18 Sciatica Treatments That Really Work
What is sciatica?
Sciatica—pain that radiates down the path of your sciatic nerve, which runs from your lower back through your hips and buttocks and down each of your legs—can make the most mundane actions feel like torture. A symptom that most commonly crops up when a herniated disk, a bone spur, or a narrowing of the spine compresses the sciatic nerve, sciatic pain can also be caused by piriformis syndrome (when the piriformis muscle, which assists in rotating the hip, spasms and irritates the sciatic nerve) and pregnancy, when a woman's expanding uterus can press on the nerve. See your primary-care doc to pinpoint the source of your sciatica, then consider one of these methods to put that pain behind you.
Tempting as it may be to throw the covers over your head when sciatic pain flares up, "it's important to note that prolonged bed rest does not help resolve symptoms faster," says Mark Milstein, MD, a neurologist at Montefiore Medical Center in New York City. Try physical therapy instead: "It's an effective treatment for most patients with sciatica, and given the usual restrictions of pharmacologic treatment during pregnancy, it's even more important for expectant mothers," Dr. Milstein says. Find a licensed physical therapist to coach you through exercises that will help you get (and stay) up via the American Physical Therapy Association.
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"Acupuncture is known to reduce pain by increasing endorphins (which help a person become more resistant to pain) and reducing the level of inflammation," notes Jiang-Ti Kong, MD, an anesthesiologist and pain specialist at Stanford Health Care in California. It's also an excellent complement to other sciatica-management strategies, Dr. Kong adds: "As an adjunct to physical therapy or even injections, it can make those therapies much more effective. It's also very safe, with minimal side effects and risks." Look for a practitioner with the professional initials DABMA (which means they've been certified by the American Board of Medical Acupuncture).
Heat or ice
If your pain is the result of a muscle spasm, as with piriformis syndrome, try applying either an ice pack or heat (in the form of a heating pad, a heating patch such as ThermaCare, or a hot water bottle; aim for a temperature of 104 degrees), whichever feels best to you. Stick to 15 or 20 minutes at a time to give your skin a chance to recover, especially if you're using ice, says Farah Hameed, MD, a sports and spine specialist and the medical director of Women's Health Rehabilitation at Columbia University Medical Center in New York. "The more local the pain is, the more beneficial the application of heat or cold will be," she adds.
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A lumbar pillow
"Prolonged sitting has been associated with increased risk of developing sciatica, so it's important to maintain good posture while sitting at a desk," Dr. Milstein notes. Placing a pillow against your lower back supports its natural curve and makes it more difficult to hunch forward. Dr. Hameed suggests the McKenzie Lumbar Roll ($16; amazon.com), a bolster-shaped cushion "that helps you to be a little more upright; you can put it behind you in your chair at the office, or in your car for use while driving."
A bathroom break
No, really: "As you sit for too long, sciatic pain can get worse and your disks can get pressurized, and movement in general can really help with that," says Dr. Hameed. "At least once an hour, get up and walk around for five minutes; get a glass of water, go to the bathroom, whatever." Back at your desk, do a quick stretch: stand and cup your lower back with both of your hands, then lean backward to the end of your range of motion, using your hands to support the muscles of your lower back. "You're putting your spine into the opposite position of when you're sitting," Dr. Hameed explains.
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A sit-to-stand desk
"For patients who experience pain because they're sitting for long periods of time, I sometimes recommend a sit/stand desk," which will get them up more," Dr. Hameed says. If you're in the market for office furniture, an adjustable-height workstation at which you could alternate, say, 30 minutes of sitting with 30 minutes of standing can provide much-needed relief to aggravated nerves in your lower back. The economics of hydraulic desks can be a bit shocking (those lifting and lowering mechanisms don't come cheap), but their ergonomics are just as dramatic.
When sciatica strikes, maintaining a moderate exercise regimen is a crucial part of the recovery process; while bed rest tends to worsen pain after a day or two, regular activity conditions and strengthens your back muscles and spinal structures. So, how much exercise are we talking about? Per Dr. Hameed, you should aim for 30 minutes of moderate-intensity activity (that is, where you have enough breath to say a few words but would have trouble belting out a show tune) at least five days a week—walking, swimming, even gardening. Exercises that target the core are also particularly helpful.
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As a first-line treatment for sciatic pain, "a short course of a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen is often very effective," says Dr. Milstein. While long-term use of oral NSAIDs can increase your risk of gastrointestinal ulcers and cardiovascular trouble, they may still be a safer option than narcotic pain medications like hydrocodone (Vicodin) or oxycodone (Percocet and OxyContin), which are associated with a serious risk of addiction as well as side effects such as drowsiness, itching, constipation, nausea, and vomiting.
