How Sciatica Is Treated

Sciatica is a common cause of low back pain and leg pain. It is usually caused by pressure on the sciatic nerve from a herniated disc. Conservative treatment and physical therapy can often help you recover. If the pain continues, spinal injections or surgery may be recommended.

Your doctor is likely to recommend that you continue to move as much as possible. Movement helps reduce inflammation, while bed rest can result in aches and pains in other areas of the body. Exercise as simple as walking and stretching should be done as soon as you can tolerate it.

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

Working with a physical therapist (PT) can help you determine which exercises are best for you, given your specific condition, as they should be individualized. For some conditions that cause sciatica, various forms of exercise might need to be avoided.

Stretching and strengthening exercises that target the muscles of the lower back, abdomen, and thighs can help reduce 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

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.

In some cases, your doctor may prescribe a muscle relaxant such as Flexeril (cyclobenzaprine), or tricyclic antidepressants or anti-seizure medications.

If your pain is severe and you haven't gotten relief with OTC medications, your healthcare provider might prescribe a short course of a stronger prescription pain-reliever.

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.

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

Spinal injections with a cortisone-like medication might be used to reduce inflammation of the spinal nerve roots. This is an outpatient procedure that is given under local anesthetic. It is used for short-term relief (up to three months). However, studies have shown this procedure has only minimal benefit, which may not outweigh the risks or expense.

Surgery to address problems of herniated discs and other causes might be done if your sciatica is still serious after three months of conservative treatment. The procedures may be a minimally-invasive microdiscectomy that removes 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.

You may need emergency surgery if you begin to have severe symptoms of cauda equina syndrome, which include loss of control of your bowel or bladder and loss of sensation in your saddle area. If the pressure is not relieved in time, cauda equina syndrome can result in permanent nerve damage, paralysis, and loss of function.

People with sciatica might turn to complementary therapies for pain relief. Acupuncture has been the focus of several studies, some of which find 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.

Stay vigilant with your exercises and work closely with your doctor and physical therapist to be sure you are doing the right things for your specific condition. Often, sciatica will be relieved over time without invasive procedures.