By Stephen H. Hochschuler, MD
For severe or ongoing flare-ups of sciatic nerve pain, the condition may need to be treated so it does not get worse over time.
Readily available nonsurgical remedies and regular exercise will go a long way toward relieving the pain most people experience.
For others, when the pain is severe or does not get better on its own, a more structured treatment approach, and possibly surgery, may be the best option for finding pain relief and preventing or minimizing future pain and/or dysfunction.
Nonsurgical Treatment for Sciatica
The goals of nonsurgical sciatica treatments are to relieve pain and any neurological symptoms caused by a compressed nerve root. There is a broad range of options available for sciatica treatment. One or more of the treatments below are usually recommended in conjunction with specific exercises.
For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some find more relief with heat. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn.
Over-the-counter or prescription medications are often effective in reducing or relieving sciatica pain. Nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen), or oral steroids can reduce the inflammation that is usually part of the cause of pain. Muscle relaxants or narcotic medications may also be prescribed for the short term (a few days and up to 2 weeks) to alleviate pain.
Epidural steroid injections
If the pain is severe, an epidural steroid injection can reduce inflammation. Unlike oral medications, an injection goes directly into the painful area around the sciatic nerve to address the inflammation that may be causing pain.
While the effects tend to be temporary (providing pain relief for as little as one week or up to a year), and it does not work for everyone, an epidural steroid injection can be effective in relieving acute sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning and exercise program.
Alternative Sciatica Treatment
In addition to standard medical treatments, several alternative treatments have also been shown to provide effective sciatica pain relief for many patients. Some of the more common forms of alternative care for sciatica include chiropractic manipulation, acupuncture, cognitive behavior therapy, and massage therapy.
Chiropractic/manual manipulation Spinal adjustments and manual manipulation performed by appropriately trained health professionals, such as chiropractors and osteopathic physicians, are focused on providing better spinal column alignment, which in turn is designed to help address a number of underlying conditions that can cause sciatic nerve pain.
Manual manipulation by appropriately trained health professionals can create a better healing environment and should not be painful.
Acupuncture This practice is centered on the philosophy of achieving or maintaining well-being through the open flow of energy via specific pathways in the body. Hair-thin needles (which are usually not felt) are inserted into the skin near the area of pain. Acupuncture has been approved by the U.S. Food and Drug Administration (FDA) as a treatment for back pain, and the National Institutes of Health has recognized acupuncture as effective in relieving back pain, including sciatica.
Cognitive behavior therapy This therapy for taking control and changing self-defeating behaviors can be helpful in managing sciatica pain, particularly in the short term. Sessions with a therapist may be face-to-face or online.
Massage therapy Certain forms of massage therapy have been shown to have a number of benefits for back pain, including increased blood circulation, muscle relaxation, and release of endorphins (the body’s natural pain relievers).
The above list represents the most common treatments but is by no means comprehensive. There are many more options, and patients will often need to use a process of trial and error to find what works best for them.
Treatment for Recurring Sciatica Pain
For most people, the good news is that sciatica typically gets better on its own, and the healing process usually will only take a few days or weeks.
Overall, the vast majority of episodes of sciatica pain subside within a 6- to 12-week time span. Following initial pain relief, a program of physical therapy and exercise should usually be pursued to alleviate pain and prevent or minimize any ongoing sciatic pain.
An ergonomic assessment of the workplace also may be helpful in recommending safer lifting or posture, depending on the nature of the job, and/or patient education on lifestyle factors that contribute to spine problems.
Medical Professionals Who Treat Sciatica
There are a number of types of nonsurgical spine care professionals who specialize in treating sciatica symptoms, such as chiropractors, physiatrists (physical medicine and rehabilitation specialists), pain management specialists, and physical therapists, all of whom may have specialized training to provide pain relief and help prevent future recurrences of sciatica. It is always advisable to have a qualified medical professional oversee any type of sciatica treatment.
Physical therapy exercises incorporating a combination of strengthening, stretching, and aerobic conditioning are a central component of almost any sciatica treatment plan.
When patients engage in a regular program of gentle exercises, they can recover more quickly from sciatica pain and are less likely to have future episodes of pain.
General Exercises for SciaticaStrengthening exercises Many exercises can help strengthen the spinal column and the supporting muscles, ligaments, and tendons. Most of these back exercises focus not only on the lower back, but also the abdominal (stomach) muscles and gluteus (buttock) and hip muscles. Strong core muscles can provide pain relief because they support the spine, keeping it in alignment and facilitating movements that extend or twist the spine with less chance of injury or damage.
Stretching exercises Stretching is usually recommended to alleviate sciatic pain. Stretches for sciatica are designed to target muscles that cause pain when they are tight and inflexible.
Hamstring stretching is almost always an important part of a sciatica exercise program. Most people do not stretch these muscles, which extend from the pelvis to the knee in the back of the thigh, in their daily activities.
Another stretch that is often helpful in easing sciatica is the Bird Dog move: After getting on their hands and knees, individuals extend one arm and the opposite leg. The arm and leg extensions are then alternated. A more advanced version of this exercise is the Plank Bird Dog move, in which the extensions are done once the person is in the plank position on their hands and toes.
Low-impact aerobic exercise Some form of low-impact cardiovascular exercise, such as walking, swimming, or pool therapy is usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment.
Aerobic conditioning also has the unique benefit of releasing endorphins, the body's natural pain killers, which helps reduce sciatic pain.
These types of exercise may be done separately or in combination. Examples of types of exercise that may include both strengthening and stretching include yoga, tai chi, and Pilates.
For anyone in chronic pain or with a relatively high level of sciatica pain, one option for gentle exercise is water therapy, which is a controlled, progressive exercise program done in a warm pool.
The specific sciatica exercises will depend on the underlying medical condition causing the sciatica pain, as well as a number of other factors, such as the patient's level of pain and overall conditioning.
When sciatica pain is at its most severe, patients may find the pain hard to bear and may need to rest for a day or two. However, resting for more than one or two days is generally not advised, as prolonged rest or inactivity can increase pain and will lead to deconditioning. Regular movement is important to provide healing nutrients to the injured structures that are causing the pain.
There are several types of health professionals who specialize in providing appropriate physical therapy and exercise programs and instruction, including physical therapists, chiropractors, physiatrists (also called physical medicine and rehabilitation physicians), and qualified certified athletic trainers.