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Sciatica

Sciatica

Sciatica describes pain that radiates from the lower back through the buttock and down the leg. It is a symptom with several possible causes, and the right approach depends on identifying the source.

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Understanding sciatica

The sciatic nerve is the longest nerve in the body, running from the lower lumbar spine through the buttock and down each leg. When this nerve is compressed or irritated, it can produce pain, tingling, numbness, or weakness along its path. Sciatica is a symptom rather than a diagnosis, which is why identifying the underlying cause is essential. The most common causes are disc herniation, spinal stenosis, and piriformis syndrome, but other conditions can mimic these symptoms.

Common causes

  • Lumbar disc herniation pressing on the sciatic nerve root
  • Spinal stenosis narrowing the space around the nerve
  • Piriformis syndrome where the piriformis muscle irritates the nerve
  • Degenerative disc disease reducing disc height and foraminal space
  • Sacroiliac joint dysfunction referring pain into the buttock and leg
  • Spondylolisthesis where one vertebra slips forward on another
  • Prolonged sitting or repetitive bending and lifting

What to expect during assessment

Assessment involves a thorough history and physical examination. Your practitioner tests range of motion, performs specific nerve tension tests like the straight leg raise, checks reflexes, muscle strength, and sensation in the affected leg. These findings help determine the level and cause of nerve involvement. If imaging is needed to confirm a disc herniation or rule out other causes, you will be referred for MRI. The results guide whether conservative care is appropriate or further medical consultation is needed.

How the clinic can help

Treatment is guided by assessment findings. Chiropractic adjustments and spinal mobilization can address joint restrictions contributing to nerve irritation. Massage therapy helps release muscle tension in the lower back, gluteal region, and piriformis. Acupuncture may be used for pain management alongside manual therapy. Shockwave therapy can be considered for chronic soft-tissue contributions. Your practitioner also prescribes specific rehabilitation exercises to strengthen core and gluteal muscles and reduce the likelihood of recurrence.

Self-care and what you can do at home

Gentle walking is generally encouraged because prolonged bed rest can worsen symptoms. Avoid sitting for long periods, especially on soft surfaces. Lying on your back with your knees bent or on your side with a pillow between your knees can relieve pressure on the nerve. Gentle stretching of the hamstrings and piriformis may help, but avoid stretches that increase leg symptoms. If pain is worsening, or if you develop weakness or changes in bladder or bowel function, seek assessment promptly.

When to seek urgent care

Seek urgent or emergency medical care for progressive weakness in the legs, loss of bladder or bowel control, saddle-area numbness, severe unexplained fever with back pain, or symptoms after significant trauma. These may indicate cauda equina syndrome or another condition requiring immediate medical intervention.

Follow-along videos that may support care between visits. Your practitioner should confirm which ones fit your assessment.

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Common questions about sciatica

What is sciatica?
Sciatica refers to pain that radiates along the sciatic nerve, typically from the lower back through the buttock and down one leg. It is a symptom rather than a diagnosis. Common causes include disc herniation, spinal stenosis, and piriformis syndrome. A clinical assessment identifies the specific origin so treatment can be directed appropriately.
Can a chiropractor treat sciatica?
Chiropractors assess the spine and pelvis to identify mechanical factors contributing to sciatic nerve irritation. When a musculoskeletal cause is identified, spinal adjustments, mobilization, and rehabilitation exercises may be appropriate. Severe cases involving progressive neurological changes may need medical referral.
How long does sciatica last?
Many episodes improve within several weeks to a few months with appropriate conservative care. The timeline depends on the underlying cause, severity, and how consistently the treatment plan is followed. Progressive weakness, loss of bladder or bowel control, or saddle numbness require urgent medical attention regardless of duration.
Is walking good for sciatica?
Gentle walking is generally encouraged because it maintains mobility and blood flow without placing excessive load on the spine. Prolonged bed rest tends to worsen sciatica. The appropriate level of activity depends on your specific situation, which your practitioner can advise on after assessment.
What is the best sleeping position for sciatica?
Sleeping on your side with a pillow between your knees, or on your back with a pillow under your knees, can reduce strain on the lumbar spine and sciatic nerve. Avoid sleeping on your stomach. A supportive mattress that maintains spinal alignment also makes a difference.
What is the difference between sciatica and piriformis syndrome?
True sciatica is caused by compression of the sciatic nerve at the spinal level, usually from a disc herniation. Piriformis syndrome occurs when the piriformis muscle in the buttock compresses the nerve as it passes underneath. Symptoms can be similar, but the treatment approach differs, which is why assessment is important.