Sciatica: Causes, Symptoms, and Chiropractic Care in Pearland

Q: Can a chiropractor help with sciatica?

Yes. Chiropractic spinal manipulation has been tested in randomized trials of patients with sciatica, including patients whose disc herniations were confirmed on MRI. In The Spine Journal trial, real manipulations left 55% of patients free of radiating pain compared with 20% who received sham treatment, and in the JMPT surgery comparison, 60% of patients who had failed other care did as well with manipulation as with surgery. Your exam tells us which approach fits your case.

Q: How long does sciatica last?

It depends on the cause and how long it has been building. Many acute episodes improve over several weeks with care. In the study of 148 disc herniation patients, most acute patients reported improvement within the first month, and 90.5% of all patients reported improvement by three months. Chronic sciatica takes longer but also improved for most patients in that study. We re-examine along the way so you can see your progress.

Q: What is the difference between sciatica and lower back pain?

Lower back pain stays in the back. Sciatica travels down the leg along the sciatic nerve, often below the knee, and frequently comes with tingling, numbness, or weakness. Many people have both. Our lower back pain guide covers back pain in depth.

Q: Will I need surgery for sciatica?

Most people do not. In the BMJ Open study of more than 11,000 adults with disc herniation or radiculopathy, fewer than 3% in either group had surgery within a year, and the chiropractic group had lower odds of surgery. If your exam shows that you need a surgical opinion, we will tell you and help you get there.

Q: Is chiropractic care safe for sciatica caused by a herniated disc?

The trials above included patients with MRI-confirmed disc herniations. The Annals of Internal Medicine trial reported no serious treatment-related adverse events, and the 148-patient disc herniation study reported no adverse events. Some patients feel mild soreness after an adjustment, much like after exercise, and it passes quickly. Your exam screens for the rare cases where a different approach is needed first.

Sciatica has a way of announcing itself. You bend to tie a shoe, or you climb out of the truck after a long drive down 288, and a bolt of pain runs from your lower back or buttock down the back of one leg. Sometimes it burns. Sometimes it tingles, or the foot feels half asleep. Sitting makes it worse, and sleep gets hard to come by.

If that sounds familiar, you are not alone. Sciatica is one of the most searched-for pain conditions in the country, and it is one of the most common reasons people walk into Premier Chiropractic. The good news is that sciatica is also one of the conditions where chiropractic care has been tested most directly, including in randomized trials of patients with MRI-confirmed disc herniations. This guide explains what sciatica is, what causes it, what the research shows about chiropractic care for it, and what to expect from sciatica treatment at Premier Chiropractic in Pearland.

What is sciatica?

Sciatica is not a diagnosis by itself. It is a description of a symptom: pain that follows the path of the sciatic nerve, the largest nerve in the body. The sciatic nerve forms from several nerve roots that leave the lower spine, passes through the buttock, and runs down the back of the thigh before branching toward the calf and foot.

When one of those nerve roots is irritated or compressed where it leaves the spine, the pain shows up along the nerve's path rather than only at the spine. That is why sciatica is usually felt in the buttock, thigh, calf, or foot, and why it is almost always on one side. Doctors call this radicular pain or lumbar radiculopathy.

Common sciatica symptoms include:

Pain that travels from the lower back or buttock down one leg, often below the knee

Burning, electric, or shooting pain rather than a dull ache

Tingling, pins and needles, or numbness in the leg or foot

Weakness in the leg, or a foot that feels clumsy or drags

Pain that gets worse with sitting, coughing, sneezing, or bending forward

What causes sciatica?

Several structures in the lower spine can irritate the sciatic nerve roots. A thorough exam is what tells them apart, and that matters because the cause shapes the plan.

Lumbar disc herniation or bulge: The most common cause in working-age adults. The soft center of a spinal disc pushes outward and presses on or chemically irritates the nerve root next to it.

Spinal stenosis: With age, the openings that nerves pass through can narrow because of arthritis, bone spurs, or thickened ligaments. This kind of sciatica often flares with walking or standing and eases when you sit or lean forward on a shopping cart.

Joint restriction and dysfunction: Spinal joints and sacroiliac joints that are not moving well can irritate nearby nerve roots and cause the surrounding muscles to guard and tighten.

Piriformis involvement: The piriformis is a deep buttock muscle that sits right next to the sciatic nerve. When it is tight or in spasm, it can produce sciatica-like symptoms.

Spondylolisthesis: When one vertebra slips forward on the one beneath it, the nerve roots can be pinched.

Injury: Car accidents, falls, and lifting injuries can herniate a disc or inflame a joint and trigger sciatica days or weeks later. If your leg pain started after a collision, see our auto accident care page.

What the research says about chiropractic care for sciatica

Lower back pain in general has decades of chiropractic research behind it. Sciatica has its own body of evidence, and much of it involves patients whose disc herniations were confirmed on MRI.

