Sciatica

What’s actually going on

“Sciatica” is a description of a symptom — pain along the sciatic nerve — rather than a single diagnosis. The sciatic nerve is the largest nerve in the body; it forms from nerve roots exiting the lower lumbar spine, runs through the buttock (passing near or through the piriformis muscle), and travels down the back of the leg into the foot.

When something along that path irritates the nerve, you feel pain along where the nerve goes — typically a sharp, burning, or electric quality that radiates from the lower back or buttock down the leg. The sensation may include numbness, tingling, or weakness depending on which nerve root is involved.

The two most common drivers we see clinically:

1. Lumbar disc-related sciatica — a disc bulge or herniation in the lower lumbar spine irritates a nerve root as it exits.
2. Piriformis-related sciatica — the piriformis muscle in the deep buttock tightens or develops trigger points and compresses the sciatic nerve as it passes nearby.

These present similarly but respond to slightly different approaches, which is why a careful assessment matters before treatment.

When to see someone

It’s worth coming in for sciatica when:

• Symptoms have been there for more than a few days without improvement
• Pain is interfering with sleep, sitting, driving, or normal activity
• Numbness or tingling is present in the leg or foot
• Symptoms keep recurring after previous episodes resolved

Urgent medical care is warranted if:

• New or worsening weakness in the leg or foot (“foot drop”)
• Numbness in the saddle region (inner thighs, groin, buttocks)
• Loss of bladder or bowel control
• Severe pain after a fall or significant trauma

These signs can indicate cauda equina syndrome or significant nerve root compression and need same-day medical assessment.

How we treat it

Sciatica responds well to conservative care in the majority of cases. Our approach typically includes:

• A thorough assessment to distinguish between disc-related, piriformis-related, and SI-joint-related presentations.
• Chiropractic care — adjustments and mobilizations matched to the specific presentation, often including the lumbar spine, pelvis, and SI joint.
• Soft-tissue work — particularly important when the piriformis or other deep hip muscles are involved. ART is well-suited to this.
• Registered massage therapy — to address the broader muscle guarding that almost always accompanies sciatica.
• Nerve mobilization techniques — gentle, specific movements that help the nerve glide more freely through the surrounding tissue.
• Exercise rehab — graded loading, McKenzie-style directional preference work where appropriate, hip and core strengthening, and a return-to-activity plan.

Most disc-related sciatica improves substantially within four to eight weeks of consistent care. Piriformis-related sciatica often improves faster — sometimes within two to three weeks. We track progress carefully and adjust the plan if expected improvement isn’t happening.

When imaging makes sense

Most uncomplicated sciatica doesn’t need imaging early on — MRI findings of disc changes are common in people without symptoms and don’t reliably predict who will or won’t respond to conservative care. Imaging makes more sense when:

• Symptoms aren’t improving with 4–6 weeks of focused care
• Significant or worsening neurological signs are present
• Surgery is being considered

If imaging is appropriate, we’ll coordinate with your family doctor or refer directly through the appropriate pathway.