Back & sciatica  ·  test

The 10-second photo test that explains why your sciatica keeps coming back

A physical therapist’s 30-year look at the movement patterns behind recurring sciatic pain, and simple tests you can try yourself.

Rick Olderman, MSPT
 ·  11 min read
 ·  Updated September 2026

Licensed orthopedic physical therapist, 30 years of clinical experience. Former clinic owner,
author of Pain Patterns, winner of the 2025 NIEA Award, and creator of a systems-based
approach to chronic pain used in his APTA-approved continuing education course.

If your sciatica keeps coming back, you’ve probably tried physical therapy, chiropractic care, injections, massage, medication, even surgery. You may have been told the cause is a herniated disc, spinal stenosis, or piriformis syndrome. But as you’ve found, those diagnoses don’t always explain why the pain keeps returning.

After 30 years as an orthopedic physical therapist, here’s what I’ve found: persistent one-sided sciatica usually has a specific pattern in the body, and that pattern is almost always caused by an older problem in the lower body. Fix the first without finding the second, and the pain comes back.

Why does my sciatica keep coming back?

For many people, one-sided sciatic pain is caused by an uneven pelvis and rib cage on the same side as the pain — what I call a sidebending problem. It narrows the space where the nerve roots exit the spine. Leveling the pelvis and rib cage out can relieve pain within minutes, and I’ll show you exactly how to do that.

But that’s only half the answer. It will likely return, because something is pulling your body into that uneven position:

• A walking pattern that turns off your glutes, often rooted in an old injury your body quietly compensated around
• Your thigh bone’s natural shape, which may put your glute at a disadvantage
• Tight thigh muscles pulling your pelvis out of position

Fix the unevenness without fixing what’s driving it, and both the sciatic pain and the sidebending problem come back. None of this replaces a medical workup — it’s the piece most workups miss, and I’ll explain why at the end.

Cause 1: the sidebending problem

Quick take: An uneven pelvis and rib cage narrows your nerve root space. It’s easy to test, but it’s a symptom of a bigger problem — covered in causes 2 to 4.

If you’ve been using your body unevenly for a while, your body will form a larger waist crease on the side where the pelvis is higher and the rib cage is lower — a sign that side is basically collapsing.

Why this causes pain. That lateral bend closes the space where the nerve roots exit, on that side. You can also imagine what it must be doing to your disc and vertebral facet joints. Level the pelvis and rib cage, and that space reopens, relieving pressure and pain almost instantly.

A temporary quick fix: reaching while walking

Is a sidebending problem due to leg length discrepancy?

If you’ve been told your uneven pelvis is from a leg length discrepancy, that’s one of the most commonly cited — and most frequently misdiagnosed — explanations for this kind of asymmetry. Here’s what’s really going on.

Relief isn’t resolution. Leveling the pelvis and rib cage brings temporary relief because it directly reduces compression. But the sidebending problem doesn’t appear from nowhere. If what’s driving it isn’t addressed, it comes back. The next three sections are about finding those drivers.

Cause 2: the walking habit that’s turning off your glutes

Quick take: A locked-knee walking habit, often rooted in an old injury or shoe wear, turns off your glute and pulls your pelvis and rib cage out of level, one step at a time.

Watch: The walking habit that’s feeding your sciatic pain

You take 5,000 to 10,000 steps a day. Most shoes let people develop a habit their bodies weren’t built for: swinging the foot out front, landing on the heel, locking the knee. That lock turns off the glute on that side. Every step nudges your pelvis and rib cage a little further out of level.

Old injuries your brain has hidden from you

In my clinical experience, aside from shoe wear, poor glute performance often results from an old forgotten injury: a sprained ankle, a banged-up knee, a hip that flared up years ago. That initial pain resolves in part because your brain figured out a way to unload the injury to let it heal. That works in the short term. The long-term consequence is a sidebending problem.

The protective walking pattern never gets undone, because the brain has found a new normal. Without precise guidance on how to restore symmetry, your brain is content to continue, because it’s pain free. Pain is an indicator that something is wrong. Without that indicator, your brain has no reason to change anything.

This is why sciatic pain confuses people: the real driver can be an old injury that hasn’t bothered you in fifteen years, quietly pushing your pelvis and rib cage out of level the entire time, with every step.

