Can a Chiropractor Help with Sciatica? Here's What You Need to Know.

What is Sciatica?

Sciatica is a painful condition that happens when the sciatic nerve, which runs from your lower back down through your hips and legs, is compressed or irritated, which typically occurs between the L4 and S3 vertebral levels.

Location of Sciatica Symptoms

Sciatica is primarily characterized by pain that originates from the low back region and radiates down one or both legs. Key locations and symptoms include:

• Low back pain radiating down to the posterior thigh that is often exacerbated by forward bending at the waist
• Shooting sharp pain radiating most commonly at the back of the leg sometimes all the way to the foot and toes
• Patients may also experience numbness or tingling in the lower leg
• Neurological deficits may be present, like muscle weakness, absence of tendon reflexes, or sensory deficit.
• In some cases, bladder dysfunction can also occur
• Common features also include tenderness to pressure and pain aggravated by movement. The pain can have a sudden or gradually vary in severity

Sciatica is not a diagnosis but rather a symptom

It’s important to know that sciatica is not a disease itself. Instead, it’s a set of symptoms that show up what something is affecting the sciatic nerve.

So, when someone says they have sciatica, it usually means they have the symptoms described above, but the exact cause could vary from person to person.

Causes of Sciatica

The compression of the sciatic nerve can stem from various factors:

• Disc Herniation
  • One of the leading causes of sciatica is lumbar disc herniation → occurs when the soft jelly like centre of the lumbar disc starts to push out of the outer layer of the disc causing compression onto the nerve
  • Disc herniations can be caused by excessive mechanical loading (lifting too heavy), or it can be caused by genetics or lifestyle factors like obesity and hypertension.

• Spinal Cord Compression/Narrowing:
  • Neural foramina stenosis → narrowing of the openings where spinal nerves exit the spinal cord
  • Lumbar spinal stenosis → narrowing of the spinal canal at the level of the lumbar vertebrae causing pressure on the sciatic nerve
  • Degenerative changes in the spine can also cause sciatica

• Muscle Tension Any Point Along the Nerve
  • A small muscle called the piriformis, located deep in the gluteal region, sits very close to the sciatic nerve. If this muscle becomes tight or inflamed, it can irritate the nerve, causing sciatica-like symptoms.
  • Muscle tightness or inflammation can be caused by overuse, lack of movement, muscle injury/strain from not properly stretching before exercise
  • Other nearby muscles and structures may also cause problems, such as:
    • Obturator internus and gemelli complex – deep muscles in the buttocks that can compress the nerve
    • Lower ischial tunnel – a small space near the hamstring where the nerve can get irritated
    • Quadratus femoris – another deep muscle that can put pressure on the sciatic nerve
    • Fibrous bands or scar tissue
    • Anatomical variations – in about 17% of people, the sciatic nerve goes through the piriformis muscle rather than under it. This makes nerve irritation more likely.

How Does a Chiropractor Treat Sciatica?

Chiropractors may help relieve sciatica symptoms using gentle spinal adjustments and other supportive therapies.

One approach used by some chiropractors is called Long Axis Distraction. It’s a type of mobilization that can also be used with a traction table.

How the Treatment Works

Long axis distraction is a manual therapy technique used to treat sciatica where gentle pulling is done along your thigh bone to create space in the hip joint and relieve pressure.

• Studies show that this treatment can:
  • Increase the space between the spinal bones (discs)
  • Reduce pressure inside the discs
  • Make the openings where the nerves exit the spine bigger
• These changes may help relieve pressure on the sciatic nerve and reduce pain.

This method falls under Spinal Manual Therapy (SMT) — techniques used to improve how spinal joints move and function.

Other Treatments That May Be Used Together

In some cases, chiropractors may combine Long Axis Distraction with other therapies for better results. These can include:

• Traction table – a type of gentle pulling on the spine to relieve pressure
• Electrical muscle stimulation (EMS) – uses mild electrical currents to relax muscles and ease pain
• Ultrasound Therapy - Promotes healing and relaxes musculature
• Home exercises – stretching and strengthening routines focused on the lower back and legs
• Ice packs and Heat – promote physiological changes and reduce pain
• Lifestyle advice – to help avoid movements or habits that make the pain worse

When Is a Chiropractor a Good Option for Sciatica?

Chiropractic care might be a good fit for you if:

• You want to avoid surgery
• For disc-related sciatica and prefer to try non-surgical treatments, CTFDD may be a helpful alternative.
• Other treatments haven’t worked
• If medications or injections didn’t help, this approach may offer relief.
• You’re starting conservative care
• Many cases of sciatica improve without surgery. Chiropractors offer non-invasive care that fits within this strategy.
• Your sciatica is from a herniated disc
• Long Axis Distraction can help reduce pressure from bulging discs that press on nerves.
• You're a surgical candidate but want to try other options first
• Studies show non-surgical treatments can offer similar results to surgery in some cases.

Conclusion

Sciatica can be a painful and frustrating condition that affects your ability to move, work, and enjoy daily life. While there are many causes, from herniated discs to muscle tension, chiropractic care offers a non-invasive and drug-free option that may help relieve symptoms and improve function.

Techniques like Long Axis Distraction, combined with other supportive therapies, have shown promising results in reducing nerve pressure, easing pain, and restoring mobility. For patients seeking alternatives to surgery — or for those who haven’t found relief with other treatments — chiropractic care may be worth considering.

As always, it’s important to speak with a qualified healthcare provider to determine the best treatment plan for your individual needs. But if you're dealing with sciatica and looking for a conservative approach, chiropractic care may offer the relief you've been searching for.

Sources

Fairag, M., Kurdi, R., ALkathiry, A., Sr, N. A., Alshehri, R. S., Alturkistany, F. O., Almutairi, A., Mansory, M. A., Alhamed, M. A., Alzahrani, A. S., Sr, A. M. A., Fairag, M., Kurdi, R., Alkathiry, A., Alghamdi, N., Alshehri, R., Alturkistany, F. O., Almutairi, A., Mansory, M., & Alhamed, M. (2022). Risk Factors, Prevention, and Primary and Secondary Management of Sciatica: An Updated Overview. Cureus Journal of Medical Science, 14(11). https://doi.org/10.7759/cureus.31405

Sharma, S., Kaur, H., Verma, N., & Adhya, B. (2023). Looking beyond Piriformis Syndrome: Is It Really the Piriformis? Hip & Pelvis, 35(1), 1. https://doi.org/10.5371/hp.2023.35.1.1

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Siciliano, T. B., Gudavalli, M. R., & Kruse, R. (2024). Spinal manipulation and mobilization forces delivered treating sciatica: a case report. Frontiers in Integrative Neuroscience, 18. https://doi.org/10.3389/fnint.2024.1356564

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Koes, B. W. (2020). Improving the management of sciatica. The Lancet Rheumatology, 2(7), e372–e373. https://doi.org/10.1016/s2665-9913(20)30130-2

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Written by Celina Khan