Condition
Sciatica
A symptom with several possible sources — and they need different treatment.
90%
of sciatica cases resolve without surgery
Pain travelling down the leg along a nerve path. The word describes the symptom, not the cause, and finding the actual compression point is what determines whether treatment works.
What it feels like
- Sharp, burning, or electric pain travelling from the low back into the leg
- Pain that follows a defined path rather than aching diffusely
- Numbness or pins and needles in the calf, foot, or toes
- Weakness in the foot, ankle, or in pushing off when walking
- Worse with sitting, coughing, sneezing, or straining
What tends to cause it
- Lumbar disc herniation compressing a nerve root — the most common cause
- Lateral or central canal stenosis, more typical over 60
- Piriformis or deep gluteal irritation of the nerve itself
- Spondylolisthesis narrowing the nerve exit
- Sacroiliac dysfunction referring in a sciatica-like pattern
Sciatica is not a diagnosis. It is a description of a symptom — pain travelling along the distribution of the sciatic nerve — and the useful clinical question is always where along its course is the nerve being irritated.
That nerve is the largest in your body. It is formed from roots exiting the spine at L4 through S3, passes through the pelvis, runs beneath or occasionally through the piriformis muscle, and travels down the back of the thigh before dividing below the knee. It can be compressed at any point along that path, and the treatment for compression at the spine has almost nothing in common with the treatment for compression in the buttock.
Reading the pattern
The distribution tells you the level, and this is one of the more elegant parts of musculoskeletal examination:
- L4 — front of the thigh into the inner shin, weak knee extension, reduced knee reflex.
- L5 — outer shin into the top of the foot and big toe, weakness lifting the foot, no reflex change.
- S1 — back of the leg into the outer foot and little toe, weak calf raise, reduced ankle reflex.
A patient who can describe where the pain goes and where the numbness sits has already given us most of the diagnosis.
Why sitting is the worst part
Intradiscal pressure is higher in sitting than in standing, and higher again in seated flexion. If your sciatica is disc-driven, that explains the drive to work, the long meeting, and the flight — and it explains why standing up brings relief within a minute or two.
That pattern is a diagnostic finding, not just an inconvenience. Tell us about it.
The part worth holding onto
Ninety percent of this resolves without surgery. Nerve pain is genuinely frightening in a way that muscular pain is not — the electrical quality of it registers as damage. But the nerve is irritated, not severed, and irritated nerves settle down.
How we treat it here
Establish which nerve root
L4, L5, and S1 each produce a distinct pattern of pain, numbness, reflex change, and weakness. Identifying the level tells us where the compression is and often what is causing it. This is straightforward clinical testing.
Rule in or out the true emergencies
Cauda equina syndrome and progressive motor deficit are surgical situations, not chiropractic ones. We screen for both at the first visit, every time, without exception.
Decompress the involved level
Where a disc is compressing a root, spinal decompression, specific positioning, and directional preference exercises reduce the pressure. Where the piriformis is involved, the work is soft tissue and needling. Different problem, different treatment.
Centralise, then strengthen
The goal early on is centralisation — symptoms retreating out of the leg and back toward the spine. That is the signal we are on the right track. Once it centralises, loading begins.
Sciatica
Questions we get about this.
How long does sciatica take to resolve?
Most cases improve substantially within six to twelve weeks, and the large majority resolve without surgery. Disc material genuinely reabsorbs over time — follow-up imaging studies show herniations shrinking, and the larger ones often reabsorb most completely. Slow is not the same as permanent.
What does centralisation mean and why do you keep saying it?
It means your symptoms moving out of the leg and closer to the spine. Pain that goes from calf to buttock to low back is improving, even if the low back part feels no better. It is the most useful progress signal we have in this condition and it is more reliable than pain intensity.
Should I have surgery?
For most people, not initially. Surgery produces faster relief in the first few months but outcomes at one and two years are broadly comparable to conservative care for typical disc-related sciatica. That changes when there is progressive weakness, cauda equina syndrome, or genuinely intolerable pain that has not responded to a proper course of conservative treatment. We will tell you plainly when we think you have crossed that line.
Is it piriformis syndrome?
Sometimes, and it is diagnosed far more often than it occurs. True piriformis syndrome involves the sciatic nerve being irritated in the buttock rather than at the spine. Distinguishing features are no back pain, no clear dermatomal pattern, and reproduction of symptoms with specific hip positioning. The majority of sciatica is coming from the spine.
New patient special — $59 New Patient Visit
Get your sciatica properly examined.
One visit, a real diagnosis, and a plan with a visit count and an end date. If it turns out we are not the right provider, we will say so and point you to who is.
Columbus, OH · Same-week appointments · Most insurance accepted