If your sciatica shows up, fades after a few weeks, and then comes roaring back five months later, I need to tell you something that surprises most of my patients. It probably never left. You just stopped feeling it.
We hear the same story almost every week in our three Houston offices. Your back goes out. The leg pain starts. You rest, take some ibuprofen, maybe stretch. Two or three weeks later the pain is gone and you call it healed. Then you are stuck on 59 for an hour, or you spend a Saturday in the yard in a Houston August, and the same burn shows up down the same leg. Most people assume they reinjured themselves.
Usually they didn’t. They crossed the same line twice.
Is it normal for sciatica to keep returning?
It’s common, which is not the same thing as normal.
A two-year prospective study of 605 primary care patients with acute low back pain, with or without sciatica, tracked how often it came back. According to PubMed, 54 percent had at least one recurrence within the first six months, and 47 percent had another one during the following 18 months (DOI). The authors were direct about what that means. The usual reassurance that back pain resolves on its own is built on return-to-work numbers, not on whether the problem actually went away.
So if yours keeps circling back, you are not unusual and you are not imagining it. You are on the standard trajectory for a problem nobody ever looked at.
Why does sciatica come back if the pain went away?
Sciatica is not a diagnosis. It’s a symptom. It means a nerve root in your low back is irritated, and in my office that irritation usually traces back to a disc.
Here’s the part that explains the pattern. When a disc bulges into the space where the nerve root sits, that nerve gets bothered two different ways at once. There’s mechanical pressure from the bulge. There’s also chemical inflammation, because the injured part of the disc leaks material that inflames the nerve. A review of the sciatica literature makes the point that both pieces have to be present for a nerve root to actually hurt, and that tumor necrosis factor alpha looks like a key driver in animal models, though how much it contributes in human radiculopathy is still argued about (DOI).
The chemical piece settles down in a few weeks whether you treat it or not. That’s the part you felt disappear.
The bulge is still sitting exactly where it was.
Can you have a disc bulge and no pain?
Yes, and this is the whole reason recurring sciatica confuses people.
A systematic review of imaging in 3,110 people with no symptoms at all found disc bulges in 30 percent of 20-year-olds and 84 percent of 80-year-olds. Disc degeneration ran from 37 percent to 96 percent across the same age range (DOI). Plenty of people walk around with a bulge and feel nothing.
Which cuts both ways, and I want to be straight with you about it. Finding something on an image does not automatically mean that thing is causing your pain. The authors of that review said the same thing: imaging findings have to be read against the patient in front of you. That’s my job, and it’s why I correlate what I see with your exam and your history instead of pointing at a picture and calling it a day.
But once you’ve had leg pain from that disc, you’re in a different category than someone who never has. You’re living just under your pain threshold. Nothing hurts. Your margin is gone.
Does sitting make sciatica worse?
The load piece is more interesting than the version you usually hear.
The classic textbook number, which came out of pressure measurements in the 1960s, said sitting loads your lumbar discs roughly 40 percent more than standing. Newer work put a 1.5 mm pressure sensor directly into a live L4-L5 disc and recorded readings across a full day of normal activity. That study found relaxed standing at 0.5 MPa and upright unsupported sitting at 0.46 MPa, essentially the same. Sitting in maximum flexion hit 0.83 MPa, and lifting a 20 kg weight with a rounded back hit 2.3 MPa (DOI).
So sitting itself is not the villain. The slump is. That 0.46 climbs toward 0.83 as your low back rounds, and by hour six in a Greenway Plaza office chair, nobody is sitting upright. That’s the same posture you’re in for a long crawl down 59.
The study was one volunteer, so I hold the exact numbers loosely. The direction is clear enough, and it matches what I see. My desk-worker patients don’t flare up because they sat. They flare up because of how they sat, for how long, on top of a disc that was already compromised.
How do I know if my sciatica is coming from a disc?
You don’t, by feel. Neither do I, and I’ve been doing this since 2006.
I can’t tell with my hands whether a disc space has collapsed on one side. I can’t see how your lumbar curve is loading you, or which direction a segment is restricted, or whether something is going on that would change my entire plan. This is where I get blunt with people: if a chiropractor starts adjusting your spine without imaging it first, ask why. Adjusting a spine you’ve never looked at is guessing, and with a disc patient, guessing costs months.
