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What is sciatica?

Sciatica causes sharp, shooting, or burning pain, tingling, or numbness that radiates down one side of the body from the lower back into the leg and often below the knee. A typical episode lasts from a few days to a week or two. It can be disruptive, and sometimes debilitating.

For many people, simple home remedies, staying active, and strengthening and stretching the body can alleviate symptoms. When pain persists, additional medical treatment can help.

What causes sciatica?

Sciatica results from irritation or compression of the sciatic nerve or its nerve root. This causes pain, numbness, or tingling anywhere along the length of the nerve.

One of the most common causes of sciatica is a bulging (herniated) disc in the lower back. Discs are small tire-shaped cushions in between the bones of the spine. If the outer rim of a disc tears, usually due to age-related degeneration and routine pressure on the lower back, the damaged disc, the leaking jellylike inner material, or a combination of both exert pressure on the nearby nerve.

Other causes of sciatica include spinal stenosis, a narrowing of the spinal canal; spondylolisthesis, a condition in which one of the bones in the spine slips out of alignment; and injury that damages the sciatic nerve. Sciatica can also occur in late pregnancy as the growing baby puts indirect pressure on the sciatic nerve.

Sciatica symptoms

Common symptoms of sciatica are intense pain (described as sharp, shooting, or burning), numbness, or tingling. Symptoms vary in intensity and location from person to person. For some people, sciatica feels like a mild ache. For others, pain is intense and disruptive.

The pain can radiate from the lower back through the buttocks and down one or both legs. Sometimes, symptoms are localized to the leg and foot, with no discomfort in the back or buttocks. The pain can feel more intense at certain times of the day or in certain body positions. Symptoms are often worse when sitting or coughing.

Self-care for sciatica

For most people, self-care treatments are sufficient to manage symptoms and prevent future flare-ups. Self-care therapies include cold and heat therapy, over-the-counter pain medication, staying active, and regular stretching.

See your doctor if your pain worsens or symptoms don't improve after a couple of weeks.

Cold and heat

Both cold and heat can be used to ease the pain of sciatica and help you function.

For the first few days, place ice packs on your lower back and other areas of pain to reduce sciatic nerve inflammation. Ice packs shouldn't directly touch the skin; wrap them in a cloth or towel. Ice the area for no more than 15 to 20 minutes at one time, with at least a 15-to 20-minute break in between. Try a cycle of on-off-on-off-on. Then, take a break to see how you feel.

Heat can be used after a few days, after some healing has occured and the pain has started to subside. Heat treatments increase the flow of blood to the area, which may speed healing. Heat also relaxes the muscles to allow for gentle stretching that can help relieve the pain.

You can use a heating pad or hot water bottle wrapped in a towel, or soak in a warm bath. If you use a hot water bottle or heating pad, apply it to your lower back. Improperly applied heat treatment can cause burns, so follow these rules:

• Place a cloth barrier between the heat source and your skin (if using a hot water bottle or heating pad).
• Make sure that the treatment feels warm, not hot; if it is uncomfortably warm, it's too warm.
• Apply heat for at least 15 minutes but no longer than two hours.
• If using a heating pad, take care not to fall asleep while using it.

Over-the-counter medications

Several over-the-counter remedies can help manage sciatica. For example:

Oral painkillers. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) help reduce inflammation and related pain. If you have other health conditions such as high blood pressure, stomach problems, or kidney or heart disease, check with your doctor about the risks and benefits of taking NSAIDs and to determine the proper dose and frequency that's safe for you.

Acetaminophen (Tylenol) can relieve pain but does not reduce inflammation. Don't take more than 3,000 milligrams (mg) per day; acetaminophen can cause liver damage if taken in very high doses, especially among people who drink alcohol regularly.

Topical painkillers. Creams, gels, sprays, or patches applied to painful areas may also offer relief. Examples include topical NSAIDs such as diclofenac gel, and products that contain anesthetics like lidocaine or pain signal interrupters such as menthol or capsaicin.

Staying active

Resting for a few days when sciatica pain starts is fine, but staying inactive too long can worsen the condition. Regular movement helps relieve pain in several ways:

• It strengthens the muscles that support your spine.
• It improves flexibility and range of motion.
• It boosts blood flow to all areas of the body, including injured areas, which may speed healing.
• It reduces the perception of pain.

Focus on low-impact activities such as walking or swimming, and flexibility activities such as yoga, tai chi, or Pilates.

Since sitting increases pressure on the discs in the lower back, avoid prolonged sitting or long driving trips while your body heals.

