Pain-Free Living

Sciatica: Treatment and Management

By Lisa Cantkier

There are a variety of treatment options for sciatica. “I have found rest during the first few days when pain begins, as well as elevating my affected leg, to be very helpful in my recovery of sciatica,” said Wendy, who has experienced a few short-term bouts of sciatica over the last 10 years.

Self-Care and Home Remedies

There’s a good chance self-care and home remedies will help you recover from the pain of sciatica. Getting yourself moving is key. Be aware that resting for a day or two may provide some initial relief; however, prolonged inactivity will worsen your symptoms. Walking and moving the right way will help you avoid the problems that accompany prolonged bedrest. Also, prolonged sitting puts more stress on your lower back than standing or walking.

Self-care treatments that could help you manage your pain include:

Ice: During the first two to three days, a cold pack placed on the painful area for up to 20 minutes several times a day may be helpful. You can use an ice pack or a package of frozen vegetables wrapped in a clean towel.

Heat: After two to three days of trying ice, try applying heat to the painful area. Try hot packs or a heating pad with the heat adjusted to the lowest setting. The University of Maryland Medical Center recommends trying to achieve a temperature of 104^o F. Some people find a hot shower helps reduce the pain. If heat is not effective for you, try alternating between ice and heat.

Lifting: Use safe lifting methods, bending at the knees. Do not lift anything over 15 pounds until you are pain free.

Stretching: Stretching exercises for your lower back can help relieve compression of your sciatic nerve. Avoid awkward movements during stretches, and try to hold each stretch for at least 30 seconds. Stretches should follow the natural alignment of your body.

Sleeping at night: Sleep at night, as bedrest is not advisable during the day. Firm mattresses are the best support for your back. Try lying on your back with soft pillows under your knees. Although less supportive, you also can lie on your side with soft pillows between your knees.

If your pain doesn’t improve with self-care, your doctor may recommend the following treatments.

Physical therapy: Once the severe pain improves, a physical therapist can create a rehabilitation program to help you prevent future injuries. Usually, this includes exercises to strengthen and stretch the muscles that support your back, correct your posture and improve your flexibility.

Strengthening exercises: Many lower back exercises can help strengthen the muscles, tendons and ligaments in your back. Some also target the muscles in your stomach (abdominal), hips and gluteus (buttocks). These muscles in your “core” support your spine, so a stronger core will lead to a stronger back, thereby reducing the risk of misalignments and disc problems.

Stretching exercises: Stretching is an effective part of alleviating sciatic pain. Stretches for sciatica help loosen tight muscles. Hamstring stretching usually is recommended.

Medications: Check with your doctor before you take any over-the-counter pain medications. Pain relievers such as ibuprofen (Advil, Motrin IB and others) and naproxen sodium (Aleve) may help you.  According to Mayo Clinic, the following medications might be prescribed for your sciatica pain: anti-inflammatories, anti-seizure medications, muscle relaxants, narcotics and/or tricyclic antidepressants.

Steroid injections: Corticosteroids can help control your pain by reducing inflammation around the irritated nerve. The treatment usually lasts a few months. There is risk of serious side effects if you receive steroid injections frequently, so this treatment generally is limited.

Acupuncture: This alternative therapy has been found effective for some back pain. Thin needles are inserted into your skin at specific pressure points on your body. If you decide to try acupuncture, choose a licensed practitioner to ensure he/she has had extensive training.

Spinal manipulation: Spinal adjustment (manipulation) is an alternative therapy provided by chiropractors to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation appears to be as effective and safe as standard treatments for lower back pain, but it might not be appropriate for radiating pain.

Surgery
Typically seen as a last resort, surgery may be recommended when the compressed sciatic nerve causes significant weakness or loss of bladder or bowel control, or if pain does not improve with other treatment options. The bone spur or the part of the herniated disc pressing on the pinched nerve is surgically removed. Several factors can affect whether you are a candidate for surgery, including age, pre-existing medical conditions and mental health.

If you require surgery, research supports its long-term effectiveness. An eight-year follow-up study of over 1,200 patients, published in Spine in 2014, (http://www.sciencedaily.com/releases/2013/12/131227161811.htm), showed for patients with herniated discs in the lower (lumbar) spine, surgery led to greater long-term improvement in pain, physical functioning and disability compared to nonsurgical treatment.

Prevention
These tips can help you prevent sciatica from reoccurring.

Body mechanics: When lifting heavy items, your movements should be straight up and down. Bend at the knees and keep your back straight (avoid any twisting movements). Hold the items you are lifting close to you. If the load is too heavy for you, ask someone for help.

Exercise: Work on strengthening your core muscles. These muscles in your abdomen and lower back are key to preventing back problems and keeping it strong. Your physical therapist or doctor can recommend the right exercises.

Posture: For your workplace, select a swivel base chair that has armrests and offers proper lower back support. A pillow or rolled towel placed in the small of your back can help with curvature. Your knees and hips should be at the same level.

Last Reviewed 2/12/16

Lisa Cantkier, CHN is a certified holistic nutritionist and a health and wellness editor.

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