What is Sciatica?
Sciatica is a medical condition in which the nerve root in the lower back is being irritated or inflamed, resulting in pain that extends down one or both leg.  The pain typically worsens after periods of sitting or standing and sometimes when trying to sleep.

The medical term for sciatica is lumbar radiculopathy. Sciatica may also be referred to as a pinched nerve or compressed nerve pain. 
 

How Do I Know if I Have Sciatica?

Although sciatic pain likely occurs in the buttocks, leg, and/or foot, it usually originates in the low back.  It typically involves the discs between the vertebra (spinal bones), but can result from a spasm of the Piriformis muscle in the buttocks, which stretches over the sciatic nerve. 

Typical symptoms of sciatica include the following:

• Pain in the leg or buttocks that increases when sitting

• Burning or tingling sensation running down the leg

• Numbness, perceived weakness, or difficulty moving the leg or foot

• Pins-and-needles feeling in the foot or toes

• Constant pain on one side of the buttocks

• Sharp or shooting pain (sometimes feeling like an electric shock) when attempting to stand after sitting, or coughing, sneezing, etc.
   

 Sciatic symptoms present differently for each person.  Some may be in constant pain, while others may only feel pain occasionally.  Some will experience a dull ache, while others will suffer from intense pain shooting down the leg into the foot and toes.  Most feel pain in only one leg, but others experience it in both, or have it switch from side to side.

Some individuals may also have a loss of bladder or bowel control.  This is a sign of cauda equine syndrome, a rare but serious condition that requires emergency care.   If you experience either of these symptoms, seek medical help immediately.

Many people hope that sciatica will just go away, but that rarely happens.  Typically, sciatica becomes progressively worse over time, and may result in serious complications if untreated, including:

• Loss of feeling in the affected leg

• Wasting of muscles, resulting in a weakness in the affected leg

• Paralysis of the affected limbs

• Loss of bowel or bladder function

• Painful distraction during the activities of daily living.

• Insomnia / trouble sleeping

• Lifelong damage to the lower body reflexes

• Permanent nerve damage
   

How Did I Get Sciatica?

Sciatica may be caused by trauma, but it can also be caused by a cumulative effect of years of subtle damage.

A traumatic event, such as an automobile accident, sports injury, or fall may cause a disc (the cushions between your vertebrae) to move out of place (bulge or herniate), placing pressure on the sciatic nerve.

Years of more subtle stresses, can accumulate so that a simple event, such as bending over to pick something up or twisting when you got out of bed in the morning could trigger sciatic pain.  These stresses include:

• Poor posture

• Poor lifting habits

• Lack of exercise (causing poor muscle tone)

• Excess weight

• Frequent constipation

• Wearing high heels

• Sleeping on a mattress that is too soft
   

There are also a number of illnesses and conditions that can result in sciatic pain, including:

• Spinal degeneration (decay) caused by aging or neglected spinal problems

• Subluxation (misalignment) and irritation of the 4^th or 5^th lumbar vertebra

• Arthritis (which may cause bone spurs that protrude into disc space)

• Spinal Stenosis (narrowing of the spinal canal in the lower back)

• Piriformis syndrome (a tight muscle in the buttocks that irritates the sciatic nerve

• Degenerative disc disease

• Pregnancy

• Spinal tumors
   

Why is Sciatica So Painful?

The sciatic nerve is powerful, partially because it is the largest and longest nerve in the body.  It originates in the lower spine and exits the spine on the right and the left as five separate nerves, each named for the vertebrae above it (L4 and L5 for the lumbar vertebra and S1, S2, and S3 for the sacral vertebra).

These five nerves group together on the front surface of the piriformis muscle (the buttocks)   traveling down the back of each leg and down into the foot and each toe.  When the sciatic nerve is irritated, its reach is long and intense.
 

What Can Cause Sciatic Pain to Get Worse?

Any activities that affect the muscles around the sciatic nerve can cause an increase in pain.  These include, but are not limited to:

• Sitting for prolonged periods of time

• Working out.

• Sports that include bending or twisting (tennis, golf, soccer, cross fit, etc.)

• Housework that involves bending or twisting. (vacuuming, mopping, doing dishes)

• Twisting to get out of your car

• Sitting back or laying down in a recliner

• Lifting things

• Carrying children on your hip

• Working above your head.
   

What if My Sciatica Goes Untreated? 

Untreated, sciatica can lead to lifelong damage of the reflexes or even causing a wasting of muscles.
 

How Do Doctors Diagnose Sciatica?

