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Quick answer
Sciatica is pain traveling from the low back or buttock down the leg, sometimes with tingling or weakness. It often involves an irritated nerve root, but hip, sacroiliac, facet or peripheral nerve problems can mimic it. Dr. Tortland finds the true pain source first with an exam, imaging review and live ultrasound, then chooses treatment.
Most common causes seen
Facet joint pain, SI joint pain, sciatica and nerve-root pain
Diagnosis method
History, exam, imaging review and live ultrasound in one visit
Interventional options
Epidurals, nerve hydrodissection, PRP, prolotherapy
First visit
At least an hour, $500 in the office with ultrasound included, or $300 by telehealth
Physician
Paul Tortland, DO, FAOASM, CAQSM, RMSK
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Significant stenosis, instability, or nerve compression causing progressive weakness
Payment
Out of network and direct pay; HSA / FSA eligible
When to see a doctor
When to seek an evaluation
Book an evaluation if your back pain has lasted more than a few weeks, keeps coming back, limits your work, sleep or activity, or has not improved with physical therapy, medication, or injections, or if it comes with pain, numbness, or tingling down a leg. A second opinion before spine surgery is also a good reason to come in.
Seek emergency care right away, not an office visit, if you have new loss of bowel or bladder control, numbness in the groin or inner thighs, rapidly worsening weakness in a leg or foot, back pain after a significant fall or accident, or back pain with fever, unexplained weight loss, or a history of cancer.
For everything else, the most important question is what is actually generating the pain. An MRI report that says "bulging disc" is often handed to patients as if it explains everything, and often it does not: a landmark study of 98 people with no back pain found 52% had a disc bulge and 27% had a disc protrusion anyway. Facet joints, the sacroiliac joint, and paraspinal muscles and ligaments are frequently the real source, and they get overlooked when a clinician goes straight from "disc finding" to "disc is the problem."
Common causes
Causes of sciatica and leg pain
The back pain and sciatica conditions seen most often in this practice, including sciatica that has been misdiagnosed elsewhere, treated with interventional and non-surgical care whenever the diagnostic workup supports it.
Validate · Investigate · Treat
Diagnosis and non-surgical treatment
Identify the likely pain generator before choosing treatment.
01
History, exam and live ultrasound
An unrushed first visit of at least an hour focuses on locating the actual pain generator: facet joints, paraspinal muscles, the sacroiliac joint, the disc, or an irritated nerve. Live musculoskeletal ultrasound is performed in the same visit.
02
Imaging review and a clear diagnosis
Your MRI, CT, and X-rays are compared against the exam findings. For leg pain, this step separates true nerve-root sciatica from look-alikes such as sacroiliac or facet-referred pain, a common source of misdiagnosis.
03
Treatment selection
Treatment targets the identified pain generator, not a generic "back pain" protocol. You are shown every reasonable option, from rehabilitation and interventional procedures to regenerative treatment or a surgical referral.
04
Interventional spine procedures
For sciatica and nerve-root pain, Dr. Tortland performs interlaminar, transforaminal, and caudal epidural injections, including the "sweet caudal" (a caudal epidural using dextrose), as well as ultrasound-guided nerve hydrodissection.
05
Ultrasound-guided regenerative treatment
For selected facet, ligament, and paraspinal pain generators, PRP is custom-prepared on site to 12 to 15 times baseline platelet concentration (commercial bedside kits typically reach 2 to 7 times) and placed under live ultrasound, often reaching the facet capsule, medial branch nerve, and paraspinal muscle through a single skin entry point. Prolotherapy may be used for sacroiliac or facet-region ligament laxity.
06
Recovery instructions
You leave with written instructions specific to your spine and the procedure performed. After a regenerative injection, expect two to five days of soreness. Dr. Tortland's clinical team gives you tailored instructions for before and after your visit.
07
Follow-up and re-evaluate
Follow-up at six to ten weeks to compare your symptoms against baseline and decide on next steps, with repeat imaging when appropriate.
Candidacy
Candidacy and when surgery fits
Comparison
Sciatica treatment options compared
| Option | What it does | Duration of benefit | Effect on tissue |
|---|---|---|---|
| Epidural steroid injection | Suppresses inflammation around an irritated nerve root or facet joint | Weeks to a few months, sometimes longer | No repair effect on the underlying structural problem |
| Physical therapy | Builds strength, flexibility and movement patterns to reduce load on the spine | Ongoing; depends on continued exercise | No direct tissue effect; foundational to most plans |
| PRP | Delivers growth factors to the facet, ligament or nerve-adjacent tissue to stimulate repair | Varies by person and condition | Aims to improve tissue quality |
| Cellular orthobiologics (BMA) | Delivers cells plus signaling proteins for advanced facet or disc degeneration | Varies by person | Stronger biologic signal for degenerated joints |
| Spine surgery | Decompresses, stabilizes or repairs a structural spine problem | Long-term, definitive for the right case | Structural change with recovery cost |
Frequently asked
Back pain and sciatica questions
What kind of doctor should I see for back pain?
My MRI shows a disc bulge. Is that definitely causing my back pain?
Why is sciatica so often misdiagnosed?
What epidural injections does Dr. Tortland perform?
What is nerve hydrodissection, and can it help sciatica?
What is prolotherapy, and is it used for the back?
Does insurance cover back pain treatment, and what does it cost?
Is all PRP for the back the same?
When is back or leg pain an emergency, and when do I need an MRI?
Sources
Sciatica evidence and research
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
02
Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.
03
Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 2007;(2):CD004059.
05
Maniquis-Smigel L, Reeves KD, et al. Short term analgesic effects of 5% dextrose epidural injections for chronic low back pain: a randomized controlled trial. Anesth Pain Med. 2016;7(1):e42550.