Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Sciatica most commonly occurs when a herniated disk or bone spur in the spine compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.
For most people, sciatica responds well to self-care measures and resolves within a few weeks. See your doctor if your sciatica:
- Is severe or gets progressively worse
- Persists for more than a week or two
- Is accompanied by significant leg weakness
- Is a result of a serious condition, such as spinal stenosis or cauda equina syndrome
Your doctor can provide medications, suggest exercises and other therapies, recommend a specialist or order tests. Some people find chiropractic treatment helps relieve sciatica. Here is some key information to help you decide which healthcare professional to consult.
What are the causes of sciatica?
In most cases, sciatica occurs when a spinal disc in the lower back herniates and presses on the sciatic nerve roots. This impedes nerve signals from traveling freely along the nerve. Prolonged pressure causes inflammation and irritation, which triggers pain.
Other spinal issues can compress the sciatic nerve and trigger sciatica, including:
- Spinal stenosis – Narrowing of the spinal canal that puts pressure on the spinal cord and nerves.
- Spondylolisthesis – A vertebra slides forward over the vertebra below it.
- Degenerative disc disease – Discs between the vertebrae deteriorate with age.
- Piriformis syndrome – The piriformis muscle in the buttocks spasms and irritates the sciatic nerve.
In rare cases, a tumor or cyst can put pressure on the sciatic nerve roots and cause sciatica. Non-spinal issues like pregnancy or endometriosis may also trigger sciatica in some people.
Symptoms of sciatica
Signs and symptoms of sciatica may include:
- Pain radiating from your lower back to your buttock and down your leg – usually on one side
- A burning or tingling sensation down your leg
- Weakness, numbness or difficulty moving the leg or foot
- A constant pain on one side of the rear
- A shooting pain that makes it difficult to stand up
You may have pain along the entire sciatic nerve pathway or only in certain areas. It can feel like a mild tingling, dull ache, or a burning sensation. The pain may be infrequent or constant, mild or so intense that it’s debilitating.
When to see a doctor
Milder cases of sciatica usually improve with time and self-care. But see your doctor promptly if your sciatica:
- Is severe or becomes progressively worse
- Spreads to your groin or genital region
- Causes muscle weakness in your leg
- Leads to bladder or bowel incontinence
- Is a result of trauma
- Follows a period of prolonged bed rest
- Persists for more than a week or two
- Is accompanied by fever, which can indicate an infection
- Is suspected to be caused by severe spinal stenosis or cauda equina syndrome
Emergency care
Seek emergency care if your sciatica is accompanied by:
- Sudden, severe pain in your low back or leg
- Muscle weakness or numbness in your leg
- Loss of bladder or bowel control
These signs indicate the need for immediate treatment to prevent permanent nerve damage.
How doctors diagnose sciatica
During your appointment, your doctor will review your medical history and symptoms and conduct a physical exam. Be prepared to describe your symptoms in detail, including when they started and what makes them better or worse.
The physical exam helps determine if you have muscle weakness, reduced reflexes, loss of sensation or other nerve damage. Your doctor may check your posture and spine mobility and assess your legs, feet and hips.
For most cases of sciatica, that’s all that’s needed for a diagnosis. But your doctor may order imaging tests if he or she suspects an underlying medical condition may be causing your sciatica, such as:
- Spinal X-rays – Use radiation to reveal bone abnormalities like fractures, tumors, degenerative changes or malalignment.
- MRI – Uses radio waves and magnets to produce detailed images of the bones and soft tissues of your back.
- CT scan – Combines X-rays taken from different angles. Good for bone abnormalities.
- Electromyography – Measures electrical activity in your muscles. Can indicate nerve compression.
Blood tests may also be ordered to judge inflammation levels or rule out other conditions.
Common treatment options from doctors
For most people, sciatica responds well to conservative treatment methods. Your doctor may recommend:
Medications
- Pain relievers – Over-the-counter medicines like ibuprofen (Advil, Motrin IB) and naproxen (Aleve) can help alleviate pain and inflammation. Prescription medications may be given for severe sciatica.
- Muscle relaxers – Prescription medications like cyclobenzaprine (Flexeril) can relieve muscle spasms pressing on the sciatic nerve.
- Antidepressants – Drugs like amitriptyline and duloxetine (Cymbalta) may be prescribed in low doses to treat nerve pain.
Steroid injections
Corticosteroid medication is injected directly into the epidural space around the spinal cord to reduce inflammation irritating the nerve roots.
Exercise
Light stretching and exercises can help relieve sciatic nerve pressure. A physical therapist can provide guidance on appropriate exercise techniques.
Heat and ice packs
Applying hot packs or ice packs may help reduce painful sciatica flareups. Heat helps relax muscles while cold numbs or distracts from pain.
Acupuncture
During acupuncture treatment, a practitioner inserts very fine needles into precise points on the body. Some research indicates this can reduce sciatic nerve pain.
When a doctor may refer you to a specialist
If initial treatments don’t relieve your sciatica, your doctor may refer you to:
Physiatrist
A physiatrist specializes in nonsurgical treatments, such as medications and physical therapy. He or she can tailor a treatment plan to address your specific case of sciatica.
