The sciatic nerve is the nerve that comes from the lower part of the spinal cord where its “roots” exit the spine and form into the largest nerve in the body. This nerve can become inflamed, irritated, pinched, squeezed, trapped, bruised, or diseased. When this nerve is irritated in any of these ways an abnormal feeling will result anywhere along the course of the sciatic nerve, from where its roots exit the spine, all the way down to the tips of the toes where the nerve ends. This condition is called sciatica. Depending on where the nerve is irritated and what is causing the irritation the sensation the person feels will be different. The feeling might be pain, burning, squeezing, pressure, aching, tingling, numbness, cramping, weakness, a feeling like the leg is wet, or a feeling that ants are crawling on the skin. Sometimes, but not always, the sciatica is accompanied by lower back pain. The most important thing in the treatment of sciatica is to find the cause of the problem. Where is the sciatic nerve being irritated? How is it being irritated? It really doesn’t matter if the pain is severe or mild. Sometimes a very serious sciatica might only cause mild pain, and sometimes a mild sciatica will cause severe pain. What matters more is the degree of leg weakness and numbness, and if there are any reflex changes in the leg. X-rays will be necessary to find certain lower back problems that might be causing the sciatica. Sometimes a CT or MRI is needed to better evaluate the source of the sciatic nerve irritation. Orthopedic tests will be done by the chiropractor to see where the nerve is being irritated. Often the problem is in the lower back, usually the lower lumbar discs. Sometimes the patient has no lower back pain at all yet they have sciatica. The chiropractor may find a lower back problem and fix it and the sciatica will resolve completely. The patient is often very surprised (and pleased) because they went to the chiropractor with a painful and weak leg and didn’t have any idea that their back was the cause of the sciatica. Sometimes the nerve is being trapped in the muscles of the buttocks. There is a small muscle called the piriformis that often gets tight and puts pressure on the sciatic nerve. This condition is sometimes called “piriformis syndrome”. Often the most painful area is a local area in the buttock known as the sciatic notch. This is the area where the sciatic nerve exits the pelvis and it is where the sciatic nerve is at its thickest. Sometimes carrying your wallet in your back pocket, sitting too much, or sleeping the wrong way might cause sciatica by irritating the nerve in that area. It is usually a simple condition to diagnose and fix. If the nerve is being inflamed by a bulging disc or a narrowed spinal canal the “fix” is not so simple and quick. Once a diagnosis is made with regard to where the sciatica is coming from, treatment can be started right away. However if the problem is in the disc the patient will be given special exercises to do. They might be instructed to lose weight, or change their sleeping or sitting habits. Sometimes medication is necessary to help with the pain while the chiropractor helps to take the pressure off the sciatic nerve. Sometimes spinal injections are needed if the pain is severe. These injections have side effects and should only be done if absolutely necessary to give the patient some short term relief. Sometimes surgery is the only thing that will take the pressure off the sciatic nerve. Obviously spinal surgery is a serious thing that should only be done if absolutely necessary, and the patient is encouraged to discuss the pros and cons with the chiropractor and the surgeon. In summary, sciatica is a common symptom of irritation of the sciatic nerve. Sciatica is not a diagnosis. If you go to your medical doctor with leg discomfort or numbness and the doctor tells you that you have “sciatica” you should say “I know I have sciatica. I want you to figure out where the sciatica is coming from!” Chiropractors are sciatica experts who will listen to your symptoms, examine you, and find out the cause of your sciatica. At that time proper treatment can begin to relive the problem that is causing the symptom known as “sciatica”.