Hi ahjay,
There are different causes for sciatica and as a result what treatment works for one doesn't necessarily work for the next.
The medical profession imo doesn't work too well when it comes to these sort of problems. You have to look at what is in the tool box and that is drugs or surgery.
In rare circumstances surgery may be necessary however should be a last resort when less invasive procedures haven't worked and adequate time has been given for the problem to rectify or heal itself. Furthermore it should only be considered if there is direct pressure on the nerve from the disc. This is generally the exception. This can be determined by MRI or CT. Be mindful however that a disc bulge does not necessarily indicate the cause of the problem. Many middle aged people have lumbar disc bulges in the absence of back pain/sciatica.
Primarily sciatica is caused by irritation of a nerve resulting from a lower back problem however it can be the result of direct pressure on the nerve from a disc protrusion or some other space occupying lesion.
For peace of mind get a MRI done and see if there is a definitive cause for the sciatica. If there isn't then my advice is to walk away from further medical attention unless you want to be pumped full of drugs or have surgery you don't need.
So back to the likely cause, nerve irritation. Several spinal nerves make up the sciatic nerve that runs down the back of the leg so it may be coming from just one of the spinal nerves or from a few. It may be irritated at the spinal level or at the pelvis or both.
So why is the nerve irritated/inflamed? Generally as a result of vertebral / spinal bone problem or a pelvic imbalance or both. In short, if a spinal bone is not aligned or moving properly then it may irritate the nerve. Same goes for the pelvis if the two halves of the pelvis are not aligned properly then the same can occur resulting in sciatica.
This can and often does occur in the absence of trauma. In fact a minimal movement or the the like can see the problem start. It is in this circumstance an accumulative problem thru work, sitting, driving, lifestyle etc. A back problem can be asymptomatic (no pain) for years all the time placing undue pressure on a joint or disc which eventually can fail in a big way. A heart problem leading eventually to a heart attack is a good analogy.
So once the nerve is sufficiently irritated it tells the muscles in the region to tighten and go into spasm ( hence a tennis ball in the gluteal region can relieve but generally doesn't fix) inflamatory chemicals are released into the area and pain results.
So you can rub a muslce or take an anti inflammatory but you are really just treating the symptoms. The body is always trying to heal itself so it may resolve on its own in time but it is better to try and get at the cause of the problem and that is treating the spine or pelvis to restore normal or improved function.
A reputable chiropractor trained in Gonstead or who is a proficient mannual adjuster should be able to diagnose and correct the spinal or pelvic problem. All chiropractors are not equal though some can work wonders in a very short period of time and others are average. Like any profession!
Physio sometimes works but their treatment is often more muscle orientated which is more a symptomatic treatment rather than treating the cause. Accupuncture or dry needling can be effective but is best possibly used in conjunction with chiropractic treatment if chiropractic on its own isn't working fast enough.
One last thing, the problem can return because we often go back to doing what caused the problem in the first place. So be mindful of aggregating factors (listen to your body!), exercise but don't irritate the problem and every once and a while have your spine checked by the chiropractor to keep it functioning well.
Good luck.
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