Sciatica: What To Do When Four Weeks Have Passed and It Has Not Settled

Written and clinically reviewed by Dr. Jun (Jun Chung): Doctor of Chiropractic (New Zealand College of Chiropractic), NZCC- and ACC-registered, 13+ years' clinical practice including non-surgical disc care. Auckland Wellness Centre, Rosedale and Milford. Last updated: August 2026 · next scheduled review: August 2027.

Quick answer: Most sciatica improves substantially in the first four weeks, and around 80 percent settles within eight. If yours has not moved after four weeks, that is not a reason to panic and not a reason to keep doing the same thing. It is the point where the assessment should be repeated and the plan should change based on what has and has not shifted.

Four weeks is a useful marker because it is roughly where the normal recovery curve should be visible. Clinical guidelines put conservative care as the right approach for the first six weeks, with review points along the way, and imaging considered from four to six weeks if things are not improving. So the question at four weeks is not whether to give up. It is whether anything has actually changed, and what that tells you.

This is what should happen at that point.

What the normal timeline looks like

Sciatica is usually self-limiting. Up to 80 percent of people recover within eight weeks and around 95 percent within a year. Most of the improvement in pain and function happens in the first four weeks, which is exactly why the four-week mark is informative: by then you should be able to see a direction of travel.

Being in the slower group is common and it is not a sign that something has gone badly wrong. What it does mean is that four weeks of no change is information, and information should be acted on rather than waited out.

First, the findings that change the timeline entirely

A small number of presentations are not a wait-and-review situation at any point in the four weeks. We screen for these at every visit, and if any appear you are sent for urgent medical assessment rather than treated:

• Numbness around the groin, inner thighs or buttocks, the area that would contact a saddle
• New difficulty starting or controlling urination, or loss of bowel control
• Weakness that is getting worse rather than staying steady, particularly in both legs
• Sciatica in both legs at once
• Sciatica with fever, unexplained weight loss, or a history of cancer

These are uncommon. Knowing them is what allows the rest of the process to be unhurried.

What "not improving" actually means

This is where a four-week review either earns its place or does not. "About the same" is a feeling, and feelings across four weeks of a fluctuating condition are unreliable. What we compare are the figures recorded at the first visit:

• Straight leg raise, in degrees, both sides. The angle at which symptoms reproduce is the single most useful number in sciatica, and it moves before comfort does.
• Where the symptoms sit. Pain that has moved back up the leg toward the spine is progress even if the intensity feels unchanged. This is the finding people most often miss in themselves, and it is recorded session by session.
• The neurological screen. Reflexes, myotome strength and dermatome sensation. Stable is good news. Worsening changes the plan immediately.
• Posture capture and lumbar range of motion. Pelvic position, lumbar curve and available movement, from the PostureScreen record taken at the first visit.

A four-week review against those numbers has three possible answers: moving in the right direction, so continue; not moving, so change the plan; or moving the wrong way, so escalate. Without the numbers, the answer is usually "give it a bit longer", which is how six weeks becomes six months.

What changes at the four-week review

Imaging becomes a reasonable question. In the first four weeks, imaging rarely changes management for sciatica without red flags, which is why guidelines advise against routine early scans. From four to six weeks without improvement, that calculation shifts. Our chiropractors refer directly for X-ray and ultrasound, so there is no GP appointment in the way, and where the picture points at a disc that needs MRI we refer for that pathway rather than treating around it.

Decompression enters the conversation. Where the assessment points at a disc carrying load, and particularly where symptoms travel below the knee, spinal decompression is the tool aimed at that specific problem. It applies a slow cyclic pull along the axis of the spine across a twenty to thirty minute session, with the intent of reducing the load on the disc space. At AWC that runs on a Win Trac 100 at $30 per session on an accepted ACC claim or $50 privately, booked in blocks and reviewed at the end of each block rather than sold as a package.

The mechanical picture gets revisited. Four weeks of altered walking and sitting changes the pelvis and the lumbar curve. Sometimes the original driver has settled and what remains is the compensation, which is a different treatment problem with a different answer.

How ACC works here

If an injury is behind the sciatica, a lifting incident, a fall, a crash or a work injury, it is generally an ACC matter. Chiropractors are ACC treatment providers with direct access, so our chiropractor lodges the ACC45 at the first visit and no GP referral is needed. Acupuncture, where it is part of the plan, runs as concurrent treatment under that same claim.

Two things worth knowing at the four-week mark. A claim can be lodged well after the injury, so having waited does not lock you out. And if you already have an open claim from another provider, treatment can usually continue under it rather than starting again.

What to ask at your four-week review

1. What were my numbers at the first visit, and what are they now? If the answer is not specific, that is the finding.
2. Has the pain moved, even if it has not reduced? Movement toward the spine is progress worth continuing for.
3. What would change your plan? A plan with no threshold for changing it is not a plan.
4. Would imaging change what we do next? If not, it can wait. If it would, four weeks in is a reasonable point to ask for it.

The full list of what gets measured at a first visit, and in what units, is on our spinal and posture assessment page.

Frequently asked questions

How long should sciatica take to go away? Most improvement happens in the first four weeks, around 80 percent of people settle within eight weeks, and about 95 percent within a year. Slower than that is common, but four weeks without change is worth reviewing properly.

Should I get an MRI for sciatica? Not usually in the first few weeks, because it rarely changes what is done and most sciatica settles anyway. From four to six weeks without improvement, or at any point with red flag findings, it becomes a reasonable question. We refer directly for X-ray and ultrasound, and refer on for MRI where that is the right image.

Does spinal decompression help sciatica? It is the tool used when the assessment points at a disc carrying load, particularly where symptoms travel below the knee. It is not a general treatment for all leg pain, which is why it follows an assessment rather than preceding one.

Is sciatica treatment covered by ACC? Where an injury is behind it, yes. Our chiropractor lodges the ACC45 at your first visit and no GP referral is required. Sciatica with no injury behind it is charged privately.

My pain has moved from my calf to my buttock. Is that better or worse? Generally better. Symptoms retreating toward the spine is one of the earliest signs of a disc-related problem settling, and it often happens before the intensity drops.

Can I keep working with sciatica? Usually yes, and staying active is part of the treatment rather than a risk to it. What matters is which positions and loads to modify, which is specific to your findings.

This article is general information, not a diagnosis. If you have any of the urgent findings listed above, seek medical assessment the same day. Auckland Wellness Centre sees patients at Unit E2, 27 William Pickering Drive, Rosedale (09 600 1939) and 177B Shakespeare Road, Milford (09 281 3687). Our approach to sciatica is set out on our sciatica treatment page.