause, or read more about how manual adhesion release works and the four tools used across all conditions.
Last reviewed: September 2026