It usually starts in the back, but the back isn't what gets your attention. What gets your attention is the leg — a hot, electric line running from your backside down the back of your thigh, sometimes past the knee, sometimes all the way into the foot. Standing up out of a chair makes it worse. So does the drive down I-35. Some mornings you can't find a way to put your sock on that doesn't hurt.
Most people give it a couple of weeks. They try ibuprofen, a heating pad, and the stretch a coworker swore by. Sometimes that's enough and it fades on its own. Often it doesn't, and the question becomes who to call — a doctor, a physical therapist, a chiropractor, or nobody, and just live with it a while longer.
Here's the honest answer to that question, along with exactly what we'd do about it here in Waco.
Sciatica is a symptom, not a diagnosis. The pain runs down your leg, but the problem is somewhere along the nerve — usually a disc, a joint, or a tight muscle deep in the hip pressing on it. That's why step one is finding the actual source, not treating the leg.
Once we know what's causing it, we have three ways to take pressure off that nerve: chiropractic adjustments (low-force, no forceful cracking), spinal decompression (gentle computer-controlled traction, about 12 minutes a session), and shockwave therapy (sound waves for the tight hip and glute muscles that are part of the problem). Most people need some combination, not just one.
No referral needed, no drugs, no surgery. And if your exam shows something that belongs with a surgeon or an ER instead, we'll tell you that on day one.
"Sciatica" is the symptom. It isn't the diagnosis.
This is the single most useful thing to understand before you book anything, so it's worth thirty seconds.
The sciatic nerve is the biggest nerve in your body. It leaves the lower spine, passes through the hip, and runs down the back of the leg. When something puts pressure on it anywhere along that path, the nerve complains — and it complains downstream, in the leg, not at the spot where it's actually being squeezed.
So "sciatica" just means "something is irritating that nerve." It doesn't tell you what, and it doesn't tell you where. In our office, the usual culprits are:
- A disc in the lower back that's bulging or herniated far enough to crowd the nerve where it exits the spine
- A joint in the lower back or pelvis that isn't moving the way it should, narrowing the space the nerve passes through
- A tight, angry muscle deep in the hip — the piriformis sits directly over the nerve, and when it's in spasm it can squeeze it like a hand around a garden hose
- Wear-and-tear narrowing of the spaces the nerve travels through, which is more common as people get older
Those four things need genuinely different treatments. A disc problem and a hip muscle problem can produce nearly identical leg pain, and stretching won't fix the first one while traction won't fix the second. This is why the stretch your coworker swore by either worked wonders or did nothing at all — it depended entirely on which problem each of you had.
"The pain in your leg usually isn't the problem — it's the messenger."
Should you see a chiropractor for sciatica?
For most cases, yes — it's a reasonable first call, and here's the plain reasoning.
Sciatica is mechanical. Something physical is pressing on a nerve. Chiropractic care is aimed squarely at the mechanical side of the problem, which means it goes after the cause rather than turning down the volume on the pain. It's drug-free and non-surgical, and in Texas you don't need a referral — you can just call and be seen.
That's not a claim that chiropractic is the answer for every case of sciatica. It isn't, and there's a whole section further down on the cases where it isn't. But if you're weighing "wait it out" against "start with an exam," an exam costs you an hour and tells you what you're dealing with. Waiting tells you nothing.
First, we find what's pressing on the nerve
Day one at our Waco office is an evaluation, not an adjustment. Plan for about an hour. Nobody is going to lay hands on your spine before we understand what's happening in it.
Here's what that hour looks like:
- A real conversation. When it started, what makes it worse, how far down the leg it goes, whether there's numbness or weakness, what you've already tried. Where the pain travels tells us a great deal about which nerve is involved.
- A hands-on exam. We test how your lower back and hips move, check the muscles around the hip and glute for the ones that are locked up, and run orthopedic and neurological tests that help separate a disc problem from a muscle problem.
- INSiGHT nervous system scans. These measure what your nervous system is actually doing rather than leaving us to guess from where it hurts.
- Digital X-rays when they're appropriate. Never during pregnancy.
- A sit-down report of findings, in plain English, with a plan built around what we found.
Then you get a straight answer to the question you came in with: what's causing this, what we'd do about it, and roughly how long it should take.
The three things we use to treat sciatica
Once we know what's pressing on the nerve, the treatment follows from the finding. We have three tools, and they do genuinely different jobs.
1. Chiropractic adjustments
This is the foundation. If the joints in your lower back and pelvis aren't moving properly, they're part of what's crowding the nerve, and no amount of stretching the leg will change that.
We use Torque Release Technique, which is low-force and instrument-assisted — a light click rather than a crack, and no sudden twisting of your back. That matters more than usual with sciatica, because when a nerve is already irritated, the last thing most people want is to be wrenched. It's also why we're able to treat sciatica in pregnant patients and in people in their seventies and eighties who'd be poor candidates for forceful adjusting.