So we take a precision digital x-ray before anyone touches you, and I measure it. Which segment lost height. Which direction the joint is stuck. How your curve is distributing load.
When it’s indicated for low back or lower extremity cases, we also run a specialized leg length study. That’s a separate short-exposure series at the hip, knee, and ankle with a ruler superimposed on each image, shot in sections to keep radiation exposure down, measuring actual bone length to the millimeter. It’s not the quick prone table check you may have had somewhere else, which tells you something about function but cannot answer the anatomical question. If one leg is genuinely shorter, your pelvis tilts, and a tilted pelvis loads one side of those discs every hour you are upright. That’s the mechanism that keeps regenerating the same flare on the same side.
What actually stops sciatica from coming back?
Getting the pain quiet is the easy half. Anybody can do that, including time.
Changing what put you under threshold in the first place is the part that determines whether you’re back here in five months. For disc patients that usually means x-ray guided adjustments aimed at the segment we actually identified, plus spinal decompression to unload the disc and give it a better environment. I’ll tell you honestly that the research on mechanical traction is mixed. A meta-analysis of eight randomized trials found that supine traction added to physical therapy helped pain and disability in the short term, but those were the lower quality studies, and the higher quality trials of prone traction did not show a significant effect (DOI). I use it because of what I watch happen with decompression patients in my own office, not because the literature has settled the question. Anyone who tells you it’s settled hasn’t read it.
Alongside that we use PEMF and HEIT. HEIT is a Zimmer high energy inductive therapy unit, running on the same electromagnetic principle as PEMF but at considerably higher energy. It’s a different tool than shockwave, which we don’t offer.
And then there’s the part that matters most and gets the least attention. Your spine is a structure you’ll be loading for the rest of your life. We look at it that way. We’re not interested in you checking in only when something screams, and we’re not going to hand you a plan that ends the day your leg stops burning. Where your discs sit, how your pelvis is leveled, and how much margin you’re carrying is worth watching over years, the same as your teeth or your blood pressure.
Come see us
We have three Houston locations and nine chiropractors, and every one of them works from your imaging.
- Galleria: 1770 Saint James Place #210, Houston, TX 77056
- Greenway Plaza: 3334 Richmond Ave #107, Houston, TX 77098
- Memorial City: 10497 Town and Country Way #100, Houston, TX 77024
One thing to know before you call. We x-ray before we adjust, without exceptions. If you’re not comfortable with imaging, we’re the wrong office for you, and I’d rather tell you that now than at your first visit.
Frequently asked questions
How long does a sciatica flare-up usually last? Most flares settle over two to six weeks, largely because the chemical inflammation around the nerve root calms down on its own. That timeline tells you the inflammation resolved. It doesn’t tell you the disc changed.
Does sciatica ever go away permanently? The pain can go away for years. Whether it stays gone depends on whether anything changed structurally. If the disc that irritated the nerve is still bulging into the same space and your pelvis is still tilted the same way, the setup for the next flare is intact.
Can a disc bulge heal on its own? Some herniations do shrink over time. That’s real. But the studies on asymptomatic imaging show bulges persist in a large share of people, and persistence alone doesn’t cause pain. What matters is whether the bulge plus your daily loading pushes the nerve back over threshold.
Why does my sciatica always hit the same leg? Usually because the mechanics are asymmetric. A disc that lost height on one side, a rotated segment, or a genuine leg length difference all load one side more than the other. Same setup, same leg, every time.
Do I need an MRI or is an x-ray enough? X-ray shows me bone position, disc height, curve, and alignment, which is what I need to plan care. MRI shows soft tissue and disc material directly. If your exam findings suggest we need that level of detail, or if you have neurological signs that concern me, I’ll refer you for imaging or to a specialist. Most cases don’t require it to start.
Should I keep stretching during a flare? Depends on the stretch. Some of the most popular sciatica stretches load a compromised disc in exactly the wrong direction. I’d rather see you before you spend six weeks reinforcing the problem.
Sources
Citations retrieved from PubMed.
- Mehling WE, et al. The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study. Spine. 2012. DOI
- Valat JP, Genevay S, Marty M, Rozenberg S, Koes B. Sciatica. Best Pract Res Clin Rheumatol. 2010. DOI
- Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015. DOI
- Wilke HJ, Neef P, Caimi M, Hoogland T, Claes LE. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. 1999. DOI
- Vanti C, et al. Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Phys Ther. 2021. DOI