How Sciatica Is Treated

Treating sciatica—pain caused by pressure on the sciatic nerve that originates in the lower back and extends down through the buttocks and the back of each leg—usually involves conservative measures such as gentle exercise and stretching, application of ice and/or heat, and pain medication. Although there are more aggressive approaches to treating sciatica, such as spinal injections or surgery, it's rarely necessary to use them.

Home Remedies and Lifestyle

It may seem counterintuitive, but if your doctor determines you have sciatica, they are likely to recommend that you move as much as possible. Movement helps reduce inflammation, while bed rest or being sedentary can result in aches and pains in other areas of the body. This doesn't mean you should hit the gym: Walking and gentle stretching to the extent that you can tolerate these activities is sufficient.

Gentle heat or cold treatment may help. When you first experience sciatica pain, apply cold packs to the tender area for 20 minutes at a time, several times per day. After a few days, switch to a hot pack or heating pad for 20 minutes at a time. If pain continues, alternate between heat and cold.

Physical Therapy

Targeted exercises often can help relieve sciatica pain. A physical therapist (PT) can provide you with exercises that are appropriate for you and your particular situation. For some conditions that cause sciatica, exercise may cause more harm than good.

Stretching and strengthening exercises that target the muscles of the lower back, abdomen, and thighs can help alleviate the symptoms of sciatica. A few beneficial exercises to help decrease pain associated with sciatica (depending on the cause) include:

• Piriformis muscle stretches
• Low back stretches
• Hamstring stretches
• Core strengthening

Over-the-Counter (OTC) Therapies

To relieve pain and reduce inflammation, your doctor may recommend OTC nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen), Naprosyn (naproxen), or aspirin. As these may have side effects, such as a risk of ulcers with aspirin, your doctor may recommend Tylenol (acetaminophen) instead.

Prescriptions

If over-the-counter pain medications don't bring relief, your doctor may prescribe a short course of a stronger prescription pain-reliever. Other types of prescription medications sometimes used to treat sciatica include muscle relaxants such as Flexeril (cyclobenzaprine), tricyclic antidepressants, or anti-seizure drugs.

Both OTC and prescription medications may have limited value in relieving sciatica. A 2012 review of studies found only low-quality evidence that they were effective in either the short-term or the intermediate term.

Surgeries and Specialist-Driven Procedures

Some episodes of sciatica may require more invasive treatments. These are usually done only after you haven't gotten relief from conservative treatment.

Injections with a corticosteroid into the epidural area of the spine might be used to reduce inflammation of the spinal nerve roots. This is an outpatient procedure that is given under local anesthesia. It is used for short-term relief (up to three months). However, studies have shown this approach to be only minimally beneficial and the risks and the expense may not outweigh the risks.

Surgery to address the underlying cause of sciatica may sometimes be worth considering if conservative treatment does not relieve pain after three months. The procedures may be a minimally-invasive microdiscectomy to remove pieces of herniated disc. Or, it can be a laminectomy in which the roof of the spinal canal is removed. The recovery from these procedures may be three to six months.

Emergency surgery if you begin to have severe symptoms of a syndrome called cauda equina which is characterized by loss of bladder and/or bowel control and loss of sensation in the area of the that would be in contact with a saddle. If the pressure is not relieved in time, cauda equina syndrome can result in permanent nerve damage, paralysis, and loss of function.

Complementary and Alternative Medicine (CAM)

People with sciatica might turn to complementary therapies for pain relief. Acupuncture has been the focus of several studies, some of which have found beneficial results. However, the National Institute for Health and Care Excellence (NICE) guidelines for treating low back pain and sciatica found the evidence to be of low quality and therefore do not recommend acupuncture.

Spinal manipulation (osteopathic or chiropractic) is also sought by some people to help relieve sciatica. There is a small amount of evidence that it is beneficial. If you have sciatica and would like to explore natural remedies, it's advisable you discuss this with your doctor beforehand.