Why Your Sciatica Keeps Coming Back (And How I Approach It Differently as Ann Arbor's Only CCSP)

By Dr. Tim Dehr, CCSP

Sciatica has a way of taking over your life. It's not just the pain — it's the way it changes everything around it. You start favoring one side when you walk. You figure out which chair in your downtown Ann Arbor office hurts less. You stop doing things you used to do without thinking — picking up your kid, running around Gallup Park, even just getting out of your car after the commute from Ypsilanti — because now everything has a cost.

Most people who come to my office dealing with sciatica have already tried a few things. Rest. Anti-inflammatories. Maybe some stretches they found on YouTube. Sometimes that helps temporarily. But if the root cause is still there, it comes back. A long drive to Detroit. A bad night's sleep. A morning where you just moved wrong getting out of bed. Same nerve, same misery.

Here's why that keeps happening — and what I do differently.

The Problem: Most People Are Chasing Symptoms, Not Fixing the Cause

After nearly two decades treating everyone from Olympic athletes to desk workers in Ann Arbor, I've seen this pattern hundreds of times:

Someone develops sciatica. They rest for a few weeks. Pain subsides. They think it's fixed. Three months later, it's back. They do more rest. More ibuprofen. Maybe some physical therapy. It helps again. Then it comes back again.

This isn't because sciatica is mysterious or impossible to fix. It's because the mechanical problem causing the nerve compression was never actually addressed.

Think of it this way: if your car tire is leaking air, you can keep refilling it every few days, or you can fix the puncture. Rest and anti-inflammatories are like refilling the tire. They manage the symptom (low air/pain) but don't fix the underlying problem (the puncture/mechanical dysfunction).

My job as a CCSP is to find the puncture and fix it.

What's Actually Happening When You Have Sciatica

The sciatic nerve is the longest nerve in your body. It runs from your lower back (specifically, nerve roots at L4, L5, and S1-S3), through your pelvis, deep into your glute muscles, and down the back of each leg all the way to your foot.

Because it's so long and passes through so many different structures, sciatica can show up in a lot of different ways:

Some people get:

• Burning pain down the back of the leg
• Sharp, shooting pain that makes them jump
• Numbness in the calf or foot
• Tingling ("pins and needles") in the toes
• Deep, grinding ache in the hip or glute
• Weakness in the leg (trouble standing on tiptoes or lifting the foot)

All of these are sciatica. But the location and quality of the pain give me clues about where the compression is happening.

The Three Most Common Causes I See in My Ann Arbor Practice

1. Lumbar Disc Issues (Herniation or Bulge)

This is what most people think of when they hear "sciatica." A disc in your lower back (usually L4-L5 or L5-S1) herniates or bulges and presses on the nerve root as it exits the spine.

Common in:

• People who sit for long periods (office workers, truck drivers, long commuters)
• People who lift heavy objects with poor mechanics
• Athletes who do repetitive bending or twisting (golfers, gymnasts)

How I approach it:
I'm looking at how your lumbar spine is moving. Is there a restriction at L4-L5? Is your pelvis tilted in a way that's putting extra stress on that disc? Are your hip flexors so tight from sitting all day that they're pulling your pelvis forward and compressing the lower lumbar discs?

The adjustment itself is about restoring proper joint mechanics so the disc has space to heal and the nerve has room to function. But I'm also addressing the movement patterns and postural habits that created the problem in the first place.

2. Piriformis Syndrome

Your piriformis is a small muscle deep in your glute. The sciatic nerve runs right next to it (and in some people, actually passes through it). When the piriformis gets tight or goes into spasm, it can compress the sciatic nerve.

Common in:

• Runners (especially those training on uneven surfaces like trails)
• People who sit with their wallet in their back pocket
• Athletes with poor hip mobility
• People who cross their legs frequently

How I identify it:
Piriformis syndrome often presents with pain deep in the glute that gets worse when sitting, especially on hard surfaces. The pain usually doesn't extend below the knee (unlike disc-related sciatica, which often goes all the way to the foot).

