Acupuncture for Sciatica in San Francisco
Pain shooting from your low back or glute down the leg? We treat sciatica and piriformis syndrome with acupuncture, dry needling, cupping and hands-on work, so you can sit, sleep and train without it running your day.
Sound familiar?
- Pain running from your low back or buttock down the back of one leg
- A sharp, burning or electric feeling, sometimes reaching the foot
- Tingling, numbness or pins and needles in the leg
What our patients say
5.0 on Google from 92 reviews
I could not recommend Andrew enough! He has so much knowledge on the human body and can figure out quickly what areas need work. I went in with major back pain that kept me from lifting weights or running, and after a few sessions I am pain free.
Gosh, I'm so happy I found Andrew! Thanks to him, I avoided going down a surgery route for my injury! In June 2022, my left knee started acting up (my best guess is overcompensation for gluteal tendonitis I was treating) but I pushed through to backpack 264 miles on the John Muir Trail. When I finished my trek, my left knee was pretty unhappy and I couldn't even get in and out of my car without feeling like a jigsaw puzzle. I tirelessly saw dozens of providers over the next year - chiropractors, physical therapists, orthopedists, massage therapists, etc. All had their own theories - soleus muscle, calf strain, chronic exertional compartment syndrome, etc. The complexity in my case was that my pain was not in my knee itself - it was on the left side in between my knee cap and calf. Despite my knee MRI showing meniscus tears, inflammation, tendonosis, etc. the doctors insisted we treat the symptoms, not the MRIs. So, I got a calf MRI, hip MRI, and an EMG, all of which were negative. Then, one doctor recommended oral Prednisone, and he told me I should see results better than Advil for pain management. It did nothing. It wasn't until I was finally referred to one doctor who noticed something in my knee MRI and caught that there is excess fluid in my proximal tibiofibular joint (PBTJ), and that area tracks with where I feel my pain. To test his suspicion diagnostically, he recommended an ultrasound-guided cortisone injection in my PBTJ to see if that reduced my pain. The pain did decrease (which was good), but it wasn't gone. The doctors informed me issues concerning the PBTJ are rare, and that they needed to refer me to one of the only specialists in the country for this. That specialist happened to be in Minnesota, and when I checked his website, he was only seeing patients for surgery. I did not want surgery. I felt completely defeated, unsure where to go next. In May, I was recommended by someone who also had a challenging journey with injuries (and was able to return to running and hiking) to try acupuncture. I was surprised, since I had not considered Eastern Medicine before for a sports injury. The person specifically recommended I search for an acupuncturist who specializes in athletes, and that led me to find "Acupuncture for Athletics." :) My first appointment with Andrew was May 30, and he patiently listened to my whole ordeal and reviewed all of the documentation I brought (MRIs, doctor's notes, etc). He assured me he treats the root cause, which I appreciated because I did not want to do a band-aid fix only for this to return again, and that he has hope I can feel better. We started off with cupping along my left leg to encourage the inflammation to dissipate, and then we did needles in my leg. Oof, I remember one session when Andrew placed a needle near my PBTJ - I screamed SO loudly lol. But once all of the needles were in, it slowly felt like a meditative experience, and I was able to relax into it. Over my 7 sessions with Andrew, I began to notice the needles felt less painful. In the beginning, I remember feeling the pain just in walking over to Andrew's office. By the 6th session, I realized I wasn't thinking about my pain anymore. I did one more session to be sure, and I was in disbelief that I actually felt pain-free! We decided to go a month testing how the pain fared without regular sessions, and so far so good! The pain flares here and there, but in a MUCH less capacity than before. Throughout this whole process, Andrew was kind, patient, and determined. He was committed to solving the underlying issue, and he was flexible and accommodating to me - whether I wanted to address my left knee or start tackling similar pain that was creeping up on my right knee. Had it not been for Andrew, I would have likely chased surgery because I was running out of ideas. I appreciate you, Andrew! If you're nearing your wits' end with a chronic injury, please go see Andrew and give it a good ~5 sessions if you can. Wishing everyone out there good luck on their chronic pain journeys! You got this!
