Sciatica Is Common, and Commonly Misunderstood
A patient came to see me recently who had spent eight months working with a physiotherapist for what had been diagnosed as sciatica. She had an MRI showing a disc bulge at L4-L5, had been prescribed core exercises and anti-inflammatories, and had been diligently following the program. By the time she reached our clinic, the pain had not only persisted, it had spread from the buttock down into the calf and foot. She was understandably frustrated and beginning to wonder whether she’d ever get on top of it.
Her MRI report described a particular spinal level as “unremarkable.” Our Gonstead analysis, including Nervoscope scanning, palpation, and full weight-bearing imaging, identified a fixation at that exact level. The structural picture on weight-bearing X-ray told a different story than the MRI in a recumbent position. Three weeks into care, her foot symptoms had resolved and the buttock pain had significantly reduced.
I’m not telling that story to criticise the treating physiotherapist, physiotherapy is a legitimate and evidence-backed approach for sciatica, and it helps a great many people. I’m telling it because it illustrates something I see repeatedly: sciatica that doesn’t respond to well-intentioned conservative care often has a structural component that hasn’t been precisely identified. And that’s where a different kind of assessment changes the outcome.
What Sciatica Actually Is
The sciatic nerve is the largest nerve in the body, formed by nerve roots exiting the lumbar spine (L4, L5) and sacrum (S1, S2, S3). When any of these roots are compressed or irritated, pain, tingling, numbness, or weakness can radiate along the nerve’s path, typically into the buttock, back of the thigh, calf, and sometimes the foot.
Nerve Root Compression vs Piriformis Syndrome
Lumbar nerve root compression occurs when a disc bulge, herniation, or bony overgrowth places pressure on a nerve root at the level of the spine. This is true spinal sciatica associated with a specific dermatomal pattern of symptoms.
Piriformis syndrome occurs when the sciatic nerve is compressed by the piriformis muscle in the buttock, not at the spine. Distinguishing between the two requires proper clinical assessment — adjusting L5 won’t help a piriformis that’s been in chronic spasm for two years.
Common Causes
- Lumbar disc herniation or bulge (most common)
- Degenerative disc disease with narrowing of the intervertebral foramen
- Lumbar spinal stenosis (more common in older adults)
- Spondylolisthesis
- Piriformis muscle tightness or hypertrophy
- Pregnancy
- Prolonged sitting with poor posture
Red Flags: When to See a Doctor Urgently
- Loss of bladder or bowel control
- Saddle anaesthesia (numbness in the inner thighs or groin)
- Rapidly progressing weakness in the leg
- Sciatica following significant trauma
- Symptoms with unexplained weight loss or fever
These may indicate cauda equina syndrome requiring prompt intervention. I screen for these at every initial consultation.
What to Expect at Gordon Chiropractic
My approach combines Gonstead chiropractic assessment with exercise physiology expertise. Where imaging is needed, patients have access to bulk-billed 3D EOS Digital X-ray. Treatment is tailored: specific spinal adjustment where needed, exercise rehabilitation where that’s the primary need, and often both.
Book with Dr Gordon: Call Gordon Chiropractic & Exercise Physiology in Rose Bay on (02) 9371 7774 or book online at gordonchiropractic.com.au.