Since there are many disorders that cause sciatica, a careful medical history, and a physical examination, including specific orthopedic and neurological tests, are needed to help determine the cause of the pain.

After completing these tests, a doctor will determine if additional diagnostic testing is necessary.  This may include x-ray, an MRI or a CT scan.

What is the Medical Treatment for Sciatica
The typical MD approach is to manage the symptoms of sciatica by utilizing drugs or injections. These reduce or eliminate the pain while they are being used, but usually don’t eliminate the cause of the pain. Therefore, the pain returns over and over again.  Medical doctors may also recommend physical therapy, but if the cause is not addressed, the condition will return.

Surgery often involves removing disc tissue or bone to make more room for the nerve or cutting a new channel for the nerve to go through the muscle.
 

What is the Most Effective Treatment for Sciatica?

Studies have found that chiropractic care is the most effective treatment for most sciatic conditions.  

A 2010 Canadian clinical trial compared the results achieved with spinal manipulation with those realized with surgery in patients suffering from sciatica caused by a disc herniation.  The findings suggest that for more than half of people suffering from sciatica caused by a herniated disc, non-surgical spinal manipulation was equally effective as surgery.  Those patients who do not respond to non-invasive, less expensive chiropractic care can then choose to try a surgical remedy.  The researchers concluded that “the obvious risk and cost profile of operative care argues for serious physician and patient consideration of spinal manipulative therapy before surgical intervention.”

A 2005 double-blind randomized trial concluded that "patients receiving active manipulations enjoyed significantly greater relief of local and radiating low back pain, fewer days with moderate-to-severe pain, and consumed fewer drugs for the control of pain.”

British researchers who followed patients with a variety of back related problems for over three years found that those who received chiropractic care experienced better results and missed less time from work than those patients who received traditional medical treatments.

Healthline.com reports that a review of multiple studies does seem to suggest that chiropractic care provides relief various types of back pain, including sciatica 

The chiropractic approach to sciatica is to find the source of the pain and correct the problem.  Then the body can heal naturally without drugs or surgery. Sciatica can often be eliminated with the restoration of normal spinal function through chiropractic care

A 2010 Canadian clinical trial compared the results achieved with spinal manipulation with those realized with surgery in patients suffering from sciatica caused by a disc herniation.  The findings suggest that for more than half of people suffering from sciatica caused by a herniated disc, non-surgical spinal manipulation was equally effective as surgery.  Those patients who do not respond to non-invasive, less expensive chiropractic care can then choose to try a surgical remedy.  The researchers concluded that “the obvious risk and cost profile of operative care argues for serious physician and patient consideration of spinal manipulative therapy before surgical intervention.”

How Can Chiropractic Care Help Relieve My Sciatic Pain?

Chiropractic care works to remove the pressure on the sciatic nerve.  Your treatment will vary according to the specific source of your sciatic pain and the severity of your condition. With most patients, chiropractic adjustments and muscle stretching will improve the range or motion and function of the spine and will remove the pressure on the sciatic nerve.

As you receive a series of adjustments, over time the vertebra should remain in their proper position and no longer impinge on the nerve. Most patients find relief in just 3 to 12 weeks.

1.   Vlater Santilli, Ettore Beghi, Stefano Finuccit, "Chiropractic Manipulation in the Treatment of A Back Pain and Sciatica with Disc Protrusion; a Randomized Double-Blind Clinical Trial of Active and Simulated Spinal Manipulations.", Spine Journal, Mar-apr 2006;6(2):131-7.doi: 10.1016/j.spinee.2005.08.001. Epub 2006 Feb 3. 

 2. Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment, T.W. Meade, Sandra Dyer, Wendy Browne, Joy Townsend, A.O. Frank, British Medical Journal, Volume 300, June 2, 1990, Pages 1431-1437.

3.  McMorland, Gordon, Esther Suter, Steve Casha, Stephan J. Du Plesis, and R. John Huribert, “Manipulation of Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study.” Journal of Manipulative and Physiological Therapeutics 33.8 (2010): 576-84. Web.


Dr. Hunter Greenwood DC ND is a chiropractor and naturopathic physician with over 37 years of experience treating patients with sciatica.  He practices at. Chiropractor Plus in Nixa, Missouri.

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The contents of this website are based upon the opinions of Dr. Hunter Greenwood DC ND. The information on this site is not intended as medical advice. Dr. Greenwood recommends that patients make their health care decisions carefully after doing their own research and consulting with a licensed health care professional.