Stretches

Stretching is one of the most effective ways to relieve sciatica and promote long-term healing. Movement and gentle stretches may provide several benefits, including:

• Increased flexibility and range of motion: Stretches targeting the hips, lower back, and legs can reduce muscle tension that may irritate the sciatic nerve.
• Stronger supporting muscles: Building flexibility helps to support proper spinal alignment and reduce stress on the lower back, reducing the chance of future episodes.
• Circulation boost: Improved blood flow may accelerate healing by delivering oxygen and nutrients to injured tissues.
• Reduced pain perception: Gentle movement releases endorphins, which act as natural pain relievers.

It's essential to approach stretching with care. Avoid overexertion or excessive bending that could strain the spine. Focus on slow, controlled movements and listen to your body. If stretching worsens your pain or feels uncomfortable, consult a healthcare provider to ensure you're on the right path to recovery.

Medical treatment for sciatica

Consult your doctor if symptoms don't improve or respond to self-care treatments. Your doctor can review your symptoms, perform a physical exam, and consider testing to confirm the diagnosis and to rule out other possible causes of your symptoms.

Additional medical treatment can prevent ongoing irritation of the sciatic nerve.

Physical therapy

If pain has not subsided after a few weeks, your doctor may refer you to a physical therapist, who will develop a treatment plan that will likely include core strengthening and aerobic exercises. The physical therapist will prescribe a program of exercises tailored to your needs and teach you how to do them at home.

Physical therapy for sciatica may also include ultrasound, transcutaneous electrical nerve stimulation (TENS), and massage therapy to ease discomfort.

Ultrasound. This treatment uses sound waves to increase circulation around the painful area. If the pain is caused by inflamed muscles or tissue damage, ultrasound may help speed healing.

Transcutaneous electrical nerve stimulation (TENS). This treatment involves a device that sends small electrical pulses through wires to sticky patches placed on the skin. TENS is thought to relieve pain by blocking pain perception or triggering the release of natural painkillers called endorphins.

Massage therapy. Massage can reduce low back pain and keep you mobile and able to perform daily activities.

Prescription medication

If over-the-counter NSAIDs or acetaminophen do not adequately relieve sciatica pain, your doctor may prescribe one or more of the following:

• prescription-strength NSAIDs
• muscle relaxants such as cyclobenzaprine (Flexeril) or carisoprodol (Soma)
• oral steroids such as prednisone
• antidepressant drugs including serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor XR); tricyclic antidepressants such as amitriptyline (Elavil) and nortriptyline (Pamelor); or selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac) and sertraline (Zoloft)
• anticonvulsant drugs, particularly gabapentin (Neurontin) or pregabalin (Lyrica).

Your doctor might support a brief course of opioids for intensely painful sciatica. However, medical guidelines state that opioids should be considered for back pain only after you have tried NSAIDs or other less risky medications due to their risk for dependency.

Injections

Steroid injections may help relieve symptoms by reducing inflammation and numbing the area around the sciatic nerve. They are worth considering for people with uncontrolled pain or for those with persistent, bothersome symptoms despite other treatments mentioned above. However, injections only provide short-term relief and cannot be used repeatedly.

Surgery

If sciatica symptoms don't subside or worsen after six weeks, surgery may be an option. The potential benefit and type of surgery will vary based on whether sciatica is caused by spinal stenosis, a herniated disc, or another cause.

In certain cases, surgery can speed up recovery. But after six to 12 months, people who do not undergo surgery tend to improve about as much (on average) as those who do. In approximately 5% to 10% of cases, surgery either won't help or can make the pain worse. Surgery is generally safe, but while complications are rare, they can happen.

Complementary and alternative therapies for sciatica

Complementary therapies and treatments might also help your sciatica. Although supporting evidence for these procedures is limited, many people find them effective.

Acupuncture

Acupuncture is an ancient healing practice involving the insertion of very thin, sterilized needles into the body to bring about pain relief. A found that acupuncture can be a safe and effective option for people with sciatica. If you decide that acupuncture is worth a try, seek out a licensed acupuncturist to minimize the chance of harmful effects, primarily infections caused by inadequately sterilized needles.

Chiropractic

Chiropractic treatment aims to relieve pain, restore function, and increase mobility. Evidence shows that chiropractic care works as well as other standard treatments such as exercise or physical therapy. Chiropractic spinal manipulation for back pain is based on the idea that displaced vertebrae can cause problems with nerves, and that pushing them back into alignment relieves pain and other symptoms.