A lacrosse ball
When it comes to targeted relief for pain associated with a particular muscle (say, "runner's butt," as piriformis syndrome is sometimes called), one of the best mobility tools is also one of the simplest. A humble lacrosse ball ($11 for 2, amazon.com) is perfect for pressing against the flesh of the specific region that feels uncomfortable to you, Dr. Hameed says. Place the ball on the ground, then lie on top of it and roll to knead pain out of your sore spots. If this feels too uncomfortable or hard on your tissue, you can swap down to a tennis ball, which has more give.
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While research has demonstrated that oral steroids don't seem to help with sciatic pain, steroid injections are considered an effective form of short-term relief for some patients. What's the difference? "With localized steroid injection you can actually target the medication to the structure with the problem," Dr. Kong explains. Cortisone shots also involve smaller doses of the steroid, which could reduce the risk of some of its side effects, such as insomnia and mood changes. Although studies suggest steroid injections aren't effective for long-term pain relief, by easing pain short-term they can help you more easily take on physical therapy, Dr. Milstein notes.
A bushy, flowering shrub that's starred in traditional herbal remedies for centuries, comfrey is now used in topical treatments for bruising, sprains, pulled muscles and ligaments, arthritis, and more; a 2012 review of research reported that comfrey can be an effective, fast-acting solution for back pain. An important note: Comfrey extracts contain both beneficial anti-inflammatories and alkaloids that can build up over time and cause liver damage, so be sure to confirm with your doctor that they're a safe option in your case.
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Prescription pain patches
Lidocaine, the active ingredient in Lidoderm patches, is a topical anesthetic that blocks pain messages from irritated nerves. Flector patches use diclofenac epolamine, a topical non-steroidal anti-inflammatory drug (NSAID)—the same class of drugs as ibuprofen and naproxen. Neither patch was designed specifically to address sciatic pain (Lidoderm is specifically approved for patients who experience burning after recovering from shingles, and Flector is generally used for acute pain from sports injuries). "But they're found to be helpful for some patients," Dr. Kong says.
Most massage therapists are well-equipped to provide short-term relief from sciatic pain, Dr. Hameed notes, since it's such a common complaint; if you've seen a masseuse in the past, so much the better, as he or she will already be familiar with what eases tension for you and can help control symptoms while you seek to resolve your pain. When it comes to massage for sciatica, make sure your practitioner sticks to moderate pressure; aggressive, deep-tissue stimulation can actually cause symptoms to flare, which defeats the purpose of getting on the table in the first place.
Once your doctor has zeroed in on the source of your pain, try yoga poses that target the parts of you that need special attention. Two of Dr. Hameed's favorites? The figure four (or thread the needle) stretch releases tension from the piriformis muscle and is perfect after a long day of sitting: Lie on your back, cross your right ankle over your left thigh, then connect your hands behind your left hamstring and pull toward your belly for 10 to 15 seconds; repeat on the other side. And a classic plank will strengthen your core and relieve pressure on stressed-out disks pinching the nerve in your lower back.
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If a herniated disk is causing unmanageable pain that radiates down your lower back and conservative treatment doesn't seem to relieve it, you might be a candidate for a diskectomy—that is, surgery to remove the damaged portion of the disk. The good news is that diskectomies can be minimally invasive and are considered safe. The bad news is that while early surgery can provide immediate pain relief for patients with herniated discs, researchers have found that a year after the procedure, improvements in pain and disability weren't significantly greater for diskectomy patients compared to those who received long-term nonsurgical care. Talk to your doctor about whether or not the procedure is a good fit for you.
As a non-invasive, non-pharmaceutical approach to sciatic pain, visiting a chiropractor has a lot going for it: In a 2010 study, for example, researchers found that 60% of sciatica patients with herniated disks who'd had yet to find success with non-surgical treatment experienced the same relief from chiropractic care that other patients enjoyed from surgery. It's also an adjunct therapy that can often complement other approaches to your pain. Find a licensed doctor of chiropractic (DC) near you through the American Chiropractic Association.
A maternity support belt
For moms-to-be who experience sciatica, "my best advice is wearing a pregnancy belt that helps lift the uterus," says Hilda Hutcherson, MD, a professor of obstetrics and gynecology at Columbia University's College of Physicians and Surgeons in New York City. Basic belly bands may be more comfortable for sitting positions, while maternity belts that cradle a pregnant wearer's belly and alleviate pressure on the lower back provide more relief from sciatica while standing and walking. (The good news: Pregnancy-related sciatica usually gets better shortly after giving birth, Dr. Hutcherson adds.) Don't turn to a back brace if you're not pregnant; the "support" will prevent your core and back from developing needed muscle mass.
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What's on the horizon for sciatic pain treatment? Animal experiments have gotten scientists excited about the possibility of using stem cells to treat sciatica by stimulating nerve regeneration. More information is needed—it's very much still in the experimental phase, Dr. Milstein notes. Until we know more, take heart from a few stats via Dr. Kong: 80% of acute lower back pain or sciatica sufferers recover within one month, and 90% recover within three months. Odds are, you're already on the road to recovery.