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Sciatica describes pain that is felt along the sciatic nerve, which runs from the lower back, through the buttock, and down the lower leg. The sciatic nerve is the largest nerve in the body, it is roughly half the length of your total height and can be as wide as your pinky finger.  It controls the muscles in the lower leg and provides sensation to the thighs, legs, and bottoms of the feet.

Sciatica is commonly seen with back and leg pain, however, this condition is often misunderstood.  It doesn’t take a degree in healthcare to diagnose sciatica – most people know when they have it. Sharp pain or numbness in the buttock and/or back of the thigh and leg is how it presents in most cases.  The challenge is diagnosing what is irritating the nerve root and causing the pain.

Sciatica is usually seen on one side of the body and depending on where the nerve is being affected pain can vary from a dull ache in the buttock, burning sensation on the back of the leg, or a sharp electrical pain while coughing or sneezing. In more serious cases, there may be muscle weakness or wasting.

As mentioned above, the cause of sciatica is the challenge and must be determined before treatment can be recommended.

Herniated Disc:

The most common cause of sciatica is a disc displacement, often called a herniated or bulging disc.  This is where the disc between two vertebrae becomes weak and irritates with the corresponding nerve root.  There are many options for treatment, a conservative approach is suggested to start with. An MRI is necessary to evaluate the severity, especially if the patient is not responding accordingly to conservative care.


Sacroiliac Joint Dysfunction:

Irritation of the sacroiliac joint, located at the bottom of the spine, can also irritate a nearby nerve root – causing sciatic pain.

Chiropractic adjustments are used to ensure proper movement of this region. Rehabilitation exercises would also be recommend to stabilize and strengthen the lower back once pain is tolerable.


Degenerative Disc Disease / Arthritis:

Degeneration is a natural process that occurs with aging, however, in some cases the degenerative disc becomes weak and unable to support the region appropriately. The joint starts to move excessively releasing inflammatory substances which can cause irritation to the nearby nerve root.


Piriformis Syndrome:

This is probably the least complex of the conditions listed. The piriformis is a muscle that is deep below the gluteal muscles surrounds the femoral head (hip). The sciatic nerves run directly underneath and sometimes through the muscle.  If for any reason, the piriform muscle becomes spastic or strained, it can irritate the sciatic nerve.  Technically this isn’t considered sciatica, but the pain presents very similar symptoms.



Whether a compression fracture or stress fracture, the vertebra can become unstable causing undue pressure on the surrounding areas including the nearby nerve root. X-Ray’s, CT, or MRI is used to diagnose accordingly. A referral is warranted to the orthopedist in most cases.

No matter the cause, sciatica can be diagnosed and managed by a doctor of chiropractic. It is important that an appropriate exam and diagnostic imaging is utilized during the first visit. This ensures proper treatment is recommended to increase the likelihood of a full recovery.


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Be safe out there,

-Dr. Justin Paeltz

If you, a friend, or a family member could benefit from chiropractic care contact us at 817-259-1300.

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