Sciatica can be a debilitating and painful condition which can linger for weeks and even months. If not managed appropriately, your sciatic pain can continue to aggravate and worsen. Sciatica typically manifests as bottom and thigh pain which can either arise suddenly or be triggered by an awkward movement. Managing sciatica by yourself can be difficult, so seeing a health professional such as a physical therapist is highly recommended. To assist your recovery, we have used peer-reviewed evidence and clinical recommendations to provide you with a few treatment tips to help with your recovery.
Sciatica and Anatomy
Sciatica is usually caused by a compromise or compression of the sciatic nerve. The sciatic nerve originates from the low back region (lumbar and sacral spine) and then travels down the gluteal muscle, hamstring and towards the leg and foot (image 1). The sciatic nerve is responsible for the movement and sensation detected from these areas of the body. Some examples of actions that are driven by the sciatic nerve include:
- Flexing the knee
- Extending the hip
- Moving the ankle up
- Moving the ankle down
- Moving the thighs together
What is Sciatica?
Sciatica indicates that the sciatic nerve has been impacted or compressed somewhere along the body. For around 90% of cases, disc bulges or herniations cause sciatica by placing additional pressure on the nerve
(image 2). A compromise to the origins of the nerve will impact the areas it travels to (e.g. hamstring, gluteus maximus and even calf). Some symptoms associated with sciatica include:
- Low back pain
- Pins and needles and/or burning down the leg(s)
- General aches and pain along the route of the sciatic nerve
- Difficulty bending or prolonged sitting
- Difficulty moving the leg(s)
What Causes Sciatica?
Although sciatica is usually caused by issues to the disc, other spinal conditions or even muscular spasm can also trigger these symptoms. Sciatic symptoms can occur suddenly after an awkward movement or seemingly out of nowhere. Additionally, there are several risk factors which increase the likelihood of developing sciatica; these include:
- Specific occupations that require manual labour (e.g. constant lifting, twisting, awkward postures etc.)
If you do have sciatica, you should always consult a relevant health professional such as your physical therapist or medical doctor. However, some specific home treatments listed below are effective for managing this condition. These exercises also bear some risks if not performed correctly so it’s always best to check with a professional.
Below we will discuss a few of these treatment options such as:
- Exercise and stretches
- Rest and activity modification
- Alternative treatments
Treatments for Sciatica
A specific exercise program is one of the most effective approaches for hastening your recovery from sciatica. As there can be multiple causes of sciatica, some exercises may prove to be more beneficial than others. It is advised to seek the professional opinion of a physical therapist before commencing your exercises.
Below will be a few exercises we would recommend in the earlier stages of your rehabilitation. We would recommend a combination of stretches and strengthening exercises to help with symptomatic relief and long-term improvement, respectively. If you are experiencing worsening symptoms(e.g. numbness, pins and needles down the leg, etc.) while performing these exercises, we would advise you to stop and seek an expert opinion.
- Cobra stretch
For many people suffering from sciatica, these symptoms are caused by irritation of the disc. Under most circumstances, flexion-based movements such as bending or sitting will increase stress through the disc. By performing an extension-based stretch such as the cobra, this helps unload the stress through the spine. The objective of this stress is to provide immediate relief to persisting symptoms.
2. Piriformis stretch
The sciatic nerve closely travels through the piriformis, which is a muscle located in the bottom. For some individuals, the piriformis is a muscle which can begin to spasm in response to an injury or increased muscular tension. When spasms in the piriformis occur, this can irritate the sciatic nerve. The piriformis stretch aims to help provide relief by reducing the tension of the piriformis and the nerve.
The bridge is also classified as an extension-based exercise which can help take the stress of the disc. Additionally, the bridge also helps strengthen up muscles such as the gluteus maximus, hamstrings, and back extensors. By strengthening these posterior muscles over time, they support the spine through movement—the more strength and endurance in these muscles, the more stress relieved from the spine.
