Active Release Technique for Sciatica and Piriformis Syndrome in Greenville, SC
When Sciatica Isn't a Disc Problem — ART Finds the Real Source
Sciatica is one of the most misunderstood pain conditions we treat. Most people assume that sciatic nerve pain always comes from a herniated disc in the lower back. And sometimes it does. But a surprising number of sciatica cases are caused by soft tissue — tight muscles, adhesions, and scar tissue in the hip and glute region that trap and compress the sciatic nerve as it passes through.
If you've had sciatica symptoms — pain, numbness, tingling, or burning radiating down your buttock and leg — and spinal treatments alone haven't resolved them, the problem may not be in your spine at all. It may be in your soft tissue. And that's exactly what Active Release Technique (ART®) is designed to treat.
At Popwell Scota Spine Center in Greenville, SC, our certified ART providers evaluate and treat both spinal and soft tissue causes of sciatic nerve pain.
Understanding the Two Types of Sciatica
Discogenic Sciatica (Spine-Related)
This is the type most people think of. A herniated or bulging disc in the lumbar spine presses on the nerve root, sending pain down the leg. Chiropractic adjustments, decompression therapy, and rehabilitative exercises are typically the primary treatment approach for this type.
Piriformis Syndrome and Soft Tissue Sciatica
The sciatic nerve exits the pelvis and travels through the buttock, passing under (and in some people, directly through) the piriformis muscle. If the piriformis is tight, hypertonic, or has adhesions, it compresses the sciatic nerve — producing symptoms that feel identical to disc-related sciatica.
But it's not just the piriformis. The sciatic nerve also passes near or through the gemelli, obturator internus, gluteus medius, gluteus minimus, and the deep hip rotators. Adhesions in any of these muscles can contribute to nerve compression.
This is where ART excels. ART protocols can specifically target each of these muscles and the fascia surrounding the sciatic nerve, releasing the adhesions that are trapping the nerve.
How ART Treats Sciatica
Palpation and nerve tension testing. Before any treatment, your provider assesses the sciatic nerve using orthopedic tests and manual palpation. We identify whether the nerve is being compressed at the spine, the piriformis, the hip rotators, or multiple sites.
Piriformis release. If the piriformis is involved — and it frequently is — your provider applies targeted ART protocols that shorten, lengthen, and mobilize the piriformis while applying precise tension to the adhesion. You'll actively move your hip through internal and external rotation during treatment. Patients often feel the nerve "free up" during this protocol.
Deep hip rotator and gluteal release. The piriformis rarely acts alone. Adhesions in the surrounding muscles create a cumulative compression effect. We treat each involved structure individually using the specific ART protocol designed for that tissue.
Hamstring and adductor protocols. The sciatic nerve continues down the back of the thigh, where tight hamstrings and adductors can create secondary entrapment sites. We check and treat these as well, because releasing the piriformis without addressing downstream restrictions often produces incomplete results.
Lumbar and pelvic assessment. If your assessment suggests a spinal component, we combine ART with chiropractic adjustments to address both the soft tissue and joint dysfunction contributing to your sciatic pain.
Why ART Often Succeeds Where Other Treatments Fall Short
Stretching alone doesn't work for adhesions. Stretching a muscle that's adhered to the nerve next to it doesn't release the adhesion — it just stretches everything together. You get temporary relief, but the adhesion remains. ART separates the layers that are stuck together, which is something stretching can't do.
Massage is too general. Deep tissue massage can relax the piriformis and gluteal muscles, and that feels good. But it doesn't apply the specific tension-and-movement combination that breaks apart adhesions between the nerve and surrounding tissues. ART is a precision tool; massage is a blunt one.
Injections treat symptoms, not causes. Piriformis injections — whether corticosteroid or botulinum toxin — reduce inflammation or relax the muscle temporarily. But if adhesions are compressing the nerve, the symptoms return when the injection wears off. ART removes the mechanical cause.
