What causes sciatica? A chiropractor's guide to causes, symptoms and red flags
Sciatica is leg pain caused by irritation or compression of the sciatic nerve or the nerve roots that form it. It is a symptom, not a diagnosis. The pain usually runs from the buttock down the back or side of the leg, often past the knee, and it is commonly driven by a disc, by narrowing where the nerve exits the spine, or by joint irritation in the low back. Finding which one is driving it is the whole job.
I am Dr Alex Freeman (chiropractor), and I run Freeman Chiropractic on Albany Highway in Victoria Park. Sciatica is one of the two or three most common reasons people walk through our door, and it is also the complaint people most often self-diagnose from a search result before they get here. So let me set out how I actually think about it in the room.
Sciatica is a symptom, not a condition
This distinction matters more than it sounds. When someone tells me they "have sciatica", they have told me where they feel it, not what is wrong. It is a bit like saying you have a cough. True, useful, and not yet a plan.
The sciatic nerve is the largest nerve in the body. It is formed from nerve roots that leave the spine between roughly L4 and S3, runs through the deep buttock, and travels down the back of the thigh before dividing below the knee. Anything that irritates it anywhere along that path can produce leg symptoms. The treatment that helps a disc-driven case is not always the treatment that helps a deep gluteal case, which is why an accurate assessment is worth more than a generic set of stretches.
What sciatica typically feels like
The presentations I see most often share a few features:
Pain that travels, rather than sitting in one spot. Buttock to hamstring, sometimes to the calf or foot.
A sharp, electric or burning quality, often different in character to the dull ache of ordinary back pain.
Pins and needles, numbness, or a patch of skin that feels less sensitive than the other side.
Symptoms that change predictably with position. Worse sitting or bending forward often points one way, worse standing and walking often points another.
Coughing, sneezing or straining making the leg jump.
Weakness is the one I pay closest attention to. Pain is unpleasant but pain alone rarely changes a management decision. A foot that is catching on a step, or a calf that cannot push off properly, is a different conversation.
The five things that most often cause it
1. Disc protrusion or herniation
Disc material presses on or chemically irritates a nerve root, most commonly at L4/5 or L5/S1. Typically worse with sitting, bending and the first part of the morning. This is the classic picture, and it is the one most people assume they have.
2. Lateral recess or foraminal narrowing
The bony channel the nerve travels through has become tighter, usually through a combination of disc height loss, facet joint enlargement and bony spurring. This is more common as we get older, and it tends to be worse with standing and walking and eased by sitting or leaning forward on a trolley. I have written a separate piece on what those MRI words actually mean, because this is the group most likely to arrive holding a report they cannot decode.
3. Facet joint and segmental irritation
An irritated joint in the lower lumbar spine can refer pain into the buttock and upper thigh convincingly enough to be mistaken for true sciatica, and can also contribute to nerve irritation at the same level.
4. Deep gluteal and piriformis involvement
Tension or entrapment in the deep buttock producing symptoms along the nerve path. Often tender to direct pressure, often worse with prolonged sitting, and frequently secondary to something happening at the spine rather than a standalone problem.
5. The mimics
Not everything that hurts down a leg is a nerve. Hip osteoarthritis refers to the groin and front of the thigh. Sacroiliac irritation refers to the buttock. Vascular claudication produces walking-related leg pain that eases the moment you stop, regardless of posture. Getting this wrong wastes months of someone's life, so ruling the mimics in or out is part of a proper examination.
When sciatica needs urgent medical attention
Most sciatica is not dangerous. A small number of presentations are, and you should not sit on these. Seek urgent medical care, not a chiropractic appointment, if you have:
Loss of bladder or bowel control, or difficulty starting or stopping urination
Numbness through the saddle region, the inner thighs or the genitals
Weakness that is getting rapidly worse, or weakness in both legs
Fever, unexplained weight loss, or a history of cancer alongside new spinal pain
Significant trauma, such as a fall or a car accident
These are screened at every new patient examination at our practice, and if they are present my job is to get you to the right place quickly rather than to treat you.