4. Slump glides
One common characteristic seen in many individuals with sciatica is neural tension. Neural tension refers to the inability of the sciatic nerve to move effectively through the body. By performing these slump glides, the nerve can slide through the back and legs to relieve neural tension. Helping ease this tension may help reduce sensitivity and sciatica symptoms.
Modifying your Daily Activities
Modifying your daily activities will also be necessary, particularly during the acute or earlier stages of sciatica. By reducing the stress through the back, this may help alleviate symptoms and increase the rate of recovery. For appropriate lifestyle modifications, seeing a health professional such as a physical therapist will help set specific restrictions.
Consider ceasing movements and activities which aggravate your pain during the earlier stages of recovery. For example, if cycling is aggravating your symptoms, you may want to consider temporarily limiting these types of activities. Instead, you may want to find alternative ways to exercise, such as walking or swimming. Once symptoms have settled, you may wish to re-commence those specific activities.
Historically, prolonged rest has been recommended by health professionals to assist recovery. Although rest can be beneficial for pain relief in the initial stages, research has comprehensively shown that extended periods of inactivity have no additional benefits. Interestingly, prolonged inactivity can actually be detrimental to your low back as it can result in muscle wastage, stiffness, and even more pain. Maintaining your physical activity levels is vital for recovery.
“Is lying on a soft or firm surface better for me?”
This is a prevalent question asked by those suffering from low back conditions. Sciatica presents variably between different individuals. For some people, their sciatica symptoms can be particularly aggravating during the night. Pins and needles. Numbness down the leg. Relentless pain. Those experiencing these problems may find it difficult sleeping.
So, what should you be lying on? Unfortunately, there is no precise answer to this question. As there are multiple causes for sciatica, it’s up to you to decide what surface or position feels the most comfortable. Experimenting with different surfaces, pillow placement, and sleeping positions will help you identify optimal ways of sleeping.
- Lying on a medium-firm surface. Surfaces that are too firm or soft may not provide sufficient support or alignment to the spine.
- Sleeping on a custom-made mattress that is contoured to your standing posture has been shown to improve sleep quality and alignment of the back.
- Placing a pillow underneath your knees may decrease the stress through the back and reposition your hips (image 4).
- Side sleepers may want to try lying with a pillow between their legs and/or a rolled-up towel to support the waist. This position will help keep your back in a neutral position. Additionally, firmer surfaces have been hypothesized to support side-sleepers more as it prevents the pelvis from sinking into the ground.
For those who attempted the previous first two options, you may want to try alternative treatments for symptomatic relief. You may find these pieces of equipment or devices at nearby health or physical therapy clinics. These modalities require equipment or devices to help reduce pain. Under most circumstances, these conservative treatments do not utilize any medicines or chemicals.
However, these methods should be used under the supervision and/or guidance of a health professional. Using this type of equipment of device can also be risky without consulting an expert. Be wary when purchasing these medical products from an un-certified seller, as this will not guarantee quality control.
Spinal decompression and traction therapy
Spinal decompression and traction are non-surgical treatments which slowly stretches and releases the spine. By performing this maneuver, this takes the pressure off structures in the spine, such as the disc and vertebrae.
Before the commencement of traction therapy, your therapist will strap your hips and your back to a traction machine via a cable. Once strapped, the machine begins to pull and elongate your spine. This treatment will be performed for roughly 15-20 minutes, where the traction machine will pull and release the spine.
However, there is a lack of research investigating these treatments’ safety and effectiveness. An extensive collection of studies had concluded that decompression or traction therapy yields no significant improvement in pain nor function. Additionally, this technique is uncommonly used in conventional practices because of a lack of evidence and its associated costs. Despite this, we have had various anecdotal stories citing that the traction machine has benefited patients immensely. Before seeking this treatment, please discuss this with your primary healthcare practitioner.
Another form of spinal decompression treatment is an inversion table. Unlike the traction machine, an inversion table can be purchased and used at home. The inversion table is a tilting platform that uses gravity to decompress the spine. Before commencing treatment, you will be strapped onto the platform, which will be tilted downwards from the head. As the angle of the decline increases, the more the spine will be stretched. Check out our list of the best inversion tables.