If the idea of being cracked is what's kept you out of a chiropractic office, that's worth knowing before you rule us out. We wrote a whole article on whether your back really needs to crack.
2. Spinal decompression
When the exam points to a disc — bulging or herniated, crowding the nerve where it leaves the spine — decompression is usually the most direct answer.
It's gentle, computer-controlled traction that creates space between the vertebrae and takes pressure off the compressed disc and the irritated nerve. We use two FDA-cleared systems: Back On Trac for the lower back, which is where most sciatica lives, and Cervi-Trac for the neck.
The practical details people ask about: a session runs about 12 minutes. You're not strapped down, there are no restraints, and you're not lying face-down. The traction builds gradually and is set to what your body can handle — most patients describe it as comfortable, some as relaxing. A full course is typically a short series spread over several weeks, alongside adjustments rather than instead of them.
More on the equipment and what a session feels like on our spinal decompression page, or in our article on what spinal decompression actually is.
3. Shockwave therapy
The third piece addresses something the first two don't reach: the muscle.
A lot of sciatica has a stubborn muscular component. The deep hip and glute muscles — the piriformis in particular, which sits right on top of the sciatic nerve — get tight, knotted, and stay that way, and they'll keep pressing on the nerve no matter how well the joints underneath are moving. Those knots are also frequently what's left over after the disc or joint problem has settled down, which is why some people improve a lot and then stall.
PiezoWave shockwave therapy sends focused sound waves into that specific spot, at a specific depth, to break up the knot and get blood flowing through tissue that's been locked up. A session runs 10–15 minutes. It feels like a firm tapping or pulsing. No needles, no numbing, no downtime — you walk in and walk out.
Two honest notes on it. First, shockwave treats the muscular side of sciatica, not the nerve directly — it's a supporting player, not a substitute for addressing what's happening in the spine. Second, it's usually an out-of-pocket add-on rather than something insurance covers, and we'll tell you the cost before you decide, not after. Our article on shockwave for plantar fasciitis explains the technology in more detail.
How we decide which ones you need
Most people don't get one of the three. They get a combination, weighted toward whatever the exam found.
A disc-driven case usually leads with decompression and adjustments, with shockwave added later if the hip muscles stay tight after the disc settles. A case that's mostly joint restriction and muscle spasm often needs no decompression at all — adjustments and shockwave handle it. Somebody who's had this for two years is a different plan from somebody who's had it for two weeks.
We'd rather tell you plainly what we found and let you decide than hand you a package. You should be able to leave the report of findings knowing what's going on, what we'd do about it, and how we'll both know it's working. If you want to go home and think about it, that's a completely normal thing to do and you'll get a friendly response.
When sciatica isn't a chiropractic problem
This is the section most practices leave out, and it's the one that matters most.
Some sciatica belongs with somebody else. Go to an emergency room, not a chiropractor, if you have any of these:
- Loss of control of your bladder or bowels
- Numbness through the groin or inner thighs — the area that would touch a saddle
- Weakness in the leg that's getting worse rather than better, or a foot you can't lift properly
- Sciatica that started with a serious fall or crash, along with severe back pain
- Leg pain with a fever, or unexplained weight loss alongside it
Those are signals of problems that need urgent medical attention, and no adjustment is the right first move. Separately, sciatica that hasn't budged at all after a fair trial of conservative care may need imaging beyond X-ray and a conversation with a spine specialist.
If your exam shows something that belongs with a medical doctor, a surgeon, or an emergency room, we'll say so on day one and help you get where you need to go. We'd rather tell you we're not the right fit than take you on and hope. That's the whole reason we examine you before we treat you.
Seeing patients across Waco and the surrounding area
We're at 5201 Bosque Blvd in Waco, an easy drive from Woodway, Hewitt, Robinson, China Spring, and Bellmead. If you're coming from further out, check the drive at the hour you'd actually be coming — sciatica and a long sit in the car are a bad combination, and it's worth picking an appointment time that doesn't put you in traffic.
A few practical things people ask before they call: we accept BCBS, Medicare, and UnitedHealthcare, we offer cash-pay and care plans, and no referral is needed to be seen. Shockwave, as noted above, is generally an out-of-pocket add-on. Our hours are on the appointments page — worth a look, since we're closed Friday through Sunday and Tuesday is mornings only.
Come find out what's actually causing it
You can keep stretching and hoping it settles. Sometimes it does. But if it's been weeks, or if it keeps coming back, the useful next step isn't another stretch — it's finding out which of those four things is pressing on the nerve, because the answer changes the treatment completely.
Day one is a full evaluation: a real conversation, a thorough exam, imaging if it's appropriate, and a plain-language explanation of what we found. No pressure to commit to anything.
Book your first visit, or call us at (254) 265-7007. You can read more about how we treat sciatica in Waco first if you'd like to know what you're walking into.