Sciatica is one of the most misunderstood diagnoses we see. Patients come in saying “I have sciatica” the way they might say “I have a headache” — but sciatica is not actually a condition. It is a symptom, and figuring out what is causing it is the difference between three weeks of relief and three years of recurring pain.
What sciatica actually is
The sciatic nerve is the largest nerve in your body. It starts in the lower back, branches through the buttock, and runs down each leg to the foot. When something irritates or compresses one of the nerve roots that form the sciatic nerve, you get the classic symptoms: sharp pain, burning, tingling, numbness, or weakness along the path of the nerve. The pain can stop at the buttock, run to the knee, or go all the way to the foot.
The four most common causes
- Disc herniation in the lower back pressing on a nerve root
- Spinal stenosis, a narrowing of the canal where the nerve travels
- Piriformis syndrome, where a deep hip muscle compresses the nerve
- Facet joint dysfunction, where joints in the lumbar spine become inflamed and irritate nearby nerve roots
Each of these has a different treatment path. This is why a careful examination matters more than a quick adjustment.
Why it keeps coming back
Most patients who tell us their sciatica “keeps coming back” have never actually addressed the underlying cause. Anti-inflammatories and muscle relaxers reduce the inflammation around the irritated nerve, which makes the symptoms quiet down. But the disc bulge, the tight piriformis, or the inflamed joint is still there. The next time you sit too long, lift something wrong, or sleep at a bad angle, the symptoms return.
What lasting relief actually looks like
Real recovery from sciatica involves three parts. First, reducing the immediate inflammation and getting the nerve out of distress. Second, restoring normal motion to the joints and tissues that are contributing to the problem. Third, building the postural and core strength that keeps the spine in good position day to day.
In our office we typically use a combination of specific adjustments, soft tissue therapy, structural correction work, and targeted home exercises. For severe cases where a disc is involved, we add spinal decompression to give the disc space to retract.
When sciatica needs more than chiropractic
If you have progressive weakness in your leg, loss of bowel or bladder control, or numbness in the saddle area between your legs, that is a medical emergency called cauda equina syndrome. Go to the emergency room immediately. For everything else, conservative care should be your first step — surgery is reserved for cases that do not respond to several weeks of skilled non-surgical treatment.
What to do next
If you have sciatica that is not improving, has been coming and going for months, or that wakes you up at night, schedule an evaluation. We will examine you carefully, identify which of the common causes is driving your symptoms, and give you a clear treatment plan. Call (209) 477-7777 or visit our sciatica treatment page for more information.