What sciatica is
The sciatic nerve is the largest nerve in the body. It forms from nerve roots in the lower spine, passes through the buttock and runs down the back of each leg to the foot. Sciatica is the name for pain that follows this path when a nerve root or the nerve itself is irritated or compressed.
Sciatica usually affects one side. It can feel sharp, burning or electric, and it is often worse in the buttock and leg than in the back itself. Many people also notice tingling, numbness or a heavy, weak feeling in the leg or foot.
Sitting, bending forward, coughing or sneezing often make sciatica flare, while walking or lying in certain positions may ease it. The pattern of your symptoms gives useful clues about where the irritation is coming from.
Many cases of sciatica improve with time and conservative care. A smaller number involve significant nerve pressure that needs prompt medical attention, which is why a careful neurological exam is always the first step.
What can cause sciatica and leg pain
Several different problems can irritate the sciatic nerve or the nerve roots that form it. These are the most common.
- Herniated or bulging disc
- A disc in the lower back can bulge or herniate and press on a nearby nerve root. This often causes leg pain that is worse with sitting, bending and coughing.
- Spinal stenosis
- Narrowing of the spaces where nerves travel is more common with age. It often causes leg pain or heaviness when standing or walking that eases when you sit or lean forward.
- Piriformis and buttock tension
- Tight muscles deep in the buttock can irritate the sciatic nerve as it passes nearby. Pain tends to sit in the buttock and may worsen with long sitting.
- Joint irritation in the low back or pelvis
- Irritated facet or sacroiliac joints can refer pain into the buttock and thigh. This referred pain usually stops above the knee and is not true nerve pain, but it can feel similar.
- Degenerative disc changes
- Age-related changes in the discs can narrow the openings where nerve roots exit. Symptoms may come and go with activity and posture.
- Pregnancy and posture changes
- Changes in posture and load during pregnancy can lead to buttock and leg pain. Chiropractic care for pregnant women uses gentle, modified techniques and works alongside your OB.
How Dr. Okhowat evaluates and treats sciatica
Because sciatica involves a nerve, the exam is thorough and safety comes first.
History and red flag screening
Dr. Okhowat asks where the pain travels, what makes it worse and whether you have numbness, weakness or any change in bladder or bowel function. Those answers decide whether care can start or whether you need a physician first.
Neurological and spinal exam
He tests reflexes, strength and sensation in both legs, along with nerve tension tests and spinal movement. The results help show which nerve root may be involved and how irritated it is.
Conservative hands-on care
Care may include gentle spinal adjustments or mobilization, soft tissue work for the buttock and hip muscles and, for some disc-related cases, spinal decompression therapy. Positions are chosen to keep you as comfortable as possible.
Positions and movement that calm the nerve
You will learn positions that ease your leg symptoms, how to sit and get out of a chair with less strain and gentle movements to keep the nerve gliding. Exercises progress as your symptoms settle.
Monitoring and referral
Your leg strength and sensation are rechecked at follow-up visits. If symptoms worsen or do not improve as expected, you will be referred for imaging or a medical or surgical opinion.
What care may help with
Sciatica responds differently from person to person. For many people without serious nerve compression, conservative care may help in these ways.
- Leg pain that may settle and move back toward the low back, which is often a sign of progress.
- Easier sitting, driving and getting in and out of a car.
- Better sleep with positions that take pressure off the nerve.
- Gradual return of comfortable walking and activity.
- A non-surgical option to try when there are no signs that surgery is needed urgently.
Is this right for me?
Chiropractic care is often a reasonable first step for sciatica when leg strength is normal and there are no red flags. It can also be coordinated with your physician, pain specialist or surgeon.
Some symptoms mean a nerve or the spinal cord is under serious pressure. These are emergencies or need prompt medical care, so please see a physician or go to the emergency room if any of the following apply.
Often a good fit
- Buttock or leg pain on one side that changes with sitting, standing or walking
- Tingling in the leg with normal strength
- Sciatica that has come and gone over months
- People who want to explore conservative care before injections or surgery
See a physician first
- Loss of bladder or bowel control, or new trouble urinating
- Numbness in the groin, genitals, buttocks or inner thighs (saddle area)
- Leg or foot weakness that is getting worse, or foot drop
- Sciatica in both legs at the same time
- Back or leg pain with fever, a history of cancer or unexplained weight loss
- Leg pain after a serious fall or accident
- Calf pain with swelling, warmth or redness, which may signal a blood clot
If you have any of these, please see a physician or go to urgent care before booking. In an emergency, call 911.
How Dr. Okhowat approaches sciatica
Over 19 years of chiropractic practice, building on his Doctor of Chiropractic training at Cleveland Chiropractic College, inform how Dr. Omid Okhowat approaches leg pain. Because sciatica involves an irritated nerve, his care follows a careful, step-by-step approach built around regular nerve checks.
As a Diplomate of the College of Manipulative and Body Based Practices and a Fellow of the American Association of Integrative Medicine, he combines precise hands-on care with attention to how you sit, sleep, work and move. He explains what he finds in plain language so you understand the reasons behind each step.
Okhowat Chiropractic sits on Wilshire Boulevard just west of Fairfax Avenue, a short drive from West Hollywood and Beverly Grove. If your exam suggests a problem that needs imaging or a surgical consultation, Dr. Okhowat will make that clear and help you plan the referral.
- DC, Cleveland Chiropractic College
- AAIM Fellow
- AAIM Diplomate, Manipulative and Body Based Practices
- Over 19 years of experience
He's not a chiropractor. He's a magician!
Sciatic nerve pain is now gone. Have no idea how he did it but honestly I do not care. Best chiropractor in L.A.
Questions patients ask
Can a chiropractor help with sciatica?
Many people with sciatica improve with conservative care such as spinal manipulation, mobilization, decompression and exercise. Whether it is right for you depends on your exam, especially your leg strength and reflexes. Serious nerve compression needs medical care first.
How long does sciatica last?
Many episodes improve over several weeks to a few months, though some people have recurring flares. Progress is often uneven, with good and bad days. Pain moving out of the leg and back toward the spine is often a positive sign.
Should I rest in bed with sciatica?
Short rest during a bad flare is fine, but long bed rest tends to slow recovery. Gentle walking and changing positions often help more. Your plan will include movements that suit your current symptoms.
Is spinal decompression safe for sciatica?
Decompression is a gentle, non-surgical traction method that may help some disc-related cases. It is not right for everyone, including people with certain fractures, implants or advanced osteoporosis. Dr. Okhowat will review your history before recommending it.
What is the most comfortable way to sleep with sciatica?
Many people do well lying on their back with pillows under the knees or on their side with a pillow between the knees. Try a few positions and note which one eases your leg. Avoid staying in one position too long if it increases your symptoms.
When does sciatica need surgery?
Surgery is usually considered when there is significant or worsening weakness, loss of bladder or bowel control, or severe pain that does not respond to conservative care. A surgeon makes that decision. Most people with sciatica do not need surgery.
Why does sitting make my leg pain worse?
Sitting increases pressure on the lower discs and can stretch an irritated nerve. Short sitting periods, a small lumbar cushion and standing breaks every 20 to 30 minutes often help.