Sciatica Is Not Just Pain: Bryce Garst on Why X-Rays Matter and Maintenance Changes Everything

Bryce Garst starts every sciatica case the same way — not with a stretch or an adjustment, but with three questions: What happened? When did it start? And has anyone actually looked at your spine? That last question, he's found, is where the conventional approach most often fails. The nerves that form the sciatic nerve exit the lumbar spine at specific, identifiable levels. If you don't image those levels, you're guessing.

Garst is a Doctor of Chiropractic at The Well Chiropractic Clinic in Mesa, Arizona. His approach to sciatica is systematic and diagnostic — consultation, orthopedic testing, and X-rays before any treatment begins. In a field where many practitioners skip imaging entirely, Garst considers it essential.

Finding the Root of the Nerve

"Our approach aims to get to the root cause of the sciatic type symptoms. If appropriate, we will take X-rays of the low back area to assess if there is any potential problems structurally with the nerves of the low back. This is a common approach that conventional medicine will omit or skip but we feel in many cases it is essential. The nerves that exit the spine in the lower back are the exact ones that make up the sciatic nerve."

Bryce Garst, DC

The Well Chiropractic Clinic · Mesa, AZ

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The anatomy Garst describes is straightforward but clinically critical. The sciatic nerve — the largest nerve in the body — forms from nerve roots at lumbar levels L4 through S3. A comprehensive review in the New England Journal of Medicine confirmed that the majority of sciatica cases involve compression or irritation of these specific nerve roots, most commonly at L5 or S1, and that accurate localization is essential for appropriate treatment.^[1]

Garst's insistence on imaging reflects a gap he sees regularly. Many patients arrive having been prescribed medications or stretches without anyone identifying which nerve root is involved, or whether structural issues — disc herniation, foraminal stenosis, spondylolisthesis — are contributing. The functional approach to pain that practitioners like Logan Engelstad and Anika Anderson also advocate starts with the same principle: know what you're treating before you treat it.

A Natural, Multi-Faceted Approach

"Sciatica is not just a simple pain down the leg or in the buttocks region. It is typically a nerve issue stemming from the low back/pelvic region. A multi-faceted natural approach to care can in many cases resolve sciatic complaints without the need for harsh medications or surgery."

Bryce Garst, DC

The Well Chiropractic Clinic · Mesa, AZ

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The evidence supports conservative approaches as first-line treatment. A randomized double-blind trial demonstrated that chiropractic manipulation produced significant improvements in acute back pain and sciatica with disc protrusion — with results comparable to surgical outcomes for many patients.^[2] The American College of Physicians has explicitly recommended nonpharmacologic therapies including spinal manipulation as first-line treatment for low back pain, before considering medications or invasive procedures.^[3]

What makes Garst's approach distinctive is the diagnostic rigor before treatment. Understanding what a chiropractor actually evaluates in a sciatica case — the specific orthopedic tests, the nerve root localization, the structural assessment — reveals a clinical process far more detailed than the "crack and go" stereotype suggests.

The Toothbrush Principle

"We do not brush our teeth every day because our teeth are in pain. We brush our teeth every day because it is the accumulation of usage over time that creates the necessity to maintain your teeth. If we do not brush our teeth every day, we will quickly see that the effects will begin to cause irreversible change. The exact same thing happens to our spine over time."

Bryce Garst, DC

The Well Chiropractic Clinic · Mesa, AZ

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The toothbrush analogy lands because it reframes spinal care from reactive to preventive. Research confirms that degenerative spinal changes accumulate over decades of normal use, and that the majority of disc herniations and foraminal narrowing develop gradually before producing symptoms.^[4] By the time pain appears, the structural changes may be years in the making — exactly Garst's point about maintenance before the problem announces itself.^[5]

For anyone navigating sciatica — whether it's a first episode or a recurring pattern — Garst's framework offers a clear sequence: diagnose first (consultation, orthopedic tests, imaging), treat conservatively (multi-faceted natural approach), and maintain consistently (the toothbrush principle). The best practitioners for sciatica share this diagnostic-first philosophy. Don't treat what you haven't properly identified. And once you've resolved it, don't wait for it to come back — maintain.