Like traction therapy, there has yet to be conclusive research about its effectiveness and safety for treating sciatica. However, a small pilot study in the UK found that using the inversion table in conjunction with physical therapy showed promising outcomes. Compared to the group that received physical therapy only, the group that used the inversion table showed a 50% decrease in the need for surgery.
Despite conveying some benefits, we would advise you to use the inversion therapy sparingly. Based on our experiences, using the inversion table will help with temporary symptomatic relief (e.g. pins and needles, numbness, etc.).
You should always seek the advice of a health professional before using this equipment. It’s essential that you are of certain risks that can occur, particularly in vulnerable individuals, such as those with:
- Neurological and cardiovascular conditions
- Digestive problems
- Eyes, nose and ear problems
- Obesity etc.
Transcutaneous Electrical Nerve Stimulation (TENS) Therapy
TENS stimulation therapy has frequently been used to help minimize low back pain and sciatica symptoms. This type of treatment is delivered through a small, handheld electrical device. By attaching adhesive pads onto the surface of the skin, the TENS unit will deliver specific electrical pulses to stimulate the body’s sensory nerves. As this occurs, the body will begin to release natural chemicals from the body called opioids to help combat pain and discomfort.
Like the decompression therapies above, there is still yet to be definitive evidence to confirm the effectiveness of TENS therapy for treating sciatica. However, some research seems to suggest that it could be used in the earlier stages of sciatica for pain relief. Anecdotally, patients have also suggested that TENS therapy may help with symptomatic relief. However, there are certain risks associated with TENS therapy, especially if you have or are the following:
- Open wounds
- Implants (e.g. pacemaker)
- Malignancy (e.g. cancer)
Consider using medication when conservative treatment such as exercises and activity modification is not relieving symptoms. Before taking medication, it’s essential to consult your family doctor or pharmacist, especially if you have a pre-existing condition(s). Medication can be an effective way of managing pain in the short term to keep you active and manage discomfort.
Over-the-counter medications can be considered to assist with managing your sciatica. For prescription medications, you will be required to consult a medical doctor. Below is a list of over-the-counter medicines:
- NSAIDs: NSAIDs are a category of medication that helps reduce inflammation and pain throughout the body. However, one of its more common side-effects is stomach irritation.
Example: Ibuprofen (e.g. Advil, Neurofen)
- Pain-Killers: You can use analgesic medications to help stunt pain. Although over-the-counter options are less potent, there are still some side-effects such as nausea and stomach irritation.
Example: Acetaminophen (e.g. Panadol)
- Muscle Relaxants: Relaxants help counter muscle spasms that can accompany sciatica. Although there are various options, using supplemental magnesium is a more natural approach for easing spasms. Magnesium is a naturally occurring muscle relaxant in the body and has traditionally been used to help relieve cramps.
Example: Magnesium powder, magnesium oil (for topical application)
Sciatica can be a long-term condition, especially if appropriate treatment has not been sought. Consequently, the above treatments can be performed to help progress your recovery. The order of the sciatica treatments above will depend on your situation and context. Under most circumstances, you should initially attempt more conservative treatments such as lifestyle changes and exercises. If symptoms continue to persist, other options may be considered such as medication, TENS or an inversion table.
If sciatica symptoms remain unchanged or worsen after attempting these options, you should consider seeking the opinion of your primary healthcare practitioner. For most sciatica cases, consulting with a physical therapist and/or medical doctor is advised to ensure a proper diagnosis. Following the initial consultations, you may be recommended for ongoing treatment such as:
- A comprehensive exercise and rehabilitation program
- Clinical Pilates and/or yoga
- Dry needling or acupuncture
- Pain management strategies
- Prescription medication
For more severe symptoms, you should seek the opinion of a medical professional immediately. These include:
- Bladder and bowel problems
- Unrelenting night pain
- Strength loss in the legs
- Coinciding fever
- Unexplained weight loss
Disclaimer: The purpose of this article is to provide general education and some recommended treatments for sciatica. If you have sciatica symptoms, please consult your primary healthcare practitioners such as a medical doctor or physical therapist.