The sciatic nerve is actually the sum of many nerve roots... most of them coming from the lower back; so there can be several causes of sciatic pain. Often a bulging, herniated, or degenerative disc can press or irritate one of the nerve roots exiting the lower back. Additionally the sciatic nerve usually passes under the piriformis muscle, located in the mid/upper buttock area, so tightness or spasm of this muscle can be a contributor to sciatic pain as well.
Treatment of sciatica naturally depends on the source of the pain. If a disc is causing the pain, attention is focused there. As I discussed in the section on disc problems, I try to optimize the alignment and motion of the lower back and pelvis so as to relieve any abnormal pressure on the discs. If there is a short leg causing pelvic unleveling, I may prescribe a heel lift for the short leg. If the piriformis muscle is tight or in spasm, I address that with stretching and massage.
Cold or therapeutic laser treatments often help to relieve pain and inflammation, and can treat much deeper into the involved joints than other types of modalities.
Patient involvement in this type of problem is always helpful. I usually demonstrate stretches and exercises that can help balance muscle weakness or imbalance. Proper abdominal and core strengthening exercises give critical support to the lower back, and minimize gravitational pressure on the involved discs.
Treatment of sciatica is rarely a quick fix. The usual involvement of lumbar discs dictates that a steady multi-faceted approach be taken. In nearly all cases, chiropractic treatment can help resolve sciatic symptoms with patience and persistence. There are situations where more aggressive approaches, such a corticosteroid injections or surgery are indicated. My experience has taught me when it’s appropriate to consider these options as well, and I have a network of surgeons and pain specialists that I trust in those situations.