Back & Neck Pain Spinal Conditions How Sciatica Is Treated By Laura Inverarity, DO Laura Inverarity, PT, DO, is a current board-certified anesthesiologist and former physical therapist. Learn about our editorial process Laura Inverarity, DO Medically reviewed by Medically reviewed by Grant Hughes, MD on November 27, 2015 linkedin Grant Hughes, MD, is a board-certified rheumatologist. He is an associate professor at the University of Washington School of Medicine and the head of rheumatology at Seattle’s Harborview Medical Center. Learn about our Medical Review Board Grant Hughes, MD Updated on May 13, 2020 Print Table of Contents View All Home Remedies and Lifestyle Over-the-Counter Therapies Prescriptions Surgeries and Procedures Complementary/Alternative Medicine 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. More than 80% of cases of sciatica resolve in several weeks with conservative treatment. fizkes / Getty Images 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 stretchesLow back stretchesHamstring stretchesCore strengthening Sciatica: Exercises to Do or Avoid 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. Never give aspirin to children or teens under 18, as it is associated with a risk of a serious condition called Reye syndrome. 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Johns Hopkins Medicine. Sciatica. Albert HB, Manniche C. The efficacy of systematic active conservative treatment for patients with severe sciatica: A single-blind, randomized, clinical, controlled trial. Spine. 2012;37(7):531-42. doi:10.1097/BRS.0b013e31821ace7f Cleveland Clinic. Sciatica: Management and treatment. Updated March 25, 2020. American Academy of Orthopaedic Surgeons. Sciatica. Updated December 2013. Pinto RZ, Maher CG, Ferreira ML, et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ. 2012;344:e497. Published 2012 Feb 13. doi:10.1136/bmj.e497 Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157(12):865-77. doi:10.7326/0003-4819-157-12-201212180-00564 American Academy of Orthopaedic Surgeons. Cauda equina syndrome. Updated March 2014. Liu CH, Kung YY, Lin CL, et al. Therapeutic efficacy and the impact of the "dose" effect of acupuncture to treat sciatica: A randomized controlled pilot study. J Pain Res. 2019;12:3511–3520. doi:10.2147/JPR.S210672 Lewis RA, Williams NH, Sutton AJ, et al. Comparative clinical effectiveness of management strategies for sciatica: Systematic review and network meta-analyses. Spine J. 2015;15(6):1461-77. doi:10.1016/j.spinee.2013.08.049 Additional Reading Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019;367:l6273. doi:10.1136/bmj.l6273