Spinal adjustments alone miss soft tissue sciatica. If the nerve isn't being compressed at the spine, adjusting the spine won't resolve the symptoms. A thorough evaluation must include both spinal and soft tissue assessment — and treatment must address whatever the evaluation finds.
Signs Your Sciatica May Be Soft Tissue-Related
Not every case of sciatic pain is piriformis syndrome, but several clues suggest your sciatica might have a soft tissue component:
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Your pain is worse when sitting on hard surfaces or for long periods
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You feel pain deep in the buttock rather than in the low back
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The pain increases with activities that involve hip rotation — getting in and out of a car, crossing your legs, or climbing stairs
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Stretching your piriformis provides temporary relief but the pain always comes back
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Imaging of your lumbar spine looks relatively normal or doesn't fully explain your symptoms
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You've had chiropractic adjustments that helped your back but didn't fully resolve the leg symptoms
If any of these sound familiar, soft tissue entrapment of the sciatic nerve is worth investigating — and ART is the most effective non-invasive treatment for it.
Who Gets Piriformis Syndrome and Soft Tissue Sciatica?
This condition is common among people who sit for prolonged periods — office workers, truck drivers, students — because sustained compression of the buttock muscles creates the conditions for adhesions to form. It's also common in runners and cyclists whose repetitive hip motion causes microtrauma in the piriformis and deep hip rotators. And it frequently develops after hip or pelvic injuries where scar tissue forms around the sciatic nerve during healing.
What to Expect at Your Appointment
Comprehensive evaluation. We test both spinal and soft tissue causes of your sciatic symptoms. This includes orthopedic testing, nerve tension assessment, and detailed palpation of the piriformis, gluteal muscles, and deep hip rotators.
ART treatment at the first visit. If we identify soft tissue adhesions contributing to your symptoms, we begin treatment immediately. Most patients feel noticeable improvement after the first session — often reduced pain intensity and improved range of motion in the hip.
Integrated care plan. Depending on your evaluation findings, your plan may include ART alone or ART combined with chiropractic adjustments for the lumbar spine and pelvis. We also provide specific stretching and strengthening exercises to support your recovery and help prevent recurrence.
How Quickly Can I Expect Results?
Piriformis syndrome and soft tissue sciatica typically respond faster to ART than disc-related sciatica. Many patients experience significant improvement within two to four sessions. More chronic cases may take longer, but you should notice measurable changes early in treatment. We track your progress using pain scores, range of motion, and functional tests so you can see objective improvement — not just how you feel on a given day.
Stop Living with Sciatic Pain
If you've been dealing with sciatica that hasn't fully resolved — especially if you've been told your imaging looks normal, or if adjustments help your back but not your leg — it's time to look at the soft tissue.
📞 Call Popwell Scota Spine Center at (864) 244-2220 or schedule your appointment online. We're located at 107 Pelham Commons Blvd, Greenville, SC 29615.
FAQs — ART for Sciatica
How do I know if my sciatica is from a disc or from the piriformis?
Our evaluation includes specific orthopedic tests that differentiate between spinal and soft tissue causes. In some cases, both contribute — and we treat both. You don't need an MRI to get started, though if imaging has already been done, we'll review it as part of your assessment.
Can ART make sciatica worse?
When performed by a certified provider, ART is a safe treatment for sciatica. You may feel soreness in the treated muscles for a day or two after your first session — similar to post-workout soreness — but this is normal and resolves quickly. Your symptoms should improve, not worsen, with each visit.
Will I need to stop running or exercising during treatment?
In most cases, no. We may modify your activity slightly — for example, reducing training volume temporarily or adjusting your warm-up routine — but our goal is to keep you active. ART works well alongside training, and many athletes continue competing during their ART treatment plan.
Can piriformis syndrome come back after treatment?
It can, especially if the underlying factors — prolonged sitting, training errors, or hip muscle imbalances — aren't addressed. That's why we include corrective exercises and ergonomic recommendations in your care plan. Periodic maintenance visits can also help prevent recurrence if you're at high risk.