Sciatica is a very painful condition, and the doctor should communicate to the patient that they understand the severity of pain that is being suffered. The Three ‘S’ Rule is an easy mnemonic to remember: Sciatic Side Serious.

The majority of patients with this condition should be adjusted in the side posture position as the prone position may exacerbate their pain. The patient should be instructed to try to walk as it may alleviate their leg pain. Tell the patient what to expect: explain to them that the pain usually moves downwards during the healing process and to not be alarmed if the pain moves into towards the lower leg. On occasion, the pain will move upwards during healing.

Typically, the subluxation is in the lower lumbar spine, in particular, L5 or L4. In cases of bilateral sciatica, check for a base posterior sacrum or a thin lumbar disc at the level of involvement. As a rule of thumb, the thin disc (D4-D6) will adjust easier in the morning, and a thick disc (D1-D2) in the afternoon. Geriatric patients may adjust in the prone position (HyLo table).

If the pain is quite severe and unbearable, have the patient place an ice bag o their leg in the area of the most severe pain. This procedure usually moves the pain downwards. As the pain moves down (caudally), and if required, have the patient move the ice downwards – this is referred to as “chasing the pain.” If the ice irritates the patient, let them try using moist heat.