During this acute phase, which sometimes results in brutal butt spasms that come on in the wee hours of the morning, I had an s1 nerve root block and it instantly reduced the pinching/stabbing pain considerably.
I think that gave you your answer. Maybe if this is not being alleviated for any useful period of time a microdiscectomy might be in order. Sounds like something is physically pressing on that nerve and you need it to stop doing so.

That said time is a good healer as many in the non-western world live full normal lives without surgical intervention. There can be some interesting postural changes though