Sciatica refers to pain that radiates along the path of the sciatic nerve, which extends from the lower back through the hips and buttocks and down one or both legs. The most common cause of sciatica is lumbar disk herniation, which compresses or irritates one of the nerve roots that make up the sciatic nerve. However, many musculoskeletal and systemic conditions can either irritate the sciatic nerve or produce symptoms that mimic sciatica, including:

• Lumbar spinal stenosis, or narrowing of the spinal canal, can compress nerve roots—often affecting both legs.
• Degenerative disk disease, characterized by thinning and inflammation of lumbar disks, may irritate nearby nerves.
• Spondylolisthesis, where one vertebra slips over another, can pinch nerve roots.
• Piriformis syndrome, involving dysfunction of the piriformis muscle in the buttock, may compress the sciatic nerve.
• Facet joint hypertrophy or osteoarthritis may inflame or irritate adjacent nerve roots.
• Epidural fibrosis, or scar tissue after spinal surgery, can entrap nerve roots.
• Spinal, pelvic, or hip tumors or cysts, though rare, can compress the sciatic nerve or its roots.
• Fractures or dislocations of the lumbar spine, pelvis, or hip may impact nerve structures.
• Spinal infections or inflammatory conditions (e.g., spinal epidural abscess, ankylosing spondylitis) may affect the nerve roots.
• Ischiofemoral impingement, a narrowing between the ischium and lesser trochanter, may compress the quadratus femoris and irritate the sciatic nerve.
• Gluteal tendinopathy or trochanteric bursitis can refer pain into the lateral hip and buttock, sometimes mimicking sciatica.
• Chronic hamstring tendinopathy at its origin on the ischial tuberosity may compress nearby branches of the sciatic nerve.
• Hip osteoarthritis may refer pain to the buttock or thigh.
• Hip labral tears or femoroacetabular impingement (FAI) may alter biomechanics and muscle activation, indirectly affecting the sciatic nerve.
• Pregnancy, due to changes in posture or uterine pressure, may irritate the sciatic nerve.
• Diabetic neuropathy, although typically bilateral and diffuse, can resemble sciatica.
• Referred pain from sacroiliac joint dysfunction or hip disorders may mimic sciatic nerve root irritation.

To determine the exact cause of sciatica-like symptoms, chiropractors will review the patient’s medical history and perform a thorough orthopedic and neurological examination. This helps identify the most likely pain generators and contributing factors. Based on the findings, they will develop a treatment plan that may include manual therapy, therapeutic exercises, and other conservative interventions. If symptoms suggest a more serious condition—such as a fracture, tumor, or infection—the chiropractor may order diagnostic imaging or refer the patient to a medical specialist or emergency care.