The pain does not stay in your back. It travels — down through the buttock, along the back of the thigh, sometimes past the knee and into the foot. Sitting makes it worse. So does standing. Some people find that lying down does not help either.
That pattern has a name, and almost everyone reaches for it: sciatica. But naming it is not the same as understanding it, and the difference matters more than most people are told.
Sciatica is a symptom, not a diagnosis
Sciatica describes pain travelling along the path of the sciatic nerve. It tells you which nerve is irritated. It does not tell you what is irritating it — and that is the part that determines what actually helps.
Two people can arrive with identical leg pain and need completely different care, because in one the nerve root is compressed by a disc and in the other the nerve is being squeezed by a tight muscle well below the spine. Treating both the same way means getting one of them wrong.
What actually compresses the nerve
Sciatica is caused by compression or irritation of the sciatic nerve, usually where it exits the lower spine. The common sources are:
- A herniated or bulging disc pressing on the nerve root as it leaves the spine.
- Spinal stenosis — narrowing of the spinal canal, which tends to feel worse standing and walking and better leaning forward.
- Piriformis syndrome — tightness in a deep buttock muscle compressing the nerve below the spine entirely.
- Degenerative disc disease — as discs thin over time, the opening the nerve passes through narrows.
- Spondylolisthesis — one vertebra slipping forward relative to the one beneath it.
Those are not interchangeable. A disc problem and a piriformis problem produce similar-sounding pain and respond to different care. We wrote separately about the case where sciatica is not actually coming from a disc, and about what it means when a specific nerve root is involved.
Why "treat the back" is not specific enough
A generic back treatment applied to leg pain is a guess. It may help, and when it does it is often difficult to say why — which makes it hard to repeat and hard to know when to stop.
The more useful question is which structure is under pressure and where. Answering it changes the technique, the expected course of care, and the point at which we would send you back to your physician instead.
How the cause gets identified
It starts with history rather than hands. What makes it worse, what makes it better, whether it changes with position, whether there is numbness or weakness as well as pain, and whether it began with a specific event — those answers narrow the field considerably before any examination begins.
From there, a physical and neurological examination checks reflexes, strength and sensation along the nerve path to work out which level is involved. Where imaging already exists, we read it alongside what the examination shows rather than in place of it.
Cox Flexion-Distraction for disc-related sciatica
Dr. Propper has treated sciatica in Westport since 1989 and is a Certified Cox Technique Specialist. For disc-related sciatica, Cox Flexion-Distraction is the technique he uses — a gentle, non-surgical decompression that creates space for the nerve rather than forcing the joint.
Depending on what the examination finds, care may also include targeted spinal adjustments to restore alignment, nerve mobilisation, and stretching and exercise you do at home between visits. The home component is not an afterthought; for most people it is what holds the progress made in the office.
When to see a physician instead
Some presentations are not chiropractic problems. Get emergency medical attention the same day if you have loss of bladder or bowel control, numbness through the groin or inner thighs, or leg weakness that is getting rapidly worse.
Those are uncommon, but they matter more than anything else on this page. If any of them apply, stop reading and call your physician or go to an emergency department.
Where to start
If your leg pain has outlasted a couple of weeks, or it keeps returning, the useful next step is finding out what is compressing the nerve rather than treating the pain in general. You can read more on our sciatica page, which covers what care involves in more detail.
Ready to find out what is actually causing it? Schedule your visit online or call (203) 226-1047.
Common questions
Is sciatica a diagnosis?
No. Sciatica describes a pattern of pain along the sciatic nerve. It is a symptom, and several different problems can produce it — which is why identifying the cause matters before choosing a treatment.
Do I need surgery for sciatica?
Not necessarily. Many people are told surgery is the option before non-surgical care has been tried. That is a conversation to have with your physician and your chiropractor together, based on what is actually compressing the nerve.
When is sciatica an emergency?
Loss of bladder or bowel control, numbness through the groin or inner thighs, or rapidly worsening weakness in a leg all need emergency medical attention the same day, not a chiropractic appointment.
How is disc-related sciatica treated at Propper Chiropractic?
Dr. Propper is a Certified Cox Technique Specialist, and Cox Flexion-Distraction is the technique he uses for disc-related sciatica. Care may also include targeted spinal adjustments, nerve mobilisation, and home stretching and exercise.