Sciatica

The pain starts in your lower back or buttock and shoots down the back of your leg. It might stop at the knee. It might run all the way to your foot. Sitting makes it worse. Coughing or sneezing sends a jolt through your leg. Some days it burns. Other days it feels like a deep ache, a numbness or pins and needles.

If this sounds familiar, you are dealing with sciatica. It is one of the most common reasons people walk into our practice, and one of the most misunderstood. The good news is that most cases respond well to conservative treatment and do not need surgery.

What is sciatica?

Sciatica is not a diagnosis in itself. It is a description of symptoms caused by irritation or compression of the sciatic nerve or the nerve roots that form it. The sciatic nerve is the longest and thickest nerve in your body. It runs from your lower lumbar spine, through your buttock and down the back of each leg.

When something presses on or irritates this nerve or its roots, the result is pain, tingling, numbness or weakness that radiates along the nerve’s path. The pattern of symptoms depends on which nerve root is affected and how much pressure it is under.

What causes it?

About 90% of sciatica cases are caused by a disc injury pressing on a nerve root in the lower lumbar spine. The vast majority of these occur at the L4-L5 or L5-S1 levels.

But a herniated disc is not the only cause. Other common drivers include:

Spinal stenosis. Narrowing of the spinal canal, usually from age-related changes, can compress the nerve roots. This is the most common cause in people over 50 and tends to cause symptoms in both legs that worsen with walking and ease with sitting or leaning forward.

Piriformis syndrome. The piriformis is a small muscle deep in the buttock. In some people, the sciatic nerve runs through or beneath it. When the muscle tightens or spasms, it can compress the nerve and produce sciatica-like symptoms without any spinal involvement. This accounts for an estimated 6% to 8% of cases.

Joint dysfunction. Facet joint irritation and SI joint dysfunction in the lower back can refer pain into the buttock and leg, mimicking sciatica.

Other causes. Less commonly, spondylolisthesis (a vertebra slipping forward), pelvic conditions or space-occupying lesions can produce sciatic symptoms.

Will sciatica resolve without treatment?

This is one of the most common questions we hear. The honest answer is: some disc herniations do resorb over time. Research by Zhong and colleagues (2017) found that approximately two-thirds of lumbar disc herniations show some degree of spontaneous resorption. But disc resorption and symptom resolution are not the same thing. Around 20% to 30% of patients still have meaningful pain at one year, and nearly half still report significant symptoms at follow-up.

Even when the disc itself improves, the secondary problems it creates do not resolve on their own. The joint restrictions, muscle guarding, nerve sensitivity and movement compensations that develop around the injury tend to persist and can become the primary driver of ongoing pain. This is exactly where treatment makes the difference.

Why early treatment matters

A large retrospective study by Trager and colleagues (2022) in BMJ Open tracked adults with newly diagnosed lumbar disc herniation and found that those who received chiropractic spinal manipulation had 31% lower odds of progressing to discectomy surgery over the following year. A separate 2025 study by the same group, tracking over 370,000 matched patients, found that chiropractic care for sciatica was associated with a 71% lower risk of opioid-related adverse events compared to those who did not receive manipulation.

These are not small numbers. Early, appropriate conservative treatment does not just help you feel better faster. It reduces the likelihood of needing more invasive interventions down the line.

How we treat sciatica

There is no single approach that works for every case of sciatica. What drives the symptoms, how long they have been present and how irritable the nerve is all shape the treatment plan. The best outcomes come from a combined approach tailored to your specific presentation.

Chiropractic adjustments

Spinal manipulation addresses the joint restrictions in the lower back and pelvis that contribute to nerve irritation. A landmark double-blind RCT by Santilli and colleagues (2006) showed that active spinal manipulation produced significantly more pain relief than sham treatment in patients with acute sciatica and confirmed disc protrusion, with more patients achieving complete resolution.

We assess the whole kinetic chain. Stiffness in the thoracic spine, restricted hip mobility and SI joint dysfunction all change how load is distributed through the lumbar spine. Addressing these factors takes pressure off the affected nerve root.

