Sciatica Explained: Why Your Leg Hurts When Your Back Is the Problem
Sciatica is one of the few things people self-diagnose and they are usually right.
They're less often right about what's causing it — and that's the part that determines whether you get better in three weeks or three months.
So let's break it down.
Sciatica is a symptom, not a diagnosis
This is the single most useful thing I can tell you.
"Sciatica" means the sciatic nerve — or more precisely, one of the nerve roots feeding it — is being irritated somewhere along its path. That's a description of what's happening, not why. Telling me you have sciatica is like telling me you have a fever: real, useful, and yet enough to treat.
Nerve roots come out of your low back, converge into the sciatic nerve, travel through the deep hip, down the back of the thigh, and split below the knee to supply most of your lower leg and foot. Anything that irritates that pathway can produce the same recognizable pain pattern. This means several, very different problems, all can present as "sciatica," and they won't respond to the same things.
What's usually actually going on
Disc-related nerve root irritation. This is the most common cause under 50 years old. A disc bulges or "herniates", and either chemically irritates or mechanically compresses a nerve root. Classic pattern: worse with sitting, worse with bending forward, worse first thing in the morning, better when you walk. Coughing or sneezing maked the pain shoot down the leg.
Lateral or central stenosis. This is more common over the age of 60. The space the nerve travels through has narrowed. This one flips the pattern: better sitting, worse standing and walking, and people find relief leaning forward on a cart. If walking three blocks makes your legs heavy and sitting on a bench for two minutes resets it, this could be what we're talking about.
Deep gluteal syndrome You may know it as piriformis syndrome. The nerve gets irritated in "the hip" rather than the spine. Pain is deeper in the buttock, often worse sitting on a hard surface, and there's usually a specific tender spot you can find with a thumb.
SI joint referral. Not true sciatica at all — but a referral pain pattern into the buttock and back of the thigh and this fools people constantly. The tell: it rarely goes below the knee.
That last point is worth writing down. Pain that stops at the knee is usually referred pain from a joint or muscle. Pain that travels below the knee — especially with numbness, tingling, or weakness — is much more likely to be genuine nerve root involvement. That distinction changes what I do in the room.
When to stop reading and go to the emergency room
I want to be direct about this. It's rare, but it matters:
Numbness in the saddle region — inner thighs, groin, genitals, the area you'd contact sitting on a bicycle seat
New difficulty starting or controlling urination, or loss of bowel control
Progressive weakness in both legs
Sudden severe symptoms in both legs at once
That combination can indicate cauda equina syndrome, which is a surgical emergency and is time-sensitive. Don't call me. Don't wait until Monday. Go. NOW!
This is genuinely uncommon. But it's the one thing in this entire post I'd rather over-warn you about than under-warn you about.
What doesn't help
Bed rest. Two days of lying down makes sciatica measurably worse, not better. Seems counterintuitive, but the nerve wants movement. Motion is lotion.
Stretching your hamstring. I know it feels tight. It isn't tight — it's guarding, because there's an irritated nerve running through it. Every time you fold forward and pull on it, you're putting tension on an already-angry nerve and confirming to your nervous system that this "yep this is a dangerous movement". This won't work.
Waiting it out. Most sciatica does improve on its own. But "most" and "on its own" are doing a lot of work in that sentence, and the people who wait six months are much more likely to end up with the pain persisting — because after long enough, the nervous system stops treating pain as information and starts treating it as a habit. Your nerve may be healed, but the brain remembers. This is the double-sided coin of "neuroplacticity".
What does help
Finding your directional preference. Almost everyone with disc-related sciatica has a direction of movement that makes the leg pain retreat back toward the spine — usually extension, but sometimes not. Finding it is often the single most useful thing that happens in a first visit, and once you have it, you have something to do at home three times a day instead of waiting.
The technical term for the leg pain pulling back toward the low back is centralization, and it's a good sign! It means you're on the right track even if the total pain hasn't dropped yet.
Nerve glides. Gentle, specific, non-stretching movement that helps the nerve slide through its tissue again. These are not aggressive and they should not increase your symptoms. If they do, they're being done wrong.
Chiropractic care and manual therapy — to restore motion at the segments that have locked down around the problem, and to take load off the irritated tissue.
Acupuncture. This is the piece people are most surprised by. There's reasonable evidence for acupuncture in sciatica and radicular pain, and clinically I find it does something manual work alone often doesn't: it turns the volume down on an over-sensitized nerve enough that you can actually start moving again. In sciatica, the two together tend to work better than either one alone.
Walking. I know, I know. It's boring, yet surprizingly effective. Start with what you can do without making it worse and add a little each day.
How long
Here's an honest answer, because you deserve one:
Most disc-related sciatica improves substantially in six to twelve weeks. Many people feel meaningfully better in two to three. Stenosis is slower and is managed more than cured, but when managed well it's very livable.
If you're not seeing any change in direction after four to six weeks of appropriate care, that's the point at which we escalate — imaging, referral, a different plan. Not before, and not never.
What happens if you come in
First, we talk. I want to know where it goes, how far down, whether it's numb or sharp or burning, what makes it worse, and what you've already tried.
Then I examine you — testing the nerve, testing the joints, testing which direction your body actually likes. I tell you what I think in plain language, including what I'm not sure about.
And then we get to work: chiropractic care, acupuncture, and something specific for you to do at home so you're not just waiting between appointments.
If I think it's not mine to treat, I'll tell you that too, and I'll tell you who to go see.
One more thing
If you've had pain dismissed before — if you've been told it's stress, or your weight, or that you just need to relax — I want you to know that's not what happens here.
You get a real exam, a real explanation, and a 75-minute first visit with my full, undivided attention.
Ready to get started? Book online today. Not sure where to start? Book a free 15-minute virtual consultation.
Dr. Sebastian Bergeron, DC is a Doctor of Chiropractic certified in acupuncture and the founder of Nord Ro Clinic at 5015 N Paulina St, Suite 345 in Andersonville. Nord Ro is in-network with BCBS, Aetna, Cigna, and United Health Care / Optum. Self-pay patients also accepted.
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