What happens at a first appointment
A first visit at Freeman Chiropractic is a consultation and examination, not an adjustment. I want a clear history first: where it started, what makes it better and worse, how it behaves through the day, and what you have already tried.
The examination is where the answer usually comes from. I check movement and where in the range symptoms appear, neural tension tests such as straight leg raise and slump, reflexes, sensation, and muscle strength through the relevant myotomes. I also check how the pelvis and lumbar joints are moving segmentally, and how leg length and muscle tone change between prone and supine, which tells me something about what is functional and what is structural.
Imaging is not automatic, but I do refer for it more readily than some. If the picture suggests a nerve root under real pressure, or if the presentation does not fit the mechanical pattern, I would rather know than guess. We refer to I-MED Radiology and go through the images with you at a report of findings appointment before care begins.
Where chiropractic care fits
Chiropractic care may help with the musculoskeletal drivers of sciatica. In practice that usually means a combination of adjusting restricted segments in the lumbar spine and pelvis to restore movement, soft tissue work or dry needling through the deep gluteal group and lumbar paraspinals, specific movement advice, and then loading and strengthening once symptoms have settled enough for you to train properly.
The mechanism I explain to patients is straightforward. If a joint is not moving, the tissue around it stays irritated and the space the nerve travels through stays unhappy. Restoring movement and settling the surrounding tissue takes mechanical stress off the nerve and reduces the inflammatory load on it. A nerve that is less inflamed hurts less, and it also sits in a better environment to recover.
This is not a promise. Some cases respond quickly, some take months, and some need a surgical opinion. What I can say is that a trial of conservative care is a reasonable first step for most mechanical sciatica, and that we reassess formally rather than letting care drift. Our standard is a progress examination at the twelfth visit, comparing the same objective measures we took on day one.
What to do in the meantime
Before you can get in, keep moving within tolerance. Complete rest tends to stiffen things and lengthen recovery. Short, frequent walks usually beat one long one. Avoid prolonged sitting, particularly slumped on a soft couch. For the first several hours after an acute flare, ice can help settle things, after which most people do better with gentle movement and heat. And be cautious with aggressive stretching into the leg, because pulling hard on an already irritated nerve often makes the next day worse.
Common questions about sciatica
How long does sciatica take to get better?
Many acute cases settle substantially within six to twelve weeks. Cases involving significant nerve root compression or long-standing narrowing usually take longer and need a more staged approach. The honest answer is that the timeline depends on the cause, how long it has been there, and how much nerve involvement is present.
Should I get an MRI for sciatica?
Not always. Imaging is most useful when there is genuine neurological involvement, when symptoms are not improving as expected, or when the presentation does not fit a mechanical pattern. An MRI changes management when it changes the plan, not simply because it confirms what the examination already showed.
Can a chiropractor help with a disc-related problem?
Chiropractic care may help manage the musculoskeletal component of disc-related pain, including restoring joint movement and reducing the mechanical and inflammatory load on an irritated nerve. Whether it is appropriate in your case depends on the examination findings, and some presentations need co-management or a surgical opinion.
Is it safe to be adjusted when I have leg symptoms?
That depends on what is causing them. This is exactly why a first appointment is an examination rather than treatment. If neurological findings suggest adjusting is not appropriate, I will tell you and refer you on.
Do I need a GP referral to see a chiropractor in Western Australia?
No. Chiropractors are primary contact practitioners, so you can book directly. A referral is only needed for specific programs such as an EPC or CCMP plan through Medicare, or for DVA and insurance-funded care.
Getting sciatica assessed in Victoria Park
Freeman Chiropractic is at 249B Albany Highway, Victoria Park, and we see patients from across East Victoria Park, Kensington, South Perth, Como, Lathlain, Carlisle, Burswood and Belmont. If leg pain has been hanging around, or if you are holding a scan report you do not understand, the useful first step is finding out what is actually driving it.
Book an appointment online, or call us on 0493 290 505. You can also read more about our approach to sciatica and disc injuries. If your back has been sore for months rather than weeks, chronic low back pain covers that separately.
This article is general information and is not a substitute for an individual assessment. Dr Alex Freeman is a registered chiropractor practising in Victoria Park, Western Australia.
