Sciatica is a symptom with three different origins.
Leg pain that runs from the low back through the buttock and down the thigh is called sciatica in every clinic, but the cause varies. The three most common are lumbar disc irritation, piriformis muscle tightness, and sacroiliac joint dysfunction. Each responds to a different technique.
Which sciatica is this?
Disc-related
Sharp radiating pain down the back of the leg, worse with forward bending, sitting, sneezing, or coughing. Often accompanied by tingling or numbness past the knee. Responds especially well to Cox flexion-distraction.
Piriformis syndrome
Deep buttock pain that can mimic disc-related sciatica but originates in a muscle that overlays the sciatic nerve. Tight piriformis compresses the nerve. Responds to trigger-point, stretch, and specific exercise.
SI joint dysfunction
Pain concentrated at the dimple above the buttock, sometimes referring into the back of the thigh but usually stopping before the knee. Responds to specific pelvic adjustment.
Examine, isolate, treat, reassess.
Nerve-root exam
Straight-leg raise, slump test, and level-specific reflex, motor, and sensory testing to isolate which level is involved.
SI and piriformis tests
Provocation tests for the SI joint and palpation of the piriformis to distinguish these from disc-driven cases.
Matched technique
Cox flexion-distraction for disc cases. Specific SI adjustment for joint cases. Piriformis-focused soft-tissue for muscle cases.
Home program
Exercise prescription specific to the cause. Disc-driven cases get a different exercise set than piriformis cases.
Go to an emergency room immediately if you develop progressive leg weakness, numbness in the saddle region (inner thighs and groin), or loss of bladder or bowel control. This is a surgical emergency. Dr. Augello screens for it on every visit.
Sciatica questions.
What is sciatica?
Sciatica is a description, not a diagnosis. It refers to pain along the distribution of the sciatic nerve, which runs from the low back through the buttock and down the back of the leg. The pain can be caused by lumbar disc compression, piriformis muscle tightness, sacroiliac joint dysfunction, or less commonly by other nerve-root issues. A proper exam identifies the source.
Can chiropractic care treat sciatica?
For most mechanical causes of sciatic pain, yes. Lumbar disc cases often respond to Cox flexion-distraction, a specific chiropractic technique that gently opens the disc space. Piriformis-driven sciatica responds to targeted soft-tissue work. SI joint cases respond to specific pelvic adjustment. High-velocity manual adjustment is not appropriate for all sciatic cases, which is why the exam matters.
When is sciatica an emergency?
Progressive leg weakness, loss of bladder or bowel control, or numbness in the saddle region (the inner thighs and groin) can indicate cauda equina syndrome, a surgical emergency. Go to an emergency room immediately if you develop any of these symptoms.
Do I need an MRI?
Not always. Most sciatica cases respond to conservative care without imaging. MRI is indicated when symptoms are severe, progressive, have failed a reasonable conservative trial, or show red flags on exam. Dr. Augello refers for imaging when the clinical picture warrants it.
How long does sciatica take to resolve with chiropractic?
Uncomplicated disc-related sciatica often improves meaningfully within 4 to 6 visits and resolves within 8 to 12 weeks of care. Piriformis-driven cases can resolve faster. Chronic or severe cases may need longer, and a small percentage require imaging and referral out.
Get a proper diagnosis first.
Sciatica from a disc is treated differently than sciatica from a muscle. The exam is what separates them.