Sciatica: Causes, Treatment, and When to See a Chiropractor

If pain is shooting down your leg from your lower back, you've probably already searched "what causes sciatica" or "can a chiropractor help with sciatica." You're not alone — sciatica and leg pain are among the most commonly searched pain conditions online, and for good reason: it's common, it's uncomfortable, and it's confusing to know what to do about it.¹ This article walks through what sciatica actually is, what causes it, when it needs urgent attention, and how conservative care — including chiropractic treatment — fits into your recovery.

What Is Sciatica?

The sciatic nerve is the largest nerve in your body. It starts in your lower back, runs through your buttock, and travels down the back of your leg.^2,3 Sciatica happens when something irritates or compresses this nerve — or the nerve roots that form it in your lower spine — causing pain, tingling, numbness, or weakness that can travel from your lower back all the way down to your foot.³

It's important to know that sciatica is a set of symptoms, not a diagnosis by itself. The real question is always: what's causing the irritation?

What Does "Pinched Nerve" Actually Mean?

"Pinched nerve" is a phrase almost everyone uses, but it can mean a few different things. According to research published by the National Institutes of Health, sciatica is most frequently caused by irritation of the spinal nerve roots — also called nerve compression, a pinched nerve, or entrapment neuropathy.⁴ In other words, when people say they have a "pinched nerve" causing pain down their leg, they're often describing exactly what a doctor would call sciatica caused by nerve root compression.

This compression is medically referred to as lumbar radiculopathy, since the irritated nerve roots are in the lumbar, or lower back, part of the spine.⁴ The irritation is most commonly caused by disc tissue pressing on the nerve, though bone spurs and other structures can also be responsible.⁴

What Causes Sciatica?

The most common cause of sciatica is a herniated or bulging lumbar disc — sometimes described as a slipped disc, disc protrusion, or disc degeneration.^3,4 Here's what those terms actually mean:

• Disc degeneration: the natural wear-and-tear process where spinal discs lose height and flexibility over time, which can make them more prone to bulging or herniating
• Bulging disc: the disc's outer layer extends beyond its normal space, without the inner material breaking through
• Herniated disc (disc protrusion): the soft inner material of the disc pushes through a crack in the outer layer, which can press directly on a nearby nerve root

Other causes of sciatica include:^3,4

• Spinal stenosis (narrowing of the space around the spinal cord and nerves), more common in older adults
• Spondylolisthesis (one vertebra slipping forward relative to another)
• Muscle spasm or inflammation near a nerve root, including piriformis syndrome, where a deep hip muscle irritates the sciatic nerve
• Injuries to the lower back or spine, including work injuries or accidents

Common Symptoms of Sciatica

Symptoms can range from mild to severe, and typically affect only one side of the body. They often include:³

• A burning or "electric shock" pain that shoots down one leg
• Pain that worsens with coughing, sneezing, bending, or sitting for long periods
• Numbness or tingling in the leg, foot, or toes
• Weakness in the leg or foot

How Chiropractic Care Can Help With Sciatica

Clinical guidelines for sciatica recommend a stepped approach: conservative care first, escalating to other options only if needed.⁷ Chiropractic care is one of the conservative treatments supported by research for sciatica caused by disc problems.^4,8

Chiropractic Manipulation and Nerve Pressure

Spinal manipulation aims to restore normal motion to the joints of the spine. When a disc is bulging or herniated and pressing on a nerve root, improving movement and alignment in that area of the spine can help reduce the pressure contributing to nerve irritation, which may lessen pain and improve function.^8,9

Flexion-Distraction Therapy

At Back In Shape Chiropractic, we use flexion-distraction therapy as one of our primary tools for sciatica caused by disc problems. This is a gentle technique using a specialized table that creates a slow, controlled stretching and flexing motion in the lower back.^9,10

Here's why this matters: research published in the Journal of Physical Therapy Science found that flexion-distraction significantly increased intervertebral disc height and improved straight-leg-raise measurements — a common test for nerve irritation — in patients with herniated discs.⁹ Separate cadaver research found that flexion-distraction reduced pressure inside the disc by as much as 65%.⁹ The idea is straightforward: gently creating more space in and around the disc can reduce the pressure on the nerve root causing your pain.

Laser Therapy for Nerve Root Irritation

We also offer laser therapy, which can be used to target inflammation around the nerve roots contributing to sciatic pain. This is often used alongside spinal manipulation and flexion-distraction as part of a broader care plan. Learn more about laser therapy at our office.

When Do People Consider Surgery for Sciatica?

If you're reading this because you're worried you might need surgery, here's what the research actually shows: most people with sciatica improve without surgery. Clinical guidelines recommend conservative treatment — such as chiropractic care, staying active, and appropriate pain management — for at least 6 to 8 weeks before surgery is even considered.^7,11

Surgery is typically considered when:^7,11

• Symptoms haven't improved after 6–8 weeks of conservative care
• There is significant, progressive leg weakness
• Imaging (like an MRI) confirms a structural cause, such as a herniated disc, that matches your symptoms

Research does show that surgery can provide faster pain relief for some patients with confirmed disc herniation.^12,13 But a major randomized trial published in the New England Journal of Medicine found that while early surgery relieved pain faster, patients who chose conservative care first often experienced similar overall improvement by one year — many never needed surgery at all.¹³

That's why surgery is generally treated as a later step rather than a first step: conservative care is genuinely effective for most people, carries far less risk, and gives your body a real chance to heal before considering a more invasive option.

What to Expect at a Chiropractic Evaluation for Sciatica

At your first visit, Dr. Segal will ask about your symptoms, when they started, and what makes them better or worse. He'll perform an exam to help identify what's likely contributing to your sciatica and rule out red-flag symptoms that would need a different kind of care. From there, he'll build a treatment plan — often including spinal manipulation, flexion-distraction, and laser therapy — based on what he finds, not a one-size-fits-all approach.

Sciatica can have many causes, and appropriate treatment depends on your specific situation. If you have any of the red-flag symptoms described above, seek emergency medical care immediately.

Dr. Kevin Segal, DC

Dr. Segal has been practicing chiropractic care in Milwaukie, Oregon since 2001, with extensive experience helping patients recover from sciatica, disc-related pain, and work and auto-accident injuries.

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