Understanding Your Sciatic Nerve Pain: The "Double Squeeze" Problem

By Dr. Chris Lakhiani, MD, FACS · April 2026

What Is the Sciatic Nerve?

The sciatic nerve is the longest and thickest nerve in your body. It starts in your lower back, travels through your buttock, down the back of your leg, and all the way to your foot. Think of it like a thick electrical cable that carries signals between your brain and your leg — signals for movement, feeling, and pain.

When something presses on this nerve, you feel it. That pressing is called nerve compression, and it can cause pain, numbness, tingling, or weakness anywhere along the nerve's path — from your lower back all the way down to your toes.

The Double Squeeze Problem

Here is the key idea that many patients — and even some doctors — don't know about: your sciatic nerve can be squeezed in more than one place at the same time.

Doctors call this the "double crush" problem. Research published in 2025 found that people who have a pinched nerve in their lower back are three times more likely to also have a pinched nerve somewhere farther down the same leg.

Where Can the Sciatic Nerve Get Squeezed?

There are several spots along the nerve's path where squeezing commonly happens:

Many patients have two or more of these squeezes happening at the same time — and that is why their pain has been so hard to treat.

Why Does This Happen?

There are several common reasons:

• A bulging or herniated disc in the lower back starts the problem. It partially damages the nerve, making it more sensitive everywhere else along its path.
• Tight or scarred muscles — especially the piriformis muscle deep in the buttock — can grip the nerve. This can happen from a fall, a car accident, too much sitting, or even a hip replacement surgery.
• Anatomy you were born with — about 1 in 10 people have a nerve that passes through a muscle rather than under it, making them naturally more likely to develop buttock compression.
• Scar tissue from prior surgeries can wrap around the nerve and squeeze it at multiple points.
• Diabetes or other health conditions make nerves more fragile and easier to compress, even by structures that normally would not cause a problem.

Why Doesn't One Surgery Fix Everything?

This is the most important question patients ask.

If your nerve is being squeezed in two places, but your surgeon only releases one of them, you will still have pain from the other squeeze. Research clearly shows that treating only one site when two are active gives far worse results than treating both.

What Does the Surgery Involve?

The goal of this surgery is to free the nerve at every place it is being squeezed. The procedure depends on which locations are involved.

Releasing the Buttock (Deep Gluteal Space)

Using a small camera (like the kind used for knee scoping), the surgeon goes into the space behind the hip joint. Tight bands of scar tissue and sometimes the piriformis muscle tendon are cut to give the sciatic nerve room to move freely. Most patients go home the same day or the next morning. Research shows that 70–93% of patients have good or excellent results with this approach.

Releasing the Back of the Knee (Soleal Sling)

A small incision is made along the inside of the upper calf. The tight arch of muscle where the nerve passes through is cut open, relieving the squeeze. The best results are in people whose nerve was compressed after a trauma or injury.

Releasing the Outside of the Knee (Peroneal Nerve)

A small incision is made on the outside of the knee, just below the knee cap. Three tight layers of tissue that press on the nerve are carefully opened. This relieves foot drop and numbness on the top of the foot. Studies show 85% of patients with weakness see improvement after this release.

Releasing the Ankle (Tarsal Tunnel)

An incision is made along the inner ankle. The tight band holding the nerve is cut, and each branch of the nerve at the ankle is individually freed. This relieves burning and numbness in the heel and sole.

What Should You Expect?

Recovery depends on how many areas were treated and how long the nerve was squeezed before surgery.

• Nerves heal slowly — usually 1 millimeter per day. Full recovery takes months, not weeks.
• Pain and tingling are usually the first things to improve — often within weeks.
• Weakness takes longer to recover and may not fully recover if the nerve was compressed for a very long time.
• The sooner surgery happens, the better the results. Nerves that have been squeezed for years may not fully recover even after a perfect release.

Questions to Ask Your Surgeon

• Has each level of my nerve been checked — my back, my buttock, my knee, and my ankle?
• Do I need an MRI of my nerve (called MR neurography) to see the whole nerve pathway?
• Do I need a nerve test (EMG/NCS) to find out exactly where my nerve is being squeezed?
• Are there one or two squeezes, or more? Should they be done together or separately?
• What results have your patients had with this type of surgery?

The Bottom Line

Sciatic nerve pain that has not gotten better with back surgery, injections, or physical therapy may be because the nerve is being squeezed in more than one place — and only one place has been treated. This is more common than most people realize. Modern surgery can safely release the nerve at each problem spot, and when all the squeezes are treated, most patients experience meaningful improvement in pain, feeling, and movement.

This article is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult your physician or other qualified health care provider with any questions about a medical condition. Full disclaimer.