Andrew is fantastic! He is knowledgeable and provides specialized treatment for my chronic nerve pain. I highly recommend him.
Andrew treated me over a period of about two years for hip and shoulder problems, and he was tremendously helpful. I was impressed with his knowledge and skill, not to mention wonderful “bedside manner” and especially his enthusiasm for staying current in his field.
I loved coming to Andrew. He was a lifesaver in helping me through some back issues when I was pregnant with my first child. A lovely, warm place and Andrew is amazing!!!!
I’ve always wanted to be able to demonstrate clearly to professional dancers when giving them corrections or setting ballets. However, without the level of daily physical preparation that my body was used to when I danced, my body now has moments of rebellion that, however careful I am, need the assistance of experts to ensure I can do my job fully. Andrew’s combination of acupuncture and soft tissue work always made a significant difference to my mobility, helping me undertake my role in the studio at a level of physicality such that I’m not confined to the minimum level of demonstration. With his level of experience with dancers it was always easy to discuss problematic muscles and joints, and reassuring that he ‘got’ what was going on and what was required to improve the situation efficiently and effectively.
In our career it is very important to stay physically healthy, because our dance career is very short. We rehearse, work out every single day, and very often, because of the physical pressure from practicing so hard, we get injuries and surgery. My story is about my back, foot and wrist. I joined San Francisco Ballet a year ago. The first day of work, during ballet class, I hurt my back. I have had problems before with my wrist, and sadly, later on with the tough season, my foot got hurt. Luckily, I was recommended to Andrew Castellanos. I started with a few visits a month, and quickly saw results, so I made sure I finished my treatments. Thanks to Andrew, I was able to finish my successful season here. Now I have to spread the word…
As an avid runner who is always training for an endurance race my body has a tendency to break down. Andrew is a legit magician. He’s able to get to the root off the problem quickly and I often don’t miss a beat with regards to my training. Marathon prep would not be possible otherwise.
I had a golfers elbow and my coach referred me to Andrew. He has been an amazing acupuncturist and worked on my right elbow, shoulder and arm for a couple of weeks. I have felt so much better just after the first session and going back really helps the blood flow so much better and my right arm, elbow and shoulder feels less tense and more relaxed. Definitely recommend this place, especially for athletes!
Andrew is the best. I’m a professional ballerina and his treatments helped me come back from a broken foot. When you see Andrew - you’re comforted by his knowledge, expertise, & strategy based treatment. Plus the clinic is so relaxing and warm. I have complete trust that he will help my aches and pains and keep me dancing for a long time.
There’s no one I trust more than Andrew to support my kids in their healing process if they’ve had a sports-related injury. As elite athletes, it’s so important that their knees, ankles and shoulders are well taken care of, and Andrew is our go-to for treatment of pain or injury and also guidance for best practices outside the treatment room to further help healing along. My daughter recently rolled her ankle and was ready for a painfully prolonged healing process when we took her into to see Andrew for a couple treatments before a tournament weekend. With his help, her recovery was amazing, allowing her to feel confident on her ankle. Thanks to Andrew, she was healthy enough to play without pain or exacerbating the injury. We are very grateful to have Andrew on speed dial when these types of injuries occur!
Andrew is a cornerstone of my care team. He successfully unwinds my ills before they can become chronic problems.
Does this sound like you?
Sciatica is pain that follows the sciatic nerve, from the low back through the buttock and down the back of the leg. These are the classic signs.
If several sound familiar, an assessment will tell us where the nerve is being irritated and what's driving it.
