Sciatica is characterized by pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. It is typically felt as a shooting pain from the buttock to the back of the thigh and calf. Sciatica is often the result of a herniated or slipped disc compressing part of the nerve, but it can also be caused by piriformis syndrome, pregnancy, spinal stenosis, spondylolisthesis, or trauma.
What causes sciatica?
The most common cause of sciatica is a herniated or slipped disc in the lower spine. This allows part of the gel-like center of the disc to push into the spinal canal, putting pressure on the sciatic nerve roots. Sciatica can also be caused by:
- Piriformis syndrome – tightness or spasm of the piriformis muscle in the buttocks pinching the sciatic nerve.
- Pregnancy – the uterus expanding and pressing on the sciatic nerve.
- Spinal stenosis – narrowing of the spinal canal placing pressure on the nerves.
- Spondylolisthesis – slippage of one vertebra onto another.
- Trauma from a car accident or fall.
In most cases, sciatica is caused by a combination of factors like aging discs, poor posture, and muscle imbalances leading to extra pressure on the sciatic nerve roots. Understanding the underlying cause will help determine the appropriate treatment approach.
Typical sciatica symptoms
The hallmark symptom of sciatica is shooting pain starting in the buttock or back of the thigh and radiating down to the calf and foot. Common symptoms include:
- Burning, tingling, or numbness along the nerve pathway
- Difficulty standing up or straightening the leg
- Muscle weakness in the affected leg
- Sharp pain when coughing or sneezing
- Sciatic pain is often worse when sitting and relieved when lying down.
In severe cases, sciatica can lead to difficulty controlling the bladder or bowels. The pain is usually felt on just one side, though it can affect both legs.
When to see a doctor
Mild sciatica often resolves with rest and home treatment within a few weeks. See a doctor if you experience:
- Symptoms lasting more than 1-2 weeks
- Severe or progressive leg weakness
- Loss of bladder or bowel control
- Fever along with sciatica pain
These can indicate a serious underlying problem requiring medical evaluation. Seek emergency care for sudden severe back pain after an injury.
Diagnosing sciatica
To diagnose the cause of sciatica, the doctor will review your medical history and perform a physical exam. You’ll be asked about your symptoms, any trauma, and daily activities aggravating the pain. The doctor will check your spine mobility, muscle strength, reflexes, and sensations along the sciatic nerve pathway.
You may be referred for medical imaging tests like:
- Spine X-ray
- MRI scan
- CT scan
- Electromyography (EMG)
These can reveal disc issues, bone spurs, tumors or other causes pressing on the nerve roots. Blood tests may also check for underlying infections or inflammation. Getting an accurate diagnosis is key to proper sciatica treatment.
Chiropractic treatment for sciatica
Chiropractic care is frequently used in treating sciatica, along with other conservative therapies. A chiropractor performs spinal manipulation to improve mobility, relieve muscle tension, and take pressure off the compressed nerves. Other chiropractic techniques used for sciatic nerve pain include:
- Flexion distraction – a gentle pumping action at the spinal joints while lightly distracting the spine.
- Active release technique – releasing tight nerve and muscle tissues through specific hand motions.
- Graston technique – specialized massage using hand-held instruments.
- Electrical muscle stimulation to reduce spasms and inflammation.
The chiropractor can also recommend ergonomic changes, exercises, stretches, and other lifestyle modifications tailored to managing your sciatic pain. Ongoing chiropractic adjustments help sustain pain relief and function as you recover.
How many chiropractic sessions needed for sciatica?
There is no universal standard for the number of chiropractic visits needed to relieve sciatica. The frequency and duration of treatment depends on factors like:
- Cause and severity of nerve compression
- Presence of other conditions like spinal stenosis or spondylolisthesis
- Your age and overall health
- If there was a specific traumatic injury
- How well you respond to initial treatments
Acute sciatic pain caused by a herniated disc or muscle strain may resolve faster, while chronic nerve compression may take longer. Most patients start with 2-3 visits per week for 2-4 weeks. You may need 10-15 sessions or more over 4-6 weeks if dealing with substantial nerve irritation or multiple complicating factors.
Early improvements
Patients often experience some pain relief and improved mobility within the first 1-2 weeks of chiropractic treatment. Shooting or stabbing pains from an inflamed nerve start to subside as the irritation decreases. Early progress helps determine the treatment frequency and duration needed.
