What is Sciatica? | Causes & Symptoms Explained by a Hagerstown Chiropractor

Hi, I’m Dr. Pat Walsh at Walsh Chiropractic and Physical Therapy of Hagerstown.

A lot of people come into the office with one big thing on their mind: sciatica. Or what they call sciatic nerve pain.

Now, what is sciatica, really?

Well, let’s break it down.

Read the Full Video Transcript Here

A lot of patients come in for sciatica, sciatic nerve pain, uh where pain is going down the leg. I'm going to take the next couple minutes to go ahead and talk about this. Hi, I'm Dr. Walsh. I'm over here at Walsh Chiropractic and Physical Therapy of Hagerstown. And I'm glad for the opportunity to explain a couple things to you. So, what is sciatica? What is sciatica pain?

You have a nerve that is built by these spinal nerves, but these are just branches of the spinal nerve, right? These are branches. These aren't the total nerves that come down. So these branches off of these nerves come and make up the sciatic nerve. That's why it's kind of a big deal. Number one, because of the fact that it has multiple levels that can affect it, right? Which is really interesting. So when you come in with sciatica pain, we can't just say it's L4 or L5. We’ve got to test them all, and usually it can be a combination depending upon mode of injury.

Okay. So you see you have a wide area of possibilities of an issue when you have sciatic pain. So why is it happening? Well typically what you're going to have is an SOL. What's an SOL? Good question. An SOL is a space occupying lesion. Oh my god, that sounds like, oh, do I have a tumor? No, that's a disc bulge, disc herniation, okay? That could be putting pressure on one or multiple of these nerves or the section of the nerve that becomes and builds into the sciatic nerve.

So when a patient comes in and they're having what's called radiculopathy—it's a funny word—but it's just radiating pain. And it can actually not only go to the sciatic nerve, but the sciatic nerve ends just above the knee on the posterior, but all the way down to the toes, right? So number one, you have to get a history on what's going on with the patient. Orthopedic tests can tell you a lot about what's going on. X-rays aren't going to tell you anything. X-rays give bone, not soft tissue.

So you know, typically the first stage is an X-ray depending upon how bad the symptomatology and the pain is. Most insurance companies—all insurance companies—want you to go through a certain protocol before they go ahead and okay an MRI. MRI can tell us everything. We usually will see that, but that's what it is.

Now, how is this happening? Well, it can be as little as a sneeze. Now, the sneeze didn't do it, right? They say if you took an MRI of 100% of the people on the street, 75% of them will have a disc issue and not even know it. So there's a lot of room for life that happens. And you can have a slight bulge, but it's not impeding on a nerve. Therefore, you're not going to get any feedback from it. But you're not far from possibly increasing that bulge and then developing a problem, right? You're a lot closer than somebody who doesn't have that—no problems—and lifts something or turns or what have you. Coughs, sneezes compared to somebody that already has and they said, "I felt fine until I just, you know, bent over and picked up a twig and then, you know, it happened." No.

To be honest with you, the history is important. Orthopedic tests are important, but once the patient comes in with the problem, then the treatment must be important. You know, that's all in the past. You can't change that. All we can do now is first step critical. Then we try to get the patient into comfort as quickly as possible.

The funny thing about something like this too is when the body says, "Okay, I've got an injury to the back," we have a reflex. We can't consciously control it. So we have a reflex that the muscles around it spasm up, tighten up. Why? Good question. It's to prevent you from further injury, right? So that spasm sometimes is even worse than the problem that you're feeling of the sciatic pain or what have you. So what happens is then the person becomes antalgic. They can't walk right. They can't move right. Everything hurts.

The beginning part of that is of course get you out of pain, and what we’ve got to do is we’ve got to try to get those muscles to relax, to breathe. We cannot do any exercises right now. I mean typically what I find, and the whole reason why I practice the way I do, is because of my own back problems and I already went through this many times before I became a doctor. So I know what worked on me and I figured hey, if it works on me it's going to work on others, right?

So typically instead of hurrying up and doing exercises right away, no. We get you out of discomfort. We get those muscles to relax—light stretches, easy movements. You know, we teach you how to move. Typically the patient will improve pretty well in the first two, three weeks to where now they're moving more freely. Okay, now they can do a little more.

But there's a danger zone when you start to improve. What do people do? If you don't have that constant pain feedback mechanism, then you forget that you have it and then you go back to the actions and the movements that you had before.