Shockwave therapy

For sciatica driven by piriformis syndrome or associated muscle tightness, shockwave therapy offers an effective non-invasive option. Randomised controlled trials comparing shockwave with corticosteroid injection for piriformis syndrome have found comparable results for pain, disability and hip range of motion. Shockwave achieves similar outcomes to injection without the risks of repeated steroid use.

We also use shockwave to address the gluteal, hamstring and lumbar trigger points that commonly accompany sciatica. These secondary muscle problems often persist even as the primary nerve irritation resolves, and shockwave is effective at releasing them.

Dry needling

Dry needling targets the myofascial trigger points that develop in the gluteals, piriformis, hamstrings and lumbar paraspinal muscles alongside sciatica. These muscles tighten as your body guards against the pain, and that guarding can perpetuate symptoms even as the underlying cause improves. Releasing these trigger points reduces muscle tension, improves local blood flow and makes rehabilitation exercises easier to perform.

Nerve mobilisation

Neural mobilisation techniques (sometimes called nerve flossing) gently restore the sciatic nerve’s ability to glide through the surrounding tissue. When a nerve is irritated, it can become sensitised and mechanically tethered. A 2023 systematic review and meta-analysis by Moustafa and colleagues found that nerve mobilisation significantly reduced both pain and disability in lumbar radiculopathy, with effects particularly notable in chronic cases.

We teach you specific nerve gliding exercises to continue at home as part of your recovery programme.

Targeted rehabilitation

This is the foundation of long-term recovery. Research consistently shows that exercise therapy produces superior outcomes in pain, disability and quality of life for disc-related symptoms. Rehabilitation includes:

Pain-free movement in the early, acute phase to maintain mobility without aggravating the nerve
Directional preference exercises to centralise symptoms and reduce nerve compression
Core stability and lumbar strengthening to support the spine and prevent recurrence
Progressive loading to rebuild tolerance and get you back to full activity

We prescribe exercises scaled to your irritability level and progress them as the nerve settles.

Do you need surgery?

Probably not. The landmark NEJM trial by Peul and colleagues (2007) randomised 283 patients with severe sciatica to early surgery or conservative management. Surgery provided faster initial pain relief, but by one year there was no significant difference in outcomes between the two groups. Two-year follow-up confirmed this finding.

Surgery does have a clearer role when sciatica has persisted beyond four months despite appropriate conservative care, or when there is progressive neurological deficit. A subsequent NEJM trial by Bailey and colleagues (2020) showed that for persistent sciatica lasting 4 to 12 months, microdiscectomy produced significantly better leg pain scores at six months compared to conservative care.

In our experience, most patients improve substantially with conservative treatment and never need to consider surgery. When surgery is appropriate, we will tell you and refer you to the right specialist.

When to get help urgently

Most sciatica, while painful, is not dangerous. But there are specific symptoms that require immediate medical attention:

Loss of bladder or bowel control
Numbness in the saddle area (inner thighs, buttocks, genitals)
Rapidly worsening weakness in one or both legs
Sciatica developing suddenly in both legs

These can indicate cauda equina syndrome, a rare but serious condition where the nerve bundle at the base of the spine is severely compressed. It requires emergency assessment and, if confirmed, surgery within 24 hours to prevent permanent damage.

When to see us

For the vast majority of sciatica cases, early assessment and treatment produces the best outcomes. See us if:

You have leg pain radiating from your back or buttock that has lasted more than a few days
The pain is affecting your ability to sit, walk, work or sleep
You have numbness, tingling or weakness in your leg or foot
You have had sciatica before and it has returned
You have been told you have a disc problem and want a non-surgical treatment plan

A proper assessment identifies what is driving your sciatica, how irritable the nerve is and what the best approach is for your specific case.

If sciatica is limiting your life, get in touch or book an appointment. We will work out what is causing it and get you on the right path.

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