Sciatica

Sciatica is the name for pain, tingling, numbness, or weakness that travels along the sciatic nerve — usually starting in the low back or buttock and running down the back of the leg, sometimes all the way into the foot.

Here's the part most people miss: sciatica isn't a diagnosis. It's a description of what you're feeling. Something is irritating or compressing the nerve, and the leg pain is the result. The real question — the one that determines whether treatment works — is what's causing it.

Patients frequently come in after being told they "just have sciatica," handed muscle relaxers or a generic set of stretches, and sent on their way. When the pain doesn't resolve, they're told to try injections or surgery.

The problem is that at least three very different things can cause the same leg pain:

• A disc issue in the lumbar spine pressing on a nerve root.
• An SI joint dysfunction — the joint where the pelvis meets the spine — referring pain down the leg.
• Piriformis syndrome — the piriformis muscle in the buttock irritating the sciatic nerve directly.

Each one needs a different treatment. Stretches that help a piriformis issue can make a disc problem worse. Adjustments that resolve an SI joint dysfunction won't do much for a herniated disc. Calling all three "sciatica" and treating them the same way is how people end up frustrated — or in an operating room they didn't need.

We start by listening, and then we test. A thorough exam — orthopedic testing, neurological screening, movement assessment, and imaging when it's warranted — tells us where the nerve is actually being irritated. Only then do we build a plan.

If it's a disc issue, we use flexion-distraction therapy to gently take pressure off the disc. If it's an SI joint, we use specific, low-force adjustments to restore normal motion. If it's piriformis, soft-tissue work and targeted release get the muscle to stop compressing the nerve.

The goal isn't to "adjust the spine and hope." It's to match the treatment to the actual cause — which is the only reason it works.

Once the pain is calming down, we build a rehabilitative program to strengthen the muscles that support the low back and pelvis, so the same thing is less likely to happen again. For inflammation-driven cases, we may also talk through simple lifestyle and anti-inflammatory support that complements the in-office work.