If you’re not sure which leg is holding an old injury like this, I cover a test for exactly that — one that reveals which side your brain quietly trusts more — in my knee pain article. It doesn’t test your knee specifically; it tests the compensation pattern underneath a lot of one-sided pain, sciatica included.

The glute mechanism itself — why a quiet glute lets the thigh bone drift and destabilizes the hip during walking — is called anterior femoral glide syndrome. I cover the full mechanism and self-test in my first hip pain article, since it’s the same pattern driving a great deal of hip pain too.

Why a quiet glute causes sciatic pain

With the glute off, the smaller piriformis muscle can take over. The piriformis and glutes have similar jobs, but if we compared them to tools, the glutes would be a backhoe and the piriformis a hand shovel. If you were digging out a new pool over months and your backhoe was broken, your shovel might develop small cracks and eventually break too. It wasn’t meant to dig out a pool. It was meant to dig out a plant.

The piriformis sits directly on the sciatic nerve — there’s also a variant where the nerve runs through it. Chronically overworked, that piriformis tension adds to nerve irritation and the radiating pain down the leg. It’s also why the figure-4 stretch feels good for an hour and then stops working: it soothes the piriformis temporarily, but the next walk puts it right back to work.

You can have sciatic nerve compression at the spine and at the piriformis, for the same reasons. This is why it’s so important to test how the whole lower body system is working. One precise fix can solve several systemic problems.

Cause 3: the shape of your thigh bone

Quick take: Your thigh bone’s natural shape can put your glute at a disadvantage before you even take a step, feeding the same walking-pattern problem from cause 2.

Watch: Why sciatica exercises help some people and make others worse

The same exercises that fix one person’s sciatica can worsen another’s, often due to femur shape. Some people’s thigh bones rotate slightly inward at the hip (anteversion), others outward (retroversion), which changes how much rotation is naturally available. Since the gluteus maximus is an external rotator, anteversion starts the glute lengthened and disadvantaged at every step — and therefore more likely to underperform and hand the job to the piriformis. I cover the full self-test and what to do about your specific shape in my hip pain series.

You’d expect retroversion to be an advantage. In practice, people with retroverted femurs often feel self-conscious about their feet, because they need to be turned out while walking. So they force their feet to point straight ahead, which recreates the same disadvantaged glute position by a different route — plus excess inner-thigh tension, locked knees, and more ankle sprains.

In my clinical experience working with people in chronic pain, anteversion is more common in women and retroversion in men. Female athletes face a two to eight times greater risk of ACL injury than male athletes. I believe poorly controlled femoral anteversion is part of why — though that specific mechanism is my clinical belief connecting the two facts, not something directly tested.

Cause 4: the thigh muscle nobody checks

Quick take: Tight quads pull your pelvis forward, often asymmetrically, which can create the sidebending problem all on its own — no walking habit or femoral shape required.

Watch: The muscle nobody checks for sciatica

The quadriceps begin at the front of the hip and insert into the knee. When tight, they can pull the pelvic bone forward into an anterior tilt. Asymmetrical tightness can then contribute to a sidebending problem, or torsion across the pelvis that also contributes to SI joint pain.

That tilt does three things: it extends the lumbar spine on that side, narrowing the nerve root space directly; it weakens the glute on that side; and it contributes to the uneven pelvis described above.

I’ve had patients whose sidebending problem, and sciatica, resolved quickly just from stretching this group of muscles.

Putting it all together

A walking habit rooted in an old injury, a disadvantaged thigh bone, or tight thigh muscles — any of these pulls your pelvis and rib cage out of level. That’s the sidebending problem you likely found in your own body if you took a photo in the test above. And it directly narrows your nerve root space, contributing to your sciatica.

That’s why reaching while walking can bring fast relief: it levels the rib cage and pelvis, opening the space back up immediately. But fixing the crease without fixing what’s pulling you into it is exactly why so many people cycle through practitioner after practitioner without lasting results. Not only are most practitioners unaware of this pattern, they aren’t trained to link lower body issues to it.

I refer to my approach as systems thinking, because it relies on understanding how the body works together as a system — rather than how we’re trained in medicine, which is to treat each joint or tissue in isolation. I call that component thinking. I’ve spent my 30-year career putting this together into a logical system that works well clinically.