Sciatica pain is a very common type of back pain that radiates down through the buttocks and legs. It’s not an actual condition, but rather a set of symptoms. When people say they are suffering with sciatica, they are describing the symptoms caused by irritation or damage to the sciatic nerve, which starts in the back of the pelvis and branches off into each leg causing what is most commonly called sciatic nerve pain. The sciatic nerve is the primary nerve in the legs and the largest in the entire body.
The good news is that in most cases an episode of sciatica will go away on its own. The vast majority of patients get better without surgery, most within six to 12 weeks with self-care treatments.
The bad news is that if sciatica pain persists more than two or three months, or if it’s accompanied by muscle weakness and other serious symptoms, sciatica surgery may be required. There are a couple of options for surgical procedures today for treating sciatica. One is an open procedure in which the surgeon makes a large incision to gain access to the affected area. Another option is a minimally invasive procedure using endoscopic techniques (and involving a much smaller incision). While success rates for both procedures are about equal, our experience is that minimally invasive procedures are associated with less pain and faster recovery.
Causes of Sciatica
In a majority of cases sciatica is caused by a herniated disc in the spine. In fewer cases, it may be the result of an injury, spinal stenosis (a narrowing of the spinal canal), an abscess or tumor, spondylolisthesis (a “slipped disc”), or piriformis syndrome (a tightening or spasm in a muscle deep in the buttocks). Some women develop sciatica when pregnant, as the growing fetus compresses the nerve.
Pain can occur at almost any point along the nerve’s pathway, but most people feel it on one side only. The intensity of sciatica nerve pain also can vary from person to person, ranging from a dull ache to a sharp shooting or burning sensation or even a jolt. In more serious cases, it is accompanied by a sensation of numbness, tingling or weakness.
Following are some do’s and don’ts for pain relief and prevention of sciatica.
- alternate cold and hot packs
- stretch regularly
- maintain a consistent exercise regimen
- try over the counter pain medications
- consider physical therapy
- stop exercising or stay on the couch waiting for it to get better
- let your weight get out of control
- carelessly lift heavy objects
- drive or sit for more than a couple of hours without getting up to stretch and move
- ignore symptoms if they persist for more than 2-3 months
The goal of alternating cold and hot packs is to get the blood flowing to and from the point of injury and pain. By rotating cold and hot packs the blood is being actively circulated, thereby helping the healing process and at the same time, providing relief from pain.
In most cases, gentle and progressive stretching can help provide relief from sciatica pain. More specifically, stretching exercises for the piriformis muscle, hamstring muscles, and hip extensor muscles are particularly beneficial to help decrease the painful symptoms along the sciatic nerve and return the patient's range of motion.
Without exercise and movement, the back muscles and spinal structures can become stiff and less able to support the back. This weakening can lead to back injury and strain, which often results in additional pain. Exercise is also important for the health of the spinal discs. Regular movement helps exchange nutrients and fluids within the discs to keep them healthy and prevent pressure on the sciatic nerve.
People suffering with sciatic pain should try common over the counter oral medications for pain relief such as acetaminophen, aspirin, or NSAIDs (such as ibuprofen [Advil, Motrin], ketoprofen, or naproxen [Aleve]). If that doesn’t work, prescription muscle relaxants to ease muscle spasms, Antidepressants for chronic low back pain and other prescription pain medications are sometimes warranted and effective.
Physical therapists can help people with sciatica pain with specific techniques such as McKenzie-based mechanical therapy, muscle energy techniques, mobilizations, spinal stabilization and core strengthening exercises, nerve slides/glides, or traction. Some people with sciatica feel better with exercises moving in a backwards bending position, some in a bending forward position. A physical therapist will be able to best offer strategies for helping individual patients and situations.
Again, the key is to keep the muscles limber, health and flexible. In the past, patients with sciatica were advised to rest. Now it’s exactly the opposite. We have learned that moving is helpful for providing relief to sciatica pain, so keep moving!
Obesity is one of the risk factors for sciatica. The additional weight causes stress on your spine and may contribute to the spinal changes that trigger sciatica
Acute injury is another risk factor for sciatica. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods may play a role in sciatica. Don’t be careless. Bend from the knees when lifting. Ask for a helper if an item is particularly heavy.
Sitting for long periods of time exacerbates sciatica pain. If you drive for a living, try to take breaks for a quick walk and stretch. If your job requires you to sit at a desk, try standing at regular intervals and mix it up with short walks and stretches. Any and all movement will be helpful in keeping the muscles more flexible and hopeful minimizing the pain from sciatica.
Sometimes “self-care” and treatment of sciatica just won’t be enough and the chronic pain will become unbearable. In these cases in which symptoms have persisted for more than 2-3 months, it is time to see a doctor and explore surgical options. Don’t ignore symptoms for longer.
In most cases an episode of sciatica will go away on its own within six to 12 weeks with self-care treatments. In some cases, if sciatica pain persists more than two or three months, or if it’s accompanied by muscle weakness and other serious symptoms, sciatica surgery may be required.