I test hip internal rotation, look at how the pelvis is moving, and check for trigger points in the piriformis itself. If that muscle is the culprit, I'm working on restoring proper hip mechanics and addressing whatever caused the piriformis to get angry in the first place (usually a compensation for restriction elsewhere).

3. Sacroiliac Joint Dysfunction

Your sacroiliac (SI) joints connect your sacrum (the triangular bone at the base of your spine) to your pelvis. When one of these joints gets stuck or misaligned, it can irritate the nerve roots that form the sciatic nerve.

Common in:

• Pregnant or postpartum women (hormonal changes loosen ligaments)
• People with one leg slightly shorter than the other
• Athletes with asymmetrical sports (golf, tennis, baseball)
• People who've had a fall or car accident

How I approach it:
SI joint dysfunction often presents with pain right at the base of the spine, usually on one side. Pain when transitioning from sitting to standing is a classic sign. I'm checking how the SI joints are moving, whether the pelvis is rotated, and what's causing the asymmetry.

Adjustments to the SI joint can make a dramatic difference, but I'm also looking at the bigger picture — why did that joint get stuck in the first place?

Why Being a CCSP Matters for Sciatica

I'm the only Certified Chiropractic Sports Physician (CCSP) in Ann Arbor. That certification required advanced post-graduate training in:

• Biomechanical analysis of movement patterns
• Sports injury diagnosis and rehabilitation
• Advanced orthopedic assessment
• Evidence-based treatment protocols

What that means for you:

I'm not just looking at your spine in isolation. I'm looking at how you move, how your pelvis and hips are functioning, how your feet are distributing force, what your training or work demands are doing to your body.

Example:
I had an NCAA track athlete come in with sciatica that kept flaring up during training cycles. Standard chiropractic approach would've been: adjust the lower back, maybe some soft tissue work, send them on their way.

My approach: I watched them run. I saw that their left hip wasn't extending properly during their stride. That was forcing their lower back to hyperextend to compensate. That hyperextension was compressing the nerve root at L5-S1.

We fixed the hip mobility restriction, retrained their running mechanics, and adjusted the lumbar spine to restore proper alignment. The sciatica resolved because we addressed the actual cause, not just the symptom.

That's what CCSP training gives me — the ability to see the whole kinetic chain, not just the area that hurts.

Treatment: How I Address Sciatica

My approach combines several elements:

1. Spinal and Pelvic Adjustments

Precise adjustments to restore proper joint mechanics in your lower back, pelvis, and SI joints. The goal is to reduce nerve compression and improve how force is distributed through your body.

2. Soft Tissue Work

If your piriformis, hip flexors, or other muscles are contributing to the problem, I'm addressing those through manual therapy techniques.

3. Corrective Exercises

You can't adjust your way out of a movement pattern problem. I give specific exercises to:

• Strengthen weak muscles (often glutes and core)
• Stretch tight muscles (often hip flexors and piriformis)
• Retrain proper movement patterns

4. Lifestyle and Activity Modification

If you're sitting at a desk in downtown Ann Arbor for 8 hours a day, we need to talk about ergonomics. If you're a runner training around Gallup Park or the Huron River trails, we need to look at your training volume and mechanics.

The goal isn't just to get you out of pain. It's to keep you out of pain.

How Long Does It Take?

This is the question everyone asks, and the honest answer is: it depends.

Acute sciatica (recent onset, first time):
Many patients notice improvement within 2-4 weeks of consistent treatment. Some feel better after just a few visits.

Chronic sciatica (recurring or present for months/years):
This takes longer because we're not just addressing the current flare-up — we're correcting the underlying mechanical dysfunctions that have been there for a while. Expect 6-12 weeks of active treatment, then periodic maintenance to prevent recurrence.