Ongoing chiropractic care
After the initial intensive phase, the frequency is reduced to 1-2 weekly sessions. Ongoing chiropractic helps strengthen the spine, improve flexibility, correct posture, and prevent future flare-ups. Maintenance care every 2-4 weeks may be recommended after resolving the acute sciatic pain. Consistent chiropractic treatment maximizes results and can reduce recovery time.
Average timeline
The average time to recover from an episode of acute sciatica is about 4-6 weeks with consistent chiropractic treatment. Chronic cases related to spinal changes like stenosis or spondylolisthesis often require 3-6 months. Surgery may be considered if symptoms persist despite exhaustive conservative therapy.
Flare-up management
Patients prone to periodic sciatic flare-ups may resume chiropractic visits as soon as symptoms appear. This can help control pain and prevent the flare from fully developing. Ongoing preventative care helps minimize flare frequency and intensity over time.
Other conservative treatments for sciatica
Chiropractic therapy works best alongside other evidence-based treatments for faster sciatica relief. Common conservative measures include:
- Medications – Over-the-counter NSAIDs or prescription muscle relaxants and neuropathic pain medications.
- Physical therapy – Specific lower back stretches and exercises to improve mobility.
- Massage – Helps relax muscles pressing on the sciatic nerve.
- Heat/ice therapy – Reduces muscle spasms and nerve irritation.
- Acupuncture – May alleviate sciatic pain and improve function.
- Exercise – Low-impact cardio and yoga help strengthen the back and core.
A combination of these treatments paired with chiropractic adjustments provides comprehensive relief. Anti-inflammatory medications and ice/heat can offer short-term pain relief while chiropractic and exercise treat the underlying cause of nerve compression.
When is surgery needed for sciatica?
Surgery is generally only considered if conservative therapy fails to provide improvement after 3-6 months. It may also be recommended earlier if there is:
- Progressive nerve damage with worsening leg weakness
- Loss of bowel/bladder control
- Persistent pain despite 6-8 weeks of focused conservative treatment
Common surgical procedures for refractory sciatica include:
- Discectomy – Removing a herniated portion of a disc pressing on the nerve.
- Laminectomy – Relieving pressure by trimming bone/tissue from the spine.
- Microdiscectomy – A minimally invasive discectomy using a small incision.
- Foraminotomy – Widening the passage where a spinal nerve exits the spinal canal.
Surgery aims to relieve direct pressure on the nerve roots causing sciatica pain and dysfunction. Though effective, it carries standard surgical risks (bleeding, infection, anesthesia) along with nerve damage or recurrent disc herniation. Chiropractic treatment is non-invasive with minimal risks.
Tips for finding relief from sciatica
Alongside professional treatment, you can take steps to manage sciatica flare-ups at home:
- Use good posture – Avoid slouching and bend at the knees when lifting.
- Exercise regularly with stretches and low-impact cardio.
- Wear shoes with proper arch support.
- Sleep on your side using a pillow between your knees.
- Lose excess weight to reduce pressure on the spine.
- Stress management helps relieve muscle tension.
Avoid prolonged sitting or activities that aggravate your sciatic pain. Take short frequent walks and change positions often. Anti-inflammatory medications can provide temporary relief during flare-ups. Try a hot or cold pack on the painful areas for 20 minutes at a time.
Does sciatica ever go away permanently?
For most people, sciatica pain is temporary and can be resolved with conservative treatment. But some factors make it more likely for symptoms to recur or become chronic:
- Older age – Discs degenerate and bones/soft tissues change over time.
- Spinal abnormalities like stenosis or spondylolisthesis.
- Previous back injuries or trauma.
- Being overweight or obese, which strains the spine.
- Jobs involving repetitive motions, frequent bending, or heavy lifting.
Even after recovery, those with chronic structural changes may need occasional chiropractic or physical therapy to minimize flare-ups. Daily back exercises, anti-inflammatory drugs, and posture/ergonomic corrections can help prevent recurrence.
Conclusion
Most cases of acute sciatica can be relieved within 4-8 weeks with focused chiropractic treatment and other conservative care. The specific frequency and number of sessions needed depends on your health status and how quickly your body responds. Ongoing maintenance care helps sustain long-term results.
Chronic nerve compression related to degenerative spinal changes often requires a longer course of treatment over 3-6 months. Surgery may become necessary if symptoms persist despite exhaustive conservative efforts. With proper management, the vast majority of sciatica patients experience good recovery and relief of leg pain.
