Condition · Sciatica · Buford GA
Sciatica is a symptom, not a diagnosis. Most cases come from a herniated disc, lumbar stenosis, or piriformis syndrome. Each one needs a different treatment plan. The first step is figuring out which one you have.
Sciatica is pain that radiates along the path of the sciatic nerve, from the lower back through the buttock and down a leg. The cause is almost always compression or irritation of a lumbar nerve root: L4, L5, or S1. About 75 to 90 percent of cases improve without surgery in 6 to 12 weeks of appropriate conservative care.
Anatomy
The sciatic nerve is formed by lumbar and sacral nerve roots that combine in the pelvis. The pattern of your leg pain tells us which root is being compressed. Each root has its own signature.
Causes
/01 Most common
Disc material presses on a lumbar nerve root, most often L4-L5 or L5-S1. The classic sciatica presentation. Responds well to non-surgical decompression in confirmed candidates. More on herniated disc →
/02 Often missed
The piriformis muscle in the deep buttock compresses the sciatic nerve as it exits the pelvis. Typically driven by glute weakness, prolonged sitting, or asymmetric hip mechanics. Soft-tissue work and hip stability training resolves most cases.
/03 Older patients
Narrowing of the spinal canal compresses one or more nerve roots. Pain is typically worse with standing and walking, better with sitting (the opposite pattern of disc-driven sciatica). Conservative care is variable but worth trying before surgery in most cases.
Treatment
/01 Diagnose
Full neurological exam plus orthopedic testing to map your symptoms to a specific nerve root or muscle group. MRI review when imaging is available.
/02 Decompress (if disc)
For confirmed disc cases, non-surgical spinal decompression draws herniated material away from the nerve root.
/03 Release (if muscular)
For piriformis cases, Active Release Technique on the piriformis and surrounding glutes. Often dramatic same-visit improvement.
/04 Rehab
Glute activation, hip mobility, and neutral-spine core work. The goal is restoring the support around the nerve, not just unloading it once.
What the guidelines say
The UK National Institute for Health and Care Excellence guideline on low back pain and sciatica (NG59) recommends exercise as the base of care and supports manual therapy, meaning spinal manipulation, mobilization, or soft-tissue techniques, as part of a package that includes exercise. It reserves surgery for sciatica that has not improved with non-surgical care and matches the imaging findings. Signs of serious nerve compression are an emergency at any point (see below).
That is how we work. We find the source of the leg pain, treat it with adjustments, soft-tissue work, and spinal decompression when a disc is confirmed, and build an exercise plan you can do at home.
Sciatica treatment in Buford
Every evaluation is done by a doctor, not an assistant. Dr. Joe Krzemien, D.C. has 23 years in practice in Buford, has been the Atlanta Dream team chiropractor for 10 seasons and counting, served the Atlanta Falcons for 13 NFL seasons, and was inducted into the Professional Football Chiropractic Society Hall of Fame in 2025.
FAQ
What is sciatica?
Sciatica is pain that radiates along the path of the sciatic nerve, which runs from the lower back through the buttock and down each leg. It's a symptom, not a diagnosis. The cause is almost always compression or irritation of one of the lumbar nerve roots (L4, L5, or S1). The most common causes are a herniated or bulging disc, lumbar spinal stenosis, and piriformis syndrome.
How do I know if my leg pain is sciatica?
Sciatica typically follows a recognizable nerve pattern down one leg. L5 nerve root pain runs along the outside of the calf and into the top of the foot. S1 pain runs down the back of the calf into the bottom of the foot. L4 pain runs into the front of the thigh and inside of the calf. Pain that follows a clear stripe like this suggests nerve root involvement. Pain that's diffuse, both-sided, and stays in the back is usually muscular instead.
How long does sciatica last?
Most cases of sciatica resolve within 6 to 12 weeks with appropriate conservative care. About 75 to 90 percent of patients with sciatica from a disc herniation improve without surgery. Severe pain that hasn't improved in 6 to 12 weeks is usually a good time to reconsider whether imaging or a surgical consult is warranted.
What treatments work best?
For disc-driven sciatica, non-surgical spinal decompression combined with manual therapy and a phased rehab program has the strongest track record. For piriformis-driven sciatica, soft-tissue work and hip stability training resolves most cases. For stenosis-driven sciatica, the response is more variable but conservative care still helps many patients enough to delay or avoid surgery. We figure out which type you have first, then build the plan around that.
When does sciatica need surgery?
Surgery is indicated when there is progressive neurological loss, cauda equina syndrome (saddle numbness, bowel/bladder dysfunction), or severe pain that has failed all reasonable conservative care over 6 to 12 weeks. Most sciatica does not meet these criteria. If we think yours does, we'll say so on day one.
Should I rest or stay active?
Stay active within tolerance. Bed rest beyond 1 to 2 days actually slows recovery. Walking is almost always safe and usually feels better than sitting. Avoid the specific positions and movements that flare your symptoms. We'll give you a list of what to do and what to avoid based on your specific case.
Can a chiropractor help sciatica?
For most sciatica caused by a disc or joint irritating a nerve root, conservative care is the first step, and manual therapy combined with exercise is part of guideline-based care. We confirm the source with an exam first and refer out when the exam shows signs that need a surgeon or a medical workup.
Is spinal decompression good for sciatica?
It can help selected patients whose sciatica comes from a disc bulge or herniation. We decide candidacy at the evaluation; it is not the right tool for every case of leg pain.
Do you treat sciatica during pregnancy?
Yes. Dr. Corie Terwilliger is Webster certified and works with pregnant patients who have low back, pelvic, and sciatic-type pain.
A 60-minute new-patient evaluation. We'll figure out which nerve root or muscle is generating your pain and tell you the best path forward.