Disc, or piriformis?
The single most useful question to ask about your sciatica. The two patterns respond to opposite routines, so getting this right is the difference between settling the flare in a week and pushing into a month. Five questions, then a matched routine.
How to read this test
Five questions, each with three answers. Note which answer fits you for each one (most people will recognise their pattern in 30 seconds). Count up which column gets most of your picks. Three or more matching answers in one column is a strong signal. If you split close to 50-50, treat as mixed and start with the maintenance routine.
Where does the pain go?
Down the leg, BELOW the knee, in a specific path (outer thigh + top of foot, or back of leg + sole)
Classic dermatomal radicular pain. L5 or S1 nerve root involvement.
Deep in the buttock, sometimes ACHES down the back of the thigh but stays vague, rarely below the knee
Buttock-dominant referred pain, suggests piriformis involvement.
In the back, with no leg pain at all
Not sciatica per se. Try lowerbackstretches.com for back-only pain.
When does it get worse?
Sitting and bending forward. Coughing or sneezing makes it shoot
Forward flexion increases intradiscal pressure; coughing transmits force through the disc. Classic disc pattern.
Sitting on a hard surface specifically (driving long distances, wooden chairs)
Direct compression of the piriformis against the chair surface is the giveaway.
Standing or walking, better when sitting
Spinal stenosis pattern (more common over 60). Extension-bias exercises typically aggravate. See a physiotherapist before self-treating.
What does the pain feel like?
Sharp, electric, burning. Sometimes pins-and-needles in a specific patch of skin
True radicular pain. Sharp neuropathic quality + dermatomal distribution.
Deep, aching, sometimes squeezing in the buttock. May tingle down the leg vaguely
Referred somatic pain quality, not classic neuropathic burning.
Both equally
Mixed presentation. Start with the maintenance routine or see a physiotherapist.
What gives temporary relief?
Lying flat on your back or your stomach. Walking sometimes
Extension positions decompress the posterior disc and reduce nerve root pressure.
Standing up after sitting too long. Hot bath on the buttock
Removing the compression source and warming the muscle ease piriformis spasm.
Curling into a ball (knee-to-chest position)
Flexion-tolerant relief pattern, more consistent with piriformis than disc.
Is there one specific test that triggers it?
Bending forward to touch toes shoots pain down the leg (straight-leg raise positive)
Positive SLR strongly suggests nerve root tension, typical of disc compression.
Crossing the affected leg over the other (figure-4 position) reproduces the deep buttock pain
The FAIR test position (flexion-adduction-internal rotation) is the classic piriformis provocation.
Neither, the pain is constant regardless of position
Constant unrelieved pain regardless of position is a yellow flag. If accompanied by night pain, weight loss, or fever, see a doctor.
Your result
Three or more disc answers
Try the disc-bias McKenzie protocol. Watch for centralisation: pain moving UP toward the spine means it's working. Pain moving DOWN the leg means stop, this is the wrong direction for your case.
Open disc-bias routine →Three or more piriformis answers
Try the piriformis-bias routine. Figure-4 stretches, supine piriformis stretches, knee-to-opposite-shoulder. Stop if any single stretch makes pain travel further down the leg, that signals nerve root irritation rather than piriformis tightness.
Open piriformis-bias routine →Roughly 50-50 split
Mixed pictures are common. Start with the gentle maintenance routine (balanced direction mix) or the acute flare routine if you're currently in pain. If the pattern doesn't clarify within a week, see a physiotherapist for a hands-on directional preference assessment.
Open maintenance routine →Worse with standing, better when sitting
This is more common over 60. The standing-aggravated pattern suggests spinal stenosis, where extension reduces the canal space further. The disc-bias McKenzie routine typically aggravates stenosis. See a physiotherapist for an assessment before self-treating.
Read the full pain guide →The centralisation principle (your real-time signal)
Whichever direction you start with, the most reliable signal of whether a stretch is the right direction is what happens to your pain location during the stretch.
- · Pain moves UP toward the spine → good, this is your direction.
- · Pain moves DOWN further into the leg → bad, stop, wrong direction.
- · Pain stays in the same place → neutral, continue gently.
From Long, Donelson and Fung (2004) in Spine: patients matched to their directional preference (extension-bias if pain centralised with extension, flexion-bias if it centralised with flexion) showed substantially better pain and function outcomes than patients given mismatched or generic exercises.