Sports Injury Treatment - Spokane, WA
Reviewed By: Stephen Byers, DC CSCS
SCIATICA--AND WHAT ACTUALLY FIXES IT
Sciatica is one of the most common things patients walk into the Movement Clinic with — and it's also one of the most misunderstood. A lot of what gets called sciatica is actually something else. Once we figure out what you're actually dealing with, the path forward gets a lot clearer.
First--Is It Actually Sciatica?
Many patients come in thinking they have sciatica when what they actually have is sacroiliac (SI) joint dysfunction. The two get confused constantly, but they're distinct conditions with different causes and different treatments. Here's the quick way to tell:
SCIATICA
Sciatica is pain that travels down the back of the thigh and into the leg, sometimes into the foot. It's often accompanied by numbness, tingling, or weakness somewhere along the path of the nerve.
SI JOINT PAIN
SI joint pain stays in the gluteal region itself. Usually one side, often described as a deep ache or a sharp catch in one cheek, without the down-the-leg traveling pain.
If your pain doesn't travel below the buttock, what you have probably isn't sciatica. Our Movement Assessment can quickly distinguish between the two and identify the right treatment plan for either. The rest of this page focuses on true sciatica.
Does This Sound Familiar?
Pain that follows you in and out of the gym
"I get a sharp pain that shoots down my leg when I bend over."
"It started after a heavy deadlift session."
"I get numbness and tingling in my foot when the pain flares up."
"Sitting for a while makes my whole leg ache."
"I have trouble standing after I've been sitting at my desk."
"I've stretched my hamstrings and lower back for months — nothing changes"
Why It Happens
Two patterns we see in almost every patient with sciatica
DISC INJURY
The disc is most vulnerable when the spine is flexed (bent forward) and rotated at the same time. That combination shows up in normal life all the time — picking up a load from the side, deadlifting with poor mechanics, swinging a golf club or bat, twisting to grab something out of a back seat. When the spine is loaded in that flexed-and-rotated position, the disc can bulge or herniate backward, putting pressure on the nerve root that becomes the sciatic nerve. The pain typically travels down the back of the thigh and leg on the side of the herniation.
PIRIFORMIS SYNDROME
The piriformis muscle runs across the back of the hip, and in most people the sciatic nerve runs underneath it on its way down the leg. When the pelvis tilts anteriorly — the front of the pelvis drops forward and downward — the geometry changes. The sciatic nerve has to make a sharper, hairpin-like turn around the piriformis to get to the back of the leg. That sharper bend compresses the surface of the nerve and restricts blood flow to it. The result feels a lot like disc-related sciatica — pain, tingling, or weakness down the back of the leg — but the cause is the muscle and pelvic position, not the disc.
The two patterns can also occur together, which is why our Movement Assessment looks at both the spine and the pelvis before we build a treatment plan.
What's Driving It
The physical reasons these patterns develop
Sciatica doesn't happen in isolation. It's usually the body's way of working around a limitation. When we evaluate patients with sciatica, we commonly find one or more of these:
LIMITED HIP MOBILITY
When the hips don't extend or rotate well, the lumbar spine has to do more of both. That extra load — especially when combined with rotation — is what damages discs over time.
WEAK GLUTES
Strong glutes help hold the pelvis in a neutral position. When they're underactive — common in anyone who spends most of the day sitting — the pelvis tips forward and the piriformis ends up trying to do work it wasn't designed for.
LIMITED THORACIC MOBILITY
When the mid-back can't rotate well, the lumbar spine has to absorb the rotation. Combined with flexion under load, that's a recipe for disc problems.
ANTERIOR PELVIC TILT
This is the upstream cause of piriformis syndrome. When the pelvis is tilted forward, the back muscles tighten, the glutes are inhibited, and the geometry through the back of the hip puts the sciatic nerve at risk. Most chronic sciatica patients we see have some degree of this.
POOR LIFTING MECHANICS
Bending forward and rotating to pick something up is the textbook mechanism for disc injury. Most patients we see with disc-related sciatica can point to a moment where this happened — or a long history of doing it without realizing the risk.
POOR RECOVERY BETWEEN SESSIONS
Small irritations accumulate. Without consistent recovery work between training, work, or daily life, stiff joints and tight muscles compound — turning a manageable issue into one that won't resolve on its own.
Our Approach
How we evaluate sciatica at the Movement Clinic
Most sciatica treatment starts with the symptom — ice, rest, anti-inflammatories, sometimes a steroid shot. We start with the movement, because that's where the answer usually is.