- Pain running from your low back or buttock down the back of one leg
- A sharp, burning or electric feeling, sometimes reaching the foot
- Tingling, numbness or pins and needles in the leg
- Pain that's worse when you sit, cough or sneeze
- A deep ache in the glute that flares when you run or climb stairs
- A leg that feels heavy or weaker than the other
What sciatica actually is
Sciatica isn't a diagnosis on its own. It describes what you feel when the sciatic nerve, the largest nerve in the body, is compressed or irritated somewhere along its path. That path starts in the low back, runs through the buttock and travels down the back of the leg, which is why the pain shows up as a line rather than a single spot.
The most common cause is a disc in the low back that bulges or herniates and presses on a nerve root. In older adults, narrowing of the spinal canal (spinal stenosis) is another frequent cause. Sometimes the trouble sits lower down, where a tight, irritated piriformis muscle deep in the buttock crowds the nerve.
Sciatica usually gets better within a few weeks to a few months, according to the NHS, but it can linger or come back. The pain you feel in your calf is usually driven by something in the back or hip, so that's where the real work happens.
Common causes
- A bulging or herniated disc in the low back
- Spinal stenosis, a narrowing of the spinal canal
- A tight, irritated piriformis muscle
- A slipped vertebra (spondylolisthesis)
- Long hours of sitting, a heavy lift or a hard training block
- Pregnancy, as posture and load shift
Sciatica or piriformis syndrome?
Both irritate the same nerve, but they start in different places, and that changes how we treat them. Telling them apart is one of the first things we do at your assessment.
| Compared on | Disc-related sciatica | Piriformis syndrome |
|---|---|---|
| Where it starts | A nerve root in the low back, usually from a disc or a narrowing in the spine | The piriformis muscle deep in the buttock, pressing on the nerve |
| Where you feel it | Low back and buttock, often running below the knee into the calf or foot | Mostly the buttock, hip and back of the thigh |
| What makes it worse | Sitting, bending forward, coughing or sneezing | Sitting, running, climbing stairs |
| Who we often see it in | Lifters, desk workers and people with a past disc injury | Runners, cyclists and anyone who sits for long hours |
| Where we focus | The low back, the muscle guarding around the spine and the nerve's path | The piriformis and deep hip rotators, then the nerve's path down the leg |
Why the difference matters
Piriformis syndrome is less common than many people think. Cleveland Clinic puts it at roughly 0.3% to 6% of low back pain cases. The two can also overlap: a disc problem and a tight glute often travel together, which is why we assess both rather than assuming.
Who gets sciatica
It isn't only a desk-worker problem or an athlete problem. In a typical week we treat it in all kinds of people.
People we see most
Related problems we treat
- Low back and long-term pain
- Running injuries
- Heel and arch pain
- Numbness and tingling in the feet (neuropathy)
- Hip and glute tightness
- Hamstring pain that won't settle
How we treat sciatica
We work on both halves of the problem: calming the irritated nerve and releasing the muscles crowding it. Most visits combine several of these.
- Sports acupuncturePoints along the low back, hip and leg to calm nerve pain and ease muscle guarding.
- Dry needlingStraight into a locked-up piriformis, glute or low back muscle to help it let go.
- CuppingTo loosen tight tissue across the low back and hips.
- Cold laserLow-level laser over irritated soft tissue, used alongside needling.
- Sports massageHands-on work for glutes, hips and hamstrings that are guarding.
Who performs dry needling in California?
In California, dry needling is performed by licensed acupuncturists. Physical therapists in California are not currently authorized to perform dry needling. All three of our practitioners are California-licensed acupuncturists.
What the research says
The evidence on acupuncture for sciatica has grown in the last few years. A 2024 trial in JAMA Internal Medicine randomly assigned 220 people with long-standing sciatica from a herniated disc to ten sessions of real or sham acupuncture over four weeks. The real acupuncture group reported about twice the drop in leg pain and better day-to-day function, and the difference was still there a year later.
Earlier research points the same way. A 2015 review of 12 trials with 1,842 people found acupuncture eased sciatic pain more than conventional medication, and a 2025 overview of seven systematic reviews called it promising and generally safe.