A randomized, double-blind trial found real adjustments beat sham adjustments. In a trial published in The Spine Journal, 102 patients with acute back pain and sciatica from an MRI-confirmed disc protrusion were randomly assigned to either active spinal manipulations or simulated manipulations. The results favored the real thing: "Manipulations appeared more effective on the basis of the percentage of pain-free cases (local pain 28 vs. 6%; p<.005; radiating pain 55 vs. 20%; p<.0001), number of days with pain (23.6 vs. 27.4; p<.005), and number of days with moderate or severe pain (13.9 vs. 17.9; p<.05)." The authors concluded that "active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion" (Santilli et al., The Spine Journal, 2006).

Manipulation was compared head to head with surgery. In a randomized study in the Journal of Manipulative and Physiological Therapeutics, 40 patients with sciatica from a lumbar disc herniation, all of whom had already failed at least three months of nonoperative care, were assigned to either surgical microdiskectomy or chiropractic spinal manipulation. The authors reported that "sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention." Patients who did not get enough relief from manipulation were able to cross over to surgery and did well, so trying manipulation first cost them nothing (McMorland et al., JMPT, 2010).

Spinal manipulation plus home exercise outperformed home exercise alone. A trial in Annals of Internal Medicine enrolled 192 patients with back-related leg pain that had lasted at least four weeks. One group received spinal manipulation plus home exercise and advice; the other received home exercise and advice alone. At 12 weeks, the spinal manipulation group had a "clinically important advantage" in leg pain, and "nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks." Global improvement, satisfaction, and medication use were still better at one year, and "no serious treatment-related adverse events or deaths occurred" (Bronfort et al., Annals of Internal Medicine, 2014).

Most disc herniation patients reported improvement, including chronic ones. In a prospective study of 148 patients with low back and leg pain from MRI-confirmed lumbar disc herniations treated with chiropractic spinal manipulation, "at 3 months, 90.5% of patients were 'improved' with 88.0% 'improved' at 1 year." Patients whose pain had been chronic did well too, with 89.2% reporting improvement at one year, and "there were no adverse events reported." This was an observational study, so it describes what patients experienced under care rather than proving cause and effect, but the numbers are encouraging (Leemann et al., JMPT, 2014).

Chiropractic care is associated with fewer surgeries and fewer opioids

Where you start your sciatica care appears to matter. Two recent studies used large U.S. health record databases to compare adults who began with chiropractic spinal manipulation against similar adults who received other care. Both are observational, so they show associations rather than cause and effect, but both point the same direction.

Fewer disc surgeries. Researchers matched 5,785 adults aged 18 to 49 with newly diagnosed lumbar disc herniation or radiculopathy who started with chiropractic spinal manipulation against 5,785 similar adults who received other care. Over one year, 1.5% of the chiropractic group had a discectomy compared with 2.2% of the other-care group, and the authors concluded that chiropractic care "is associated with significantly reduced odds of discectomy over 2-year follow-up" (Trager et al., BMJ Open, 2022).

Fewer opioid prescriptions. In a similar study of adults aged 18 to 50 with newly diagnosed radicular low back pain who had never been prescribed opioids, 1.3% of those who started with chiropractic spinal manipulation received a tramadol prescription within a year, compared with 4.0% of those who started with usual medical care. The authors concluded that "US adults initially receiving CSM for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up" (Trager et al., BMJ Open, 2024).

Surgery and medication have their place, and when an exam shows that a patient needs them, we say so. For most sciatica, though, the research supports starting with conservative chiropractic care.

What happens during a sciatica evaluation at Premier?

Your plan starts with the exam, not a template. Sciatica can come from a disc, a narrowed nerve opening, a restricted joint, or a tight muscle, and each calls for a different emphasis. Your first visit includes:

A detailed history: when the leg pain started, exactly where it travels, whether it goes below the knee, what makes it better or worse, any numbness or weakness, and what it is keeping you from doing.

A hands-on examination: orthopedic tests such as the straight-leg raise, range-of-motion testing of the lower back and hips, palpation of the spine, sacroiliac joints, and buttock muscles, and a neurological screening of strength, sensation, and reflexes in both legs.

Imaging when the exam calls for it: X-rays show the bones and alignment of the spine. MRI shows discs and nerves and is the study that confirms a disc herniation. Your doctor will explain what any recommended imaging is meant to answer.

A clear explanation: what we found, which structure is irritating the nerve, and what we recommend.

Come with two or three goals. "I want to sit through a workday without my leg burning." "I want to drive to Galveston without stopping every twenty minutes." Goals like these let us measure your progress in terms that matter to you.

Sciatica treatment at Premier: more than an adjustment

The chiropractic adjustment is the center of care because it restores motion to spinal and pelvic joints that are not moving properly and takes pressure off irritated nerve roots. The best results come from a complete plan matched to what your exam found. Depending on your findings, your plan at Premier may include:

Chiropractic adjustments:** specific adjustments to the lower spine and pelvis, chosen for the location of your disc or joint problem. This is the kind of care studied in the trials above.

Spinal decompression:** gentle, computer-controlled traction designed to create space in the lower spine and reduce pressure on a bulging or herniated disc. It is often part of the plan when a disc is the source.