01
FULL MOVEMENT ASSESSMENT
We assess basic mobility, stability, and movement patterns across your whole body — not just your low back. This is where we distinguish between disc-related sciatica, piriformis syndrome, SI joint dysfunction, and other potential drivers.
02
ACTIVITY-SPECIFIC BIOMECHANICAL TESTING
We test hip mobility, pelvic position, glute activation, and how your body handles flexion, extension, and rotation under load. Sciatica rarely lives in just the low back — we look up and down the chain to find the real driver.
03
SPORTS CHIROPRACTIC CARE
Targeted adjustments restore motion to stiff joints in the lumbar spine, pelvis, and hips so the affected tissues aren't forced to compensate. Soft-tissue treatments help calm down irritated areas, including the piriformis and surrounding deep hip rotators.
04
ACTIVITY-SPECIFIC REHABILITATION
We use exercises to wake up the glutes, restore hip mobility, retrain a neutral pelvic position, and teach proper lifting and rotation mechanics. The goal isn't just to feel better — it's to fix the movement pattern that caused the problem in the first place.
05
RETURN TO ACTIVITY PLANNING
We work with you on lifestyle modifications — desk setup, lifting technique, training program adjustments, warm-up routines — so you can keep moving while you recover and stay pain-free long-term.
Every plan starts with a Movement Assessment.
Common Question
Should you stop training or working if you have sciatica?
Some initial rest can be helpful, but long-term rest and avoidance is rarely a solution. Pain is a signal that something needs to change, not necessarily that activity needs to stop. With the right plan, most patients are able to keep moving while they recover.
What we want to understand is why it's happening. Once that's clear, we can usually modify your lifting technique, your sitting setup, your training volume, and what you're doing between sessions — and the pain starts to improve without stopping life entirely.
Pain lasting more than 1–2 weeks, pain that wakes you up at night, progressive weakness in the foot or leg, or any loss of bowel or bladder control are signs that it's worth getting assessed sooner rather than later. The last one — bowel or bladder changes — is an emergency and means you should be evaluated immediately.
What to Expect
Realistic recovery timelines
Every athlete is different, but here's what we typically see based on the nature of the issue.
6-8 VISITS
Acute Flare-up
Recent onset, first-time issue. Fast response with the right treatment and activity modification
4-8 WEEKS
Persistent or Recurring Pain
Pain that has been present for weeks or months, or keeps coming back. Requires addressing the underlying movement dysfunctions.
8-16 WEEKS
Performance Rebuild
Full recovery requires building the necessary mobility, strength and movement mechanics needed to stay pain-free for the long term.
Frequently Asked Questions
Questions patients ask us about sciatica
Q: Can a chiropractor actually help with sciatica?
A: Yes — particularly when the care is movement-based rather than just adjustment-focused. Chiropractic care that combines adjustments with targeted mobility and strength work addresses both the pain and the underlying pattern driving it. Most patients see meaningful improvement within a few weeks.
Q: Do I need imaging before coming in?
A: No. In most cases of sciatica, imaging isn't the first step. Our movement assessment gives us the information we need to get started and to decide whether imaging is warranted. If we find signs of a significant disc problem or other red flags, we'll let you know and help refer you for imaging.
Q: How do I know if it's sciatica or SI joint pain?
A: The quickest tell is where the pain goes. Sciatica travels — down the back of the thigh, into the leg, sometimes into the foot. It often comes with numbness or tingling. SI joint pain stays in the buttock and doesn't travel below the gluteal fold. Our Movement Assessment will confirm which one is driving your symptoms (and many patients have some of both).
Q: Will a steroid injection fix it?
A: A steroid injection can reduce inflammation and provide short-term pain relief, which is useful for getting through an acute flare-up. But it doesn't change the underlying movement pattern and mechanical issue that caused the problem. Many patients we see have had multiple injections that helped temporarily, then the pain came back. We use the same approach either way — find the mechanical driver and address it.
Q: Should I keep stretching my hamstrings?
A: Probably not — at least not the way most people are doing it. When the sciatic nerve is irritated, hamstring stretches can actually pull on the nerve and aggravate the problem rather than help. We often have patients pause hamstring stretching during recovery and focus on glute activation and hip mobility work instead.
Q: How is this different from seeing a regular chiropractor or physical therapist?
A: Our team specializes in working with athletes and active individuals. We assess movement patterns, understand the demands of lifting, rotation, and sustained postures, and build treatment plans that include targeted exercise and adjustments. We're focused on solving the underlying problem and getting you back to doing what you love.