Sciatica is the term used for sciatic nerve pain that goes down the back of a leg. It can be from a disc bulge, pinched nerve, or tight muscles in the back of the hip.


What is sciatica?

Sciatica is the term used to describe pain that travels along the sciatic nerve path. Although sciatica is often used as a diagnosis, there are several causes, including disc bulges, pinched nerves, and piriformis syndrome. Depending on the cause of sciatica, there are multiple options for treatment. Sciatica treatment options often include decompression therapy, neurodynamic techniques, stretching, myofascial release, spinal manipulation, and rehabilitation.

The essential component of successful treatment is first to identify the cause. For example, a disc bulge will be treated differently than piriformis syndrome. Next, discovering triggers or activities that aggravate the pain must be eliminated. An example of this could be changing sleeping positions or bending movements.

How is sciatica diagnosed?

The first step in diagnosing sciatica requires a comprehensive evaluation, including orthopedic exams, neurodynamic tests, mechanical diagnosis therapy, and discovering what provides the most relief.

If no improvement is made after six weeks of conservative therapy with a chiropractor or physical therapist, an MRI may be recommended. MRI is used to look for disc bulges in the low back. X-ray is usually not helpful in diagnosing sciatica. Also, neither MRI nor X-ray is useful in diagnosing piriformis syndrome.

How long does sciatica take to heal?

Sciatica healing time will vary depending on the cause and severity. Other factors to consider are a person’s age, overall health, and if the appropriate therapies are being done.

In some instances, sciatic pain can feel better within a couple of weeks. On the other end of the spectrum, sciatica pain can sometimes take nine months before it begins to feel better.

Most commonly, six weeks of conservative therapy (such as with a chiropractor) are recommended. When a combination of treatments are applied appropriately, there is a greater chance for a more speedy recovery.

What is the best treatment for sciatica?

The best treatment for sciatica will depend on the cause and severity. After a thorough exam, a care trial should consist of combining several therapies. Some of the more common treatments are spinal decompression, neurodynamics, mechanical diagnosis therapy, spinal manipulation, myofascial release, stretching, and rehabilitation.

Spinal decompression creates more space around the nerves as they exit the spine. Ideally, the traction should be intermittent (coming in and out) rather than only holding the traction for an extended period.Intermittent traction allows time to create space and promotes movement back and forth, which acts as a pump to help with inflammation and swelling around the nerve.

Neurodynamic techniques increase circulation and mobility in the sciatic nerve itself. For example, it’s common for people with sciatica to have difficulty putting on socks and shoes. Nerve flossing and nerve mobilizations are neurodynamic techniques that improve the nerve’s ability to be stretched while experiencing less pain.

Mechanical Diagnosis Therapy is a technique that helps discover which direction would be best for stretching the spine. Depending on the size and type of disc bulge, some people do better with stretching one direction over the other. Finding the correct direction is also vital to discover if there is a stretch or position that should be avoided. For example,some disc bulges should avoid stretching forward, while others should avoid stretching backward.

Chiropractors frequently use spinal manipulation to reduce joint restrictions and muscle tension. These chiropractic adjustments are also a great option to create more mobility in the area, which can help with pain and improve the overall healing response.

Myofascial release is like a massage and promotes blood flow, induces relaxation reflexes, and relieves pain.

Stretching the surrounding muscles such as the piriformis, hamstrings, and hip flexors, are a great way to improve overall mobility. Inthe case of piriformis syndrome, stretching the hips may be especially valuable.

Rehabilitation helps strengthen muscles in or around the area of injury. Strengthening is beneficial in the later stages to develop more resilience and prevent future occurrences.

Can chiropractors help with sciatica?

Yes. Especially chiropractors that combine the above therapies. Each therapy can be valuable; however, the critical component is applying them in the necessary situation. Before committing to a chiropractor, it is recommended that they utilize and have experience with the therapies mentioned above.

Are there any other options to help sciatica heal faster?

Yes. What’s considered healthy lifestyle choices, in general, are usually essential to promote healing. Examples include getting good sleep, managing stress, and maintaining a good diet.

Sleep is essential for recovery. If the body is not getting adequate and quality sleep, then the healing response will suffer. Everyone is different, but it is mainly recommended for 7-9 hours of sleep/night. Keep in mind that quality is essential too.

Nutrition can be critical in recovery from sciatica. Avoiding processed foods can keep inflammation down, which is crucial for faster healing response.

Managing stress and anxiety can be valuable. Stress Responses increase cortisol, and cortisol is a stress hormone that can slow the recovery process.

Does sciatica require surgery?

Sciatica can be managed and will recover with the therapies that have already been described in most cases (80-90%). Some severe cases can require surgery; however, this is usually only pursued as a last resort.

Other forms of therapy may include NSAIDs, oral steroids, and steroid injections. These options should be explored by visiting your primary care physician, orthopedist, or a pain management specialist.

Why does the pain go down my leg?

Sciatic pain travels down the back of the leg because that is the location of the sciatic nerve. Once the nerve gets irritated, inflammation will begin to travel downward. Sometimes it stops near the knee; other times, it can travel towards the foot.

Whether it’s a disc bulge or piriformis syndrome, the nerve is more common to be pinched on only one side. If you’re noticing long-standing pain going down both legs, a condition called stenosis should be considered.

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