Physical rehabilitation:* nerve-gliding movements, directional exercises, core and hip strengthening, and soft-tissue work on the piriformis and hip muscles so the nerve has room to move and your results last. The Annals of Internal Medicine* trial paired spinal manipulation with home exercise, and that is how we practice.

MLS laser therapy:** a non-invasive, drug-free option your doctor may add when the exam findings call for it.

Guidance for daily life: how to sit, lift, sleep, drive, and move while the nerve settles down.

We re-examine along the way. If you are not progressing the way we expect, we adjust the plan.

Practical self-care tips for sciatica

Keep moving, within reason. Bed rest tends to make sciatica worse. Short, frequent walks on flat ground are usually the best starting point.

Change positions often. Sitting loads the discs more than standing. Stand, walk, or lie down for a few minutes every half hour.

Watch your posture in the car. Long commutes are a common trigger. Sit upright with your hips level with your knees, keep your wallet out of your back pocket, and take breaks on longer drives.

Sleep supported. Side sleepers can place a pillow between the knees. Back sleepers can place one under the knees.

Follow your exercise plan. The exercises your chiropractor gives you are chosen for the specific cause of your sciatica. Ask before adding stretches you found online, because some popular "sciatica stretches" make disc-related sciatica worse.

When sciatica needs emergency care

Chiropractors are trained to recognize the rare cases that need a different kind of help, and screening for them is part of every sciatica exam. Go to the emergency room or call 911 if you have:

New loss of bladder or bowel control, or difficulty starting urination

Numbness in the groin, inner thighs, or around the rectum

Rapidly worsening weakness in the leg or foot, or weakness in both legs

Leg pain with fever, chills, or unexplained weight loss

Sciatica that begins after a serious accident or fall

These signs are uncommon, but they call for same-day medical evaluation, and we will help you get it.

Sciatica: frequently asked questions

Can a chiropractor help with sciatica?

Yes. Chiropractic spinal manipulation has been tested in randomized trials of patients with sciatica, including patients whose disc herniations were confirmed on MRI. In The Spine Journal trial, real manipulations left 55% of patients free of radiating pain compared with 20% who received sham treatment, and in the JMPT surgery comparison, 60% of patients who had failed other care did as well with manipulation as with surgery. Your exam tells us which approach fits your case.

How long does sciatica last?

It depends on the cause and how long it has been building. Many acute episodes improve over several weeks with care. In the study of 148 disc herniation patients, most acute patients reported improvement within the first month, and 90.5% of all patients reported improvement by three months. Chronic sciatica takes longer but also improved for most patients in that study. We re-examine along the way so you can see your progress.

What is the difference between sciatica and lower back pain?

Lower back pain stays in the back. Sciatica travels down the leg along the sciatic nerve, often below the knee, and frequently comes with tingling, numbness, or weakness. Many people have both. Our lower back pain guide covers back pain in depth.

Will I need surgery for sciatica?

Most people do not. In the BMJ Open study of more than 11,000 adults with disc herniation or radiculopathy, fewer than 3% in either group had surgery within a year, and the chiropractic group had lower odds of surgery. If your exam shows that you need a surgical opinion, we will tell you and help you get there.

Is chiropractic care safe for sciatica caused by a herniated disc?

The trials above included patients with MRI-confirmed disc herniations. The Annals of Internal Medicine trial reported no serious treatment-related adverse events, and the 148-patient disc herniation study reported no adverse events. Some patients feel mild soreness after an adjustment, much like after exercise, and it passes quickly. Your exam screens for the rare cases where a different approach is needed first.

Sciatica care at Premier Chiropractic in Pearland

Leg pain that follows you from the couch to the car to the bed is not something you have to live with, and you do not have to start with pills or surgery. Learn more on our sciatica care page and our herniated and bulging disc page, then choose the location that works for you:

Old Town Pearland: 2018 E Broadway St, Pearland, TX 77581. Call (281) 485-2955.

Town Center Pearland: 11470 Broadway St #110, Pearland, TX 77584. Call (281) 741-1409.

Schedule your sciatica evaluation online or contact Premier Chiropractic with your questions. Bring your goals. We will find the cause and give you a clear plan to get back to your life.

References

1. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6(2):131-137.

2. McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. 2010;33(8):576-584.

3. Bronfort G, Hondras MA, Schulz CA, Evans RL, Long CR, Grimm R. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014;161(6):381-391.

4. Leemann S, Peterson CK, Schmid C, Anklin B, Humphreys BK. Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: a prospective observational cohort study with one-year follow-up. J Manipulative Physiol Ther. 2014;37(3):155-163.

5. Trager RJ, Daniels CJ, Perez JA, Casselberry RM, Dusek JA. Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States' data. BMJ Open. 2022;12(12):e068262.

6. Trager RJ, Cupler ZA, Srinivasan R, Casselberry RM, Perez JA, Dusek JA. Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data. BMJ Open. 2024;14(5):e078105.

This article is for educational purposes and is not a substitute for an examination by a licensed healthcare provider.