So, kind of looking back at this, there's a wide variety of places that you can get that sciatica, that radiculopathy down the leg. So you know, it could be anywhere from in the sacrum to the lower lumbar. And it could be for a vast amount of reasons, too. Even nothing really physical or straining, but from sitting too long all the time at a desk. I sit at a desk. I've been there for 20 years now. I can't—you know—even if you cross your legs, people like that cross their legs are more apt to have something like this on a gentle—what I call gentle—there wasn't an impact or there wasn't a violent type of injury for them.

But that's basically what sciatica is. Many different reasons for it. And if you have any questions, go ahead and just leave them in the remarks and we'll get back to you.

What Is Sciatica?

You’ve got this big nerve in the body called the sciatic nerve. And it’s not just one nerve. It’s made up of a bunch of branches. These branches come off the spinal nerves in your low back—L4, L5, S1 and so on.

They come together and form a thick cable that runs down the back of your leg.

So when someone comes in and says, “Doc, it’s going down my leg,” we can’t just assume it’s one specific disc or one exact level. We’ve got to test them all because it’s usually a combination, depending on how the injury happened.

Why Does Sciatica Happen?

Most of the time, there’s pressure somewhere. Could be a disc bulge. Could be a herniation.

We call that a space-occupying lesion, or S.O.L. Sounds scarier than it is. It’s just something—like a disc—taking up space where a nerve doesn’t want it to be.

That pressure can affect one branch or several. That’s when you get radiating pain, which we call radiculopathy.

And here’s the wild part. Sometimes that pain doesn’t stop above the knee like you’d expect with sciatic nerve irritation. It can go all the way down to your toes.

What Triggers Sciatica?

It doesn’t have to be some big trauma.

You could just bend over to pick up a twig. Or sneeze. That’s right—even a sneeze.

But the truth is, the sneeze didn’t cause it. It just exposed what was already there.

They’ve done studies. If you took MRIs of 100 people walking down the street, probably 75 of them have some kind of disc issue and don’t even feel it.

So you can have a little bulge that’s not touching anything. But if that bulge gets worse, it can put pressure on a nerve and pain shows up.

How We Approach Sciatic Pain in the Office

When someone comes in, the first thing we do is get a good history. Then we run through orthopedic tests to figure out what’s really going on.

Now, I’ll say this, X-rays aren’t going to show it.

They’re great for looking at bones, but they don’t show soft tissue like discs or nerves. For that, we might need an MRI, but insurance usually has a process before they’ll approve it.

Why It Hurts So Bad (and Why You Can’t Move Right)

Here’s something most people don’t realize. When your body senses an injury in the back, it reacts automatically. You can’t control it.

Your muscles spasm up to protect the area.

It’s like your body is saying, “Stop moving. Don’t twist. Don’t lift.” That spasm might actually hurt more than the nerve pain itself.

Now you’re walking funny. Everything feels tight. And you’re in more pain.

How We Give Sciatica Pain Relief in Hagerstown

When people are in that much pain, the goal is not to jump into exercises. I don’t go that route right away.

I’ve had my own back problems. I’ve lived this personally.

So first, we calm things down. We get you comfortable. Get those muscles to relax.

We start with simple movement, light stretches, some adjustment work. I teach you how to move without triggering pain.

Usually, in the first two or three weeks, people feel a lot better.

But There’s a Catch: The Danger Zone

Here’s what I see happen all the time.

As soon as people start to feel better, they go back to their old habits.

They forget their body is still healing. And just like that, things flare up again.

That’s why we don’t stop at pain relief. We keep going until you’ve got full function and know how to protect the progress you’ve made.

Everyday Triggers People Overlook

It’s not always about lifting something heavy.

I’ve seen it happen from just sitting too long at a desk. Or people who always cross their legs.

Those little habits create stress on the spine over time.

You don’t need a big injury to end up with sciatica.

Final Thoughts

So sciatica is more complex than most people think.

There are lots of reasons you could be feeling that pain down the leg. But you don’t have to live with it or try to figure it out alone.

If you're dealing with pain in your lower back, hip, or leg, come in or call the clinic in Hagerstown to book an appointment. We also accept walk-ins for physical therapy and chiropractic services. Call ahead for availability.

Let’s take a look, figure out what’s going on, and build a real plan to help you move better and feel better.