Neurologist or neurosurgeon
A neurologist treats neurological conditions. A neurosurgeon performs operations involving the nervous system. Either may be helpful if your sciatica is severe or fails to improve with conservative treatments.
Orthopedic surgeon
If spinal alignment or stability is contributing to your sciatica, your doctor may refer you to an orthopedic surgeon who specializes in spine surgery.
Pain management specialist
A pain clinic can provide advanced pain relief techniques, prescribe medications, and develop a tailored pain management plan.
When surgery may be necessary
Surgery for sciatica is generally only considered if the condition is severe or persists after trying nonsurgical treatments. Surgical options may include:
- Microdiscectomy – Removes a herniated disc fragment pressing on a nerve root.
- Laminectomy – Removes part of a vertebra to increase space for the spinal cord and nerves.
- Spinal fusion – Joins two or more vertebrae together to improve spinal stability.
Surgery carries risks like infection, bleeding and reaction to anesthesia. Success rates vary depending on the individual case and surgical procedure used. It may take weeks or months to fully recover from spinal surgery.
Can a chiropractor treat sciatica?
Yes, chiropractic care may help relieve pressure on the sciatic nerve and alleviate sciatica symptoms. Chiropractors use nonsurgical approaches focused on the interrelationship between the body’s structure, mainly the spine, and function.
Benefits
Potential benefits of chiropractic treatment for sciatica include:
- Improve spinal mobility and posture
- Reduce nerve inflammation and irritation
- Align the vertebrae and pelvis to take pressure off the sciatic nerve
- Provide pain relief through massage, heat therapy, electrical stimulation
- Offer personalized exercise and stretching regimens
- Collaborate with your other doctors and healthcare providers
- Provide a drug-free alternative to pain medications
Techniques
Chiropractors use a variety of hands-on techniques and treatments, which may include:
- Spinal manipulation – The chiropractor applies controlled force and pressure to joints to restore mobility.
- Mobilization – Gentle, rhythmic techniques to relax muscles and increase range of motion.
- Flexion-distraction – Gentle pumping action on the lower back to relieve pressure on the discs and nerve roots.
- Instrument-assisted manipulation – Handheld tools help apply force to treat restricted joint movement.
- Ultrasound – Sound waves applied to deep tissues to promote healing and decrease inflammation.
Improving spinal alignment can remove pressure from the sciatic nerve roots and allow tissues to heal. Combining spinal adjustments with massage, exercise and other therapies may provide better pain relief.
Risks and considerations
Potential drawbacks of seeing a chiropractor for sciatica include:
- Requires multiple visits for ongoing relief
- Provides only temporary pain management
- Carries a small risk of adverse effects like muscle strains or disc injuries
- Not recommended if certain spinal issues or osteoporosis is present
- Relatively expensive out-of-pocket costs since many health plans limit coverage
- May delay proper diagnosis and more effective treatment
Talk to your doctor before seeking chiropractic treatment. While generally considered safe, spinal manipulation could make certain medical conditions worse.
Lifestyle remedies and home care
There are also self-care measures you can try at home to manage sciatica discomfort:
- Use good posture and proper body mechanics to avoid putting pressure on the sciatic nerve.
- Apply cold and heat packs to alleviate muscle tension and spasms.
- Do gentle stretches and exercises that target the piriformis muscle.
- Practice tai chi, yoga or Pilates to help strengthen your back and improve flexibility.
- Use firm mattresses and ergonomic chairs that maintain neutral spine alignment.
- Wear flat shoes with cushioned soles and avoid high heels.
- Lose excess weight to avoid stress on the lower back.
- Quit smoking since nicotine impedes blood flow needed for disc nutrition and nerve healing.
Over-the-counter pain relievers, muscle relaxers and anti-inflammatory drugs may also provide symptom relief at home.
When to try chiropractic or medical treatment
In general, consider seeing:
- A doctor first if your sciatica results from a serious medical condition, involves severe pain, numbness or muscle weakness, or does not improve with rest and conservative care.
- A chiropractor or medical doctor if you have mild to moderate sciatica that has persisted for several weeks and home remedies don’t provide adequate relief.
A combination approach is common, where a doctor oversees your medical care but refers you for chiropractic or physical therapy as needed. Discuss all treatment options with your doctor to determine the best sciatica recovery plan for your situation.
Conclusion
Sciatica can be an extremely painful condition that interferes with daily functioning. However, there are many effective treatment options available. A doctor can provide medications, steroid injections, therapy referrals and surgery if sciatica is severe. Chiropractic techniques like spinal manipulation may also bring relief by correcting spinal and pelvic misalignment.
Most cases of sciatica resolve within a few weeks using conservative self-care remedies. But see your doctor promptly if symptoms are debilitating or persist longer than two weeks. Getting an accurate diagnosis is key, as some serious medical issues can mimic sciatica.
Weigh the pros and cons of medical and chiropractic care in consultation with your healthcare providers. An integrated treatment approach often provides the best results. But many people find adequate pain relief and mobility improvement from non-invasive chiropractic techniques and lifestyle changes.