Factors that affect recovery:

• How long you've had it
• Whether there's a disc component
• Your overall health and activity level
• How closely you follow through with exercises and activity modifications
• Whether you address the ergonomic or lifestyle factors that contributed to it

I'm not promising overnight miracles. I'm offering a systematic approach to actually fixing the problem.

If I suspect something outside my scope, I'll refer you to the appropriate specialist — orthopedic surgeon, neurologist, or your primary care physician for imaging or further workup.

Why Sciatica Tends to Recur (And How to Prevent It)

Sciatica has a frustrating tendency to come back if you don't address the root cause.

Common reasons for recurrence:

1. The mechanical problem was never fixed
Rest and medication reduce inflammation and pain, but they don't correct a misaligned pelvis, a restricted lumbar joint, or a tight piriformis. As soon as you return to normal activity, the same mechanics that caused the problem are still there.

2. Movement patterns haven't changed
If you sit hunched over at your desk all day, that forward head posture and rounded lower back are going to keep compressing those nerve roots. If you run with poor hip extension, you're going to keep overloading your lower back.

3. Muscle imbalances persist
Weak glutes and core muscles mean your lower back has to work harder to stabilize your pelvis. Tight hip flexors pull your pelvis into anterior tilt, which compresses the lumbar discs.

My approach addresses all three of these factors, which is why patients who follow through with the full treatment plan tend to have much better long-term outcomes.

Who I Work With in Ann Arbor

I treat sciatica in a wide range of people throughout Ann Arbor, Ypsilanti, and Washtenaw County:

Office workers and professionals:
Long hours sitting at desks downtown, driving to client meetings, hunched over computers. Sciatica from prolonged sitting and poor ergonomics is incredibly common.

Athletes (NCAA, high school, recreational):
Runners, cyclists, gymnasts, football players, soccer players. Sciatica from repetitive motion, poor mechanics, or asymmetrical loading.

Parents and caregivers:
Lifting kids awkwardly, carrying car seats, bending over cribs, sitting in awkward positions while nursing. Sciatica from repetitive strain and poor body mechanics.

Active adults:
People in their 30s, 40s, and 50s trying to stay active — running, weightlifting, playing recreational sports — but dealing with pain that limits their training.

The common thread: Everyone benefits from proper biomechanical assessment and treatment that addresses the root cause, not just the symptoms.

When to Call My Office

You should schedule an evaluation if:

• You've had sciatica for more than a few weeks
• Pain is getting worse instead of better
• You're having trouble walking or standing
• You're relying on pain medication to get through the day
• This is a recurring problem that keeps coming back
• You want to understand what's actually causing it (not just mask the pain)

Schedule Your Sciatica Evaluation in Ann Arbor

I'm located on East Stadium Boulevard in Ann Arbor. If you've been dealing with sciatica and standard approaches aren't working, it's worth getting a proper biomechanical assessment.

Call (734) 929-4523 or schedule online.

Performance Health Chiropractic
2330 E Stadium Blvd #3
Ann Arbor, MI 48104

Hours:
Monday – Thursday: 9:00 AM – 1:00 PM, 3:00 PM – 6:00 PM
Friday – Sunday: Closed

We serve patients throughout Ann Arbor, Ypsilanti, and Washtenaw County who are looking for answers, not just temporary relief.

Related Articles:

• Lower Back Pain Treatment
• Sports Rehabilitation in Ann Arbor
• Chiropractic Adjustments

About the Author:

Dr. Tim Dehr is a Certified Chiropractic Sports Physician (CCSP) and the only CCSP practicing in Ann Arbor, Michigan. He has nearly two decades of experience treating musculoskeletal conditions, with advanced training in biomechanical analysis and sports injury rehabilitation. Dr. Dehr combines precise spinal adjustments with movement pattern correction to address the root cause of sciatica, not just the symptoms.

Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice. Sciatica can have multiple causes, some of which require medical intervention. If you're experiencing severe pain, progressive weakness, or loss of bladder/bowel control, seek immediate medical attention.