The National Center for Complementary and Integrative Health notes that acupuncture may help ease sciatica pain. For chronic low back pain, the American College of Physicians lists acupuncture among its first-line non-drug options.
We add dry needling, cupping and cold laser for the muscle tension and guarding that come with nerve pain, and we'll be straight with you about what's working. Curious about the mechanics? Read how acupuncture works.
What studies have found
- Lasting relief from leg pain in a large 2024 trial of disc-related sciatica
- More pain relief than conventional medication in a 2015 review
- It works best alongside movement and home care
- It doesn't replace medical care when red flags are present
Your first visit and your plan
Plan on about an hour for your first visit. How many sessions you'll need varies, and we'll give you an honest estimate after your assessment.
Assess
We take your history, watch how you move and check where the pain travels. Then we examine the low back, glutes and hip rotators to see whether the pattern looks disc-driven, piriformis-driven or both.
Treat
You'll usually lie face down while we needle points along the back, hip and leg. Some people feel the leg pain ease or shorten during the session itself.
Afterwards
Some people feel lighter right away. Others feel a little worked over for a day, like after a deep massage. Gentle walking helps more than lying still.
Build it back
We give you two or three simple things to do at home, then space visits out as the leg settles, so it holds when you return to sitting and training.
When to go to the ER instead
Most sciatica is painful but not dangerous. A small number of cases involve severe pressure on the bundle of nerves at the base of the spine, called cauda equina syndrome. It needs emergency treatment to protect bladder, bowel and leg function.
If you have any of the symptoms listed here, go to the emergency room or call 911 now. Please don't wait for an appointment with us.
For other worrying signs, such as sciatica after a fall or accident, a fever, unexplained weight loss or a history of cancer, see your doctor before starting treatment. We're glad to work alongside your physician once you're cleared.
Go to the ER if you have
- Numbness in the groin, buttocks or inner thighs (saddle numbness)
- New trouble urinating, or loss of bladder control
- Loss of bowel control
- Leg weakness or numbness that keeps getting worse
- Sciatica in both legs at once
Who'll treat you
Three California-licensed acupuncturists, all trained in Traditional Chinese Medicine, see sciatica and hip pain here every week. Andrew Castellanos brings more than 25 years with athletes, from USF Athletics to MLB spring training. Your first visit may include a check of your pulse and tongue, as Chinese medicine does.
Andrew Castellanos
L.Ac, CST · Clinic owner
Sciatica, piriformis syndrome and disc issues in active people.
- Sciatica, back pain and disc issues are core to his work
- Dry needling for a tight piriformis and glutes
- Neuromuscular re-education to restore movement
Ali Hakimi
L.Ac
Nerve pain care with targeted acupuncture and moxibustion.
- Neuropathy and nerve pain are a main focus
- Scalp acupuncture for stress and poor sleep
Suzanne Lange
DACM, L.Ac, CMT
Orthopedic acupuncture plus trigger point work for the glute and low back.
- Advanced study in orthopedics and sports medicine
- Advanced training in pregnancy and postpartum care
Pricing and booking
Sciatica treatment happens within a standard session, using whatever mix of acupuncture, dry needling, cupping, cold laser and massage your case calls for. There's no separate sciatica package to buy.
We don't bill insurance, but we provide a superbill you can submit for possible out-of-network reimbursement. We accept HSA and FSA cards and all credit cards. You'll find us on Webster Street, a short walk for anyone looking for acupuncture in Cow Hollow or the Marina.
Appointments
- 60-min initial acupuncture & assessment
- $225
- 45-min acupuncture follow-up
- $195
- 60-min acupuncture/massage combo
- $225
- 75-min acupuncture/massage combo
- $265
- 90-min acupuncture/massage combo
- $300
Sciatica FAQ
Can acupuncture help sciatica?
