What you need to know about sciatica

Sciatica is one of the most misunderstood — and most painful — conditions we treat. This post walks you through what sciatica actually is, the symptoms that tell us it’s the real thing (versus another nerve problem), the most common causes, and how we approach treatment to get you out of pain and keep you there.

What the sciatic nerve actually is

You have five nerves in your low back. They clump together to form the lumbar plexus, and those nerves merge into the sciatic nerve. The sciatic nerve is the thickest nerve in your body — about as thick as your thumb.

“Sciatic” is the nerve. The “-a” on the end (sciatica) means the nerve is inflamed.

What true sciatica feels like

If it’s true sciatica, the pain follows a very specific path: out of the pelvis, through the middle of your glute, down the back of your hamstring, and all the way into your heel, foot, and toes. That path is called a dermatome — the area of skin a single nerve supplies.

It’s intense, and it can be stubborn to treat.

Here’s an important distinction: if your pain crosses into the front of your leg, crosses the knee, or stops at the ankle, that’s not sciatica. That’s nerve root impingement higher up in the lower back, and it gets treated differently.

Symptoms to watch for

• Sharp or burning pain radiating down the back of the glute, leg, and foot
• Pain that follows the same path every time (the sciatic dermatome)
• Low back pain or pelvic dysfunction alongside the leg pain
• Numbness, tingling, or weakness along the same path

What causes sciatica

Piriformis syndrome and muscle adhesion

The piriformis is a small muscle on the side of the hip that helps rotate your leg in and out. It’s commonly involved in sciatic pain — but six other muscles in that area can create the same problem.

Here’s how it happens. If you sit at a desk all day, your core stops engaging and your glutes get weak. Then you go play racquetball or pickleball and suddenly demand a lot of side-to-side movement from muscles that aren’t ready for it. The piriformis (and its neighbors) get tight and overworked.

Nerves pass through channels between, above, and below those muscles. When muscles break down from overuse, they fill with something called adhesion — essentially glue inside the muscle. Normally the sciatic nerve should floss smoothly through the surrounding tissue when you bend or lift your leg. With adhesion, the nerve sticks to the structures it’s supposed to glide through. You bend over to put your socks on, the nerve tugs against the adhesion, and you get a flare of sciatic pain down the dermatome.

Disc degeneration and nerve impingement

Sciatica can also come from degeneration in the spine itself. You have five bones in your lower back, with shock-absorbing discs between them. Years of poor alignment — usually from sitting — break those discs down and shrink the space the nerves travel through.

The L5/S1 disc is the last disc in your spine, and it’s the most common culprit. If that nerve gets compressed by a disc bulge, or if the nerve canal narrows (occlusion), you get classic sciatic pain referring from the low back down into the foot.

How we diagnose it

To confirm sciatica, we do a detailed history, a spinal exam, an orthopedic exam, and a neurological exam. When there’s referral pain into the leg, we also take X-rays so we can see exactly what’s happening structurally.

On the physical exam, we usually find weak core muscles paired with overworked, over-tight low back and glute muscles — the exact recipe for the adhesion pattern described above.

Dealing with shooting pain down your leg? Don’t guess at what’s causing it. Come in for a $49 new patient exam and X-rays at Advanced Health and we’ll tell you exactly what we’re working with and whether chiropractic care is the right fit. Book online at /schedule or call (312) 987-4878.

How we treat sciatica

Treatment has three layers, and they work together:

1. Restore motion and alignment

We use adjustments to get the joints in the low back and pelvis moving again, and we work on restoring your lumbar lordosis — the natural inward curve of your lower back — using traction. This is where our Chiropractic BioPhysics approach really shines, because we’re not just chasing symptoms, we’re changing the underlying structure.

If disc involvement is significant, spinal decompression can take pressure off the nerve directly.

2. Break down the adhesion

We use pressure point therapy, stretching, and mobility work to break up the glue in the muscles that are crowding the nerve. Once the nerve can floss freely again, a lot of the referred pain calms down.

3. Rebuild the muscles that failed you

Physical therapy is non-negotiable here. We have to retrain the core, the glutes, and the hamstrings so the same compensation pattern doesn’t rebuild itself the moment you leave the office.

Realistic expectations

When you repeat this work consistently over time, sciatica can absolutely be corrected. That said, every case is different. We have to consider:

• How degenerative is the spine?
• Was there a single trauma that herniated a disc?
• Has this been a problem for 10 years, or 10 weeks?

Sciatica is one of the more difficult conditions we treat — but it’s also one where we consistently get strong results. If you suspect you have it, the sooner we look at it, the more options you have.

Learn more about how we approach sciatica and related disc injuries, or book a new patient visit to get started.