Sciatica
Sciatica: What's Actually Pinching the Nerve, and How Chiropractors Check for It
Sciatica is a description of where the pain travels, not a diagnosis of what's causing it. Here's what most often puts pressure on the sciatic nerve, how a chiropractic exam narrows it down, and the warning signs that mean you should skip the chiropractor and go straight to the ER.
By Dr. Edward Johns, DC · September 24, 2026 · 7 min read
Sciatica Describes Where It Hurts, Not Why
Sciatica gets used like a diagnosis, but it's really a description. It means pain, tingling, numbness, or weakness that follows the path of the sciatic nerve, which is the largest nerve you have. There's one on each side. It starts near the base of your spine, passes through your pelvis and buttock, then runs down the back of your thigh and into your lower leg.
That's why sciatica usually shows up in your bottom and the back of one leg, often all the way into the foot and toes. The nerve is the messenger. Something upstream is irritating or pressing on it, and figuring out what that something is decides how it should be treated.
What Usually Puts Pressure on the Sciatic Nerve
A slipped or herniated disc is the most common cause. The soft center of a disc pushes out and crowds the nerve root where it leaves the spine. In people under 40, a herniated disc is the typical culprit, while older adults are more likely to have arthritis and bone spurs doing the crowding. These are the usual suspects:
- Herniated (slipped) disc pressing on a nerve root in the low back
- Spinal stenosis, a narrowing of the space the nerves travel through
- Spondylolisthesis, where one vertebra slips forward over the one below it
- Degenerative disc disease and osteoarthritis
- Piriformis syndrome, where a muscle deep in the buttock irritates the nerve
- Pelvic injury or fracture
- Pregnancy
- A tumor, cyst, or other growth near the spine
Signs Your Leg Pain Is Coming From the Sciatic Nerve
Not every sore leg is sciatica. A pulled hamstring hurts where you pulled it. Nerve pain tends to travel, and it usually has a few telltale features:
- A sharp or burning pain that runs from your bottom down the back of one leg
- Tingling, like pins and needles, in the leg, foot, or toes
- Numbness somewhere along that same path
- Weakness in the leg or foot, like trouble walking on your toes
- Pain that gets worse when you move, sneeze, or cough
How a Chiropractor Narrows Down the Cause
The exam starts with conversation: when it started, what makes it better or worse, and whether anything like a fall or heavy lift kicked it off. From there, a lot can be learned from simple hands-on tests that are standard in orthopedic and chiropractic exams alike.
Imaging comes next when it's useful. X-rays show bone: abnormal curves, fractures, bone spurs, and narrowing between vertebrae. What they can't show is the disc, the nerve, or the soft tissue itself, so an X-ray alone can't diagnose a herniated disc, spinal stenosis, or sciatica. When a disc or nerve problem looks more significant, an MRI (or sometimes a CT scan) is what shows it.
- Watching how you walk, squat, and stand back up
- The straight leg raise, where your leg is slowly lifted while you lie on your back to see if it brings on the nerve pain
- Walking on your heels and toes
- Checking your reflexes and whether you've lost any feeling or have numbness
Warning Signs That Need Emergency Care, Not a Chiropractor
Most sciatica is painful but not dangerous. A few symptoms are different. They can mean serious pressure on the nerves at the bottom of the spine, and they need the ER (or 911), not a scheduled appointment with us or anyone else:
Two other situations deserve a prompt call to your doctor rather than waiting it out: back pain with a fever you can't explain, and back pain after a hard fall or blow.
- Loss of bladder or bowel control
- Numbness around or under your genitals, or around your bottom
- Sciatica on both sides at once
- Weakness or numbness in both legs that's severe or getting worse
How We Approach Sciatica at North River
We start with a hands-on exam and digital X-rays to find where the compression is likely coming from and what your spine's structure looks like. If we find signs of a more significant nerve problem, like true muscle weakness or lost reflexes, we'll tell you directly and help coordinate an MRI or a referral rather than treating around it.
When a disc is involved, CBP traction helps take pressure off the nerve, and chiropractic adjustment works on the alignment problem underneath it. Physiotherapy builds the strength and mobility that help keep it from coming back. We'll be straight about the research, too. For low back pain in general, spinal manipulation has moderate-quality evidence for modest improvements in pain and function, and the American College of Physicians lists it as a treatment option (while rating its own supporting evidence as low-quality). Those findings are about low back pain broadly, not sciatica specifically, which is one more reason we build the plan around what your own exam shows.
What Recovery Usually Looks Like
The good news is that most sciatica gets better. Many cases improve within four to six weeks, and roughly 80 to 90% of people with sciatica get better without surgery. More stubborn cases can take a few months.
Staying moving helps. Keep up your normal activities as much as you can, start gentle exercise as soon as you're able, and avoid sitting or lying down for long stretches. Bed rest isn't recommended. Sciatica does have a habit of coming back, especially when the thing pressing on the nerve calmed down but never really changed. That's the part of care we pay the most attention to.
FAQ
Frequently asked questions
Is sciatica always caused by a herniated disc?+
No. A herniated disc is the most common cause, but spinal stenosis, spondylolisthesis, degenerative disc disease, osteoarthritis, piriformis syndrome, pelvic injury, and pregnancy can all irritate the sciatic nerve.
Will an X-ray show if I have sciatica?+
Not directly. X-rays show bone, curves, and things like bone spurs or narrowing between vertebrae, but they can't show discs or nerves. If a disc or nerve problem looks significant, an MRI or CT scan is the test that shows it.
How long does sciatica last?+
Many cases improve within four to six weeks. Some take a few months, and about 80 to 90% of people get better without surgery.
Should I rest in bed with sciatica?+
No, bed rest isn't recommended. Keep up your normal activities as much as you can, start gentle exercise early, and avoid sitting or lying down for long periods.
When is sciatica an emergency?+
Go to the ER if you lose bladder or bowel control, have numbness around your genitals or bottom, have sciatica on both sides, or have weakness or numbness in both legs that's severe or getting worse.
Can a chiropractor help with sciatica?+
For many people, yes, as part of a plan built around the actual cause. At North River that usually means an exam and digital X-rays first, then a mix of adjustment, CBP traction, and physiotherapy. If your exam points to a bigger nerve problem, we'll refer you instead.
Sources
- 1. Cleveland Clinic - Sciatica
- 2. NHS - Sciatica
- 3. MedlinePlus (U.S. National Library of Medicine) - Sciatica
- 4. MedlinePlus (U.S. National Library of Medicine) - Lumbosacral spine x-ray
- 5. OrthoInfo (American Academy of Orthopaedic Surgeons) - Sciatica
- 6. NCCIH (National Institutes of Health) - Low-Back Pain and Complementary Health Approaches
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