Often, yes. A 2024 randomized trial found that real acupuncture reduced leg pain and improved function more than sham acupuncture in people with chronic sciatica from a herniated disc, and the benefit lasted a year. Results vary from person to person, and it works best alongside movement and home care. We'll estimate how many sessions you'll need after your assessment.
What's the difference between sciatica and piriformis syndrome?
Sciatica usually starts in the low back, where a disc or a narrowing of the spine irritates a nerve root, and the pain often travels below the knee. Piriformis syndrome starts in the buttock, where a tight piriformis muscle presses on the nerve, and the pain tends to stay in the buttock, hip and back of the thigh. They can overlap, so we assess both.
How many sessions will I need?
It varies with how long you've had it and what's driving it. A recent flare often settles faster than sciatica you've carried for months, which usually starts with visits closer together and spaces out as the leg improves. We'll give you an estimate after your first assessment rather than selling a package.
Does it hurt?
Acupuncture needles are very thin and most people find the treatment relaxing. If we use dry needling in a tight glute or piriformis, you may feel a deep ache or a brief muscle twitch that passes within seconds, followed by a sense of release. Mild soreness for a day or two is possible.
Can you help if I have a herniated disc?
Acupuncture can help manage the pain and muscle guarding that come with a disc problem, and the strongest recent sciatica trial was in people with herniated discs. If your case needs imaging or a specialist, we'll tell you and help you coordinate care rather than keep you in treatment that isn't working.
Should I rest or keep moving?
For most sciatica, staying gently active helps more than bed rest. The NHS advises carrying on with normal activities where you can and avoiding long spells of sitting or lying down. We'll show you which movements to keep and which to ease off for now.
Can I keep training?
Usually, with changes. Many people keep walking, cycling or easy running while we treat it, and pause heavy lifting or anything that sends pain down the leg. We'll help you decide what to cut back and what's fine to keep.
Can you treat sciatica during pregnancy?
Sciatic pain is common in pregnancy as posture and load change. Acupuncture can be an option when it's performed by a licensed acupuncturist who adjusts positioning and point selection. Please tell us you're pregnant when you book so we can plan your visit, and check with your prenatal provider first.
Do I need a referral or an MRI?
No referral is needed to book with us, and most people don't need an MRI to start treatment. If your symptoms suggest something more serious, or you aren't improving as expected, we'll refer you to a physician for further assessment.
Where can I get acupuncture for sciatica in San Francisco?
Andrew Castellanos treats sciatica and piriformis syndrome at 2920 Webster Street in Cow Hollow, one block north of Union Street. He combines acupuncture, dry needling, cupping and hands-on work to ease pain that runs from the low back or glute down the leg.
Do patients come from outside Cow Hollow?
Yes. Patients come from Pacific Heights, Presidio Heights, Russian Hill, the Mission, SoMa and the Richmond District, and from across the Bay in Marin, Oakland and Berkeley. Most live, work or train within a mile or two of the clinic. If sitting in a car is hard right now, the 45 Union/Stockton stops one block away.
References
- Tu JF, et al. Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk: A Randomized Clinical Trial. JAMA Internal Medicine. 2024.
- Ji M, et al. The Efficacy of Acupuncture for the Treatment of Sciatica: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine. 2015.
- Zhang J, et al. Acupuncture Therapy for Sciatica: An Overview of Systematic Reviews and Meta-Analysis. Journal of Pain Research. 2025.
- National Center for Complementary and Integrative Health. Acupuncture: Effectiveness and Safety.
- Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2017.
- NHS. Sciatica.
- Cleveland Clinic. Piriformis Syndrome: Symptoms, Causes and Treatment.
Ready to get your stride back?
Book an assessment at our Cow Hollow clinic, or call us to talk it through first.
Visit us in Cow Hollow
2920 Webster Street, between Union and Filbert. A short walk from the Marina, Pacific Heights and the Presidio.
Address
Acupuncture for Athletics2920 Webster Street
San Francisco, CA 94123 Gate code: in your booking confirmation email
Hours
- Every day
- 7:30am – 9:00pm