01
Identify which one it is
A disc-driven sciatica and a piriformis-driven sciatica need different care. Orthopaedic and neurological testing is how you tell them apart, and it comes before anything else.
Health conditions · Sciatica
Sciatica is a symptom.Not a diagnosis.
Pain that starts in the low back and runs down the back of the leg. It affects millions of people a year, it can be genuinely debilitating — and the word itself tells you almost nothing about what is causing it.
Down the back of the leg. Five nerve roots leave the lumbar spine and sacrum and braid into one nerve.
What sciatica actually is
Patient education — general information about the condition, not medical advice about your body. Only an examination can tell you what is going on with yours.
The sciatic nerve is the longest nerve in the body. It is not really one nerve — it is a bundle of five, which exit the lumbar spine and the sacral foramen, group together near the piriformis muscle deep in the buttock, and then run as one thick nerve down the back of each leg. It supplies strength and sensation to the leg, and it connects the big muscles down there to the spinal cord.
Here is the part that matters and that almost nobody explains: sciatica is not a diagnosis. It is a set of symptoms. Saying you have sciatica is like saying you have a cough — it describes what you are feeling, not what is wrong. Something is irritating the nerve at its root, and the actual clinical question is always what.
The usual culprits are a herniated or bulging disc pressing on a nerve root (the most common cause by far), piriformis syndrome where the muscle in the buttock tightens or spasms onto the nerve, spinal stenosis where the canal narrows and crowds the nerves, spondylolisthesis where a vertebra slips forward and narrows the exit the nerve leaves through, and plain wear and tear in the lower spine. Those are five very different problems that all feel like the same leg pain — which is exactly why the exam matters more than the label.
How it shows up.
Does this sound like you?
Tick what you actually feel.
Not a diagnosis, and not a test — nothing here can tell you what you have. It is a list you can take with you, because everybody forgets half of it the moment a doctor walks into the room.
0 things to mention. However many you ticked, the exam is what tells you anything.
What tends to be behind it
01
Disc herniation
The most common cause. A disc bulges or herniates and presses on the nerve root as it leaves the spine.
02
Piriformis syndrome
The piriformis muscle sits deep in the buttock, directly over the nerve. When it tightens or spasms it can irritate the sciatic nerve without any disc being involved at all.
03
Stenosis and slippage
Spinal stenosis narrows the canal; spondylolisthesis is a vertebra slipping forward and narrowing the exit the nerve uses. Both crowd the nerve.
04
Risk that stacks
Age-related change in the spine, excess weight, diabetes (which raises nerve-damage risk generally), and occupations with prolonged sitting all raise the odds.
How care approaches it
What Dr. Meansactually does about it.
Written as aims, not outcomes — because that is all anyone can honestly promise you before they have examined you.
02
Take pressure off the root
Where the problem is mechanical, adjustments aim to restore motion and reduce the irritation at the nerve root rather than chase the leg pain where you feel it.
03
Work the soft tissue
If the piriformis is the offender, the disc was never the point. Soft-tissue work and specific stretching address the muscle that is actually sitting on the nerve.
04
Try conservative care first
Sciatica is a case where the conservative option is worth exhausting before the invasive one. That is a general principle, not a promise about your leg.
Chiropractic care is not a cure for any condition on this page, and no honest clinic will promise you one. What Dr. Means can do is examine you, tell you plainly whether this is something chiropractic care is suited to help with, and refer you elsewhere if it isn't.
If you come in
Here is what actually happens.
Step 01
Free consultation
Call or book online and we'll sit down with you at no cost or obligation. Tell us what's going on and we'll start building the picture.
Read this part
When this is not a chiropractic problem.
Some of what looks like sciatica is something else, and some of it is urgent. A clinic that only ever tells you it can help is not being straight with you. If any of the following is true, do not book a chiropractic appointment — get medical care.
- Numbness through the groin, genitals or inner thighs, or new loss of bladder or bowel control — go to an emergency room now. This can be cauda equina syndrome and it is time-critical.
- Weakness that is getting worse, especially a foot you cannot lift.
- Sciatic pain down BOTH legs at once.
- Sciatica that starts right after a serious fall or crash.
This page is general health information, not medical advice, and it is not a substitute for examination by a qualified provider. In an emergency call 911. See our healthcare disclaimer.
Is sciatica the same as a pinched nerve?
Not quite. A pinched nerve is one of several things that can cause sciatica. The sciatic pain is the symptom; the pinch — if there is one — is the cause.
Why does sitting make it worse?
Sitting raises the pressure inside the lumbar discs and folds the low back into the position that tends to crowd the nerve root. It is one of the most reliable tells.
Will it go away on its own?
Many episodes settle over time. That is not the same as saying the thing causing it has resolved, which is why it is worth finding out what it was.
Do I need surgery?
That is not a question a chiropractor answers for you — it is a conversation with a surgeon, and it depends on findings a chiropractor does not own. What Dr. Means can do is tell you honestly whether he thinks conservative care is a reasonable thing to try first, and refer you on if it is not.
Not sure if this is what you have?
That is what the consultation is for — and it costs you nothing to find out. If it turns out Dr. Means is not the right person for it, he will tell you that too.