The term “sciatica” is often confused with general back pain. However, sciatica is not just limited to the back. The sciatic nerve is one of the longest and widest nerves in the human body; it extends from the lower back, through the buttocks, and branches down each leg, ending at the soles of the feet.
Thus, the shooting pain associated with the compression or irritation of the sciatic nerve radiates along the same route, emanating from the lower back and culminating at the tip of the big toes of the feet.
Since the sciatic nerve is responsible for regulating the movement of several muscles in the thighs and legs, this kind of painful nerve irritation and inflammation can be extremely debilitating. However, one must bear in mind that there is no uniformity in the severity and symptoms of various sciatica episodes.
The discomfort can range from mild swelling, muscle weakness or numbness, and a tingling sensation along the nerve site to far more excruciating pain that feels like an intense electric shock. In severe cases, the stabbing pain worsens with the slightest movement, rendering the patient completely unable to bend their knees, move their foot and toes, walk, or even stand.
It most commonly occurs in people between the ages of 30 and 50 years.
It usually affects only one part of the body but tends to be severe and debilitating.
Signs and Symptoms of Sciatica
Pain is the most common symptom of sciatic nerve pain. The pain usually extends from the lower back to the rear of the thigh and down through the leg. The pain can range in severity and may be aggravated by sitting for long periods.
It can be accompanied by symptoms such as:
- Burning or tingling sensation down the leg
- Shooting pain that causes difficulty standing up or sitting down
- Numbness and weakness down the affected leg and even in the toes
Causes of Sciatica
- Sciatica is most often caused by a herniated or slipped disc. These discs form a cushion between the spinal vertebrae and keep them in place. With advancing age, these jelly-filled discs tend to degenerate or rupture, causing the fluid to leak out. As the discs progressively become thinner and harder, they tend to stress out the adjoining nerves in the lower back.
- Moreover, a weakened intervertebral disc might slip from its place and protrude forward, exerting greater pressure on the sciatic nerve fibers. A slipped disc can result from spinal injury or trauma and from years of bending or sitting for extended periods.
Besides this usual culprit, the compression of the sciatica nerve might be rooted in a number of other factors including:
- A spinal injury or infection
- Degenerative disc disease, which involves the gradual breakdown of the cushioning discs between spinal vertebrae
- Development of bone spurs or bone overgrowths on your vertebrae
- Spinal stenosis or narrowing of the spinal canal
- Isthmic spondylolisthesis, wherein a vertebra slips forward overlapping another one
- Piriformis syndrome, in which the piriformis muscle, located deep in the buttocks, spasms or tightens, putting pressure on the adjoining sciatic nerve
- Pelvic injury or fracture
People in their thirties and forties have a higher risk of developing sciatica. Even people who are into jobs that require lifting heavy loads for long periods or those who enjoy a sedentary lifestyle are more likely to develop sciatica. Moreover, the following factors can make one increasingly susceptible to developing this condition:
- Being tall
- High stress levels
- Physically demanding work that involves a lot of strenuous activity, such as frequent lifting, especially while bending and twisting
- Jobs that require extensive driving, especially if it causes vibration of your whole body
- Excessive body weight, putting extra pressure on the spine
- Diabetes, which increases the risk of nerve damage
- Sitting for long stretches
Dealing with Sciatica Pain
Although sciatica pain usually resolves on its own with adequate time and rest, some cases might warrant primary treatment or even surgery. You might even have to enlist the help of a physiotherapist who will determine appropriate exercises for your condition.
Sciatica exercises are designed to strengthen the spinal column and the surrounding muscles and tendons and, thus, can substantially assist with pain management and help you retain or recover mobility.
Depending upon the root cause of the pain, and after taking account of your symptoms and complete health history, the doctor might prescribe the following methods to alleviate your painful discomfort:
- Sciatica sufferers must refrain from sitting for long periods of time on end, unless it is more comfortable than standing.
- Keeping yourself comfortable while staying active is key. You can benefit from alternating lying down with short walks. Staying bed-ridden can prove counter-intuitive and end up aggravating other parts of the body. It is recommended to gradually increase your walking distance, but only if you feel up to the task. Exerting your body through painful walking sessions will only amplify the damage.
- Another way to soothe the pain is by applying a heating pad on a low or medium setting to the affected area, for 15 to 20 minutes every 2 or 3 hours. You can even swap one heating pad session with a warm shower, and try both these therapies alternatively. Moreover, if you don’t want to go to the trouble of switching pads every few hours, try a single-use heat wrap that can last you for up to 8 hours.
- Applying a cold compress or an ice pack for 10 to 15 minutes every 2 to 3 hours might also prove helpful in relieving your pain to a certain degree. Neither heat nor cold therapy is conclusively backed by science for effective pain management, but since they come without any side effects, there is no harm in trying both to see which one works for you.
- You can take over-the-counter NSAIDs such as ibuprofen, aspirin and muscle relaxants to relieve the pain. However, be mindful not to become excessively dependent on these analgesics which are only recommended for temporary relief. Long-term use of such strong medications will do more damage than good for this particular condition as well as your overall health.
- If your symptoms fail to subside despite these first-line treatments, your doctor may recommend more aggressive treatments such as physical therapy, massage therapy, chiropractic treatments, acupuncture, yoga, or a combination of these modalities.
- After 6-8 weeks of the aggressive treatments, if there is no noted improvement, then it is possible to move to the next step which would be epidural injections followed by a possible surgical intervention. It is important to note that 80 percent of patients will not require to go beyond the aggressive treatment modalities.
The following preventive steps can help stave off this condition from developing or recurring:
- Try to maintain an upright posture when standing, walking and sitting. When standing for extended periods, try to rest one foot on a stool or box at regular intervals.
- Work out your core muscles in the abdomen and the lower back from time to time, by undertaking certain exercises that have been approved by your doctor or physiotherapist. Customize your exercise regime as per your strengths and weaknesses, and stick with it. A regular dose of aerobic fitness can go a long way in strengthening your back and improving your muscle flexibility.
- When lifting heavy objects, exert maximum pressure on your lower extremities. A safe lifting technique entails holding the object close to your as you lift it up, bending only the knees while keeping the back straight. By holding the load close to your body, you are essentially minimizing the stress on your lower back. Also, the entire brunt work is carried out by the hips and legs, not the back. Take the help of a partner if the load is excessively heavy.
- Use ergonomic furniture to keep your back well supported, especially when seated. The ideal chair for sciatica patients are designed to provide adequate lower back support and usually come with an armrest and a swivel base. Moreover, maintain an appropriate sitting posture by placing a rolled towel or cushion in the small of your back to retain its normal curve.
- Quit smoking.
- Keep your weight in check, as excessive body load can irritate the sciatica nerve.
- Use a mattress that’s neither too hard nor too soft for sleeping.
When to See a Doctor
Mild sciatica usually goes away over time. Call your doctor if self-care measures fail to ease your symptoms or if your pain lasts longer than a week, is severe or becomes progressively worse. Get immediate medical care if:
- The sciatica symptoms afflict both your legs at the same time
- You have sudden, severe pain in your low back or leg and numbness or muscle weakness in your leg, thigh, pelvis or buttocks
- The pain follows a violent injury, such as a traffic accident
- You have trouble controlling your bowels or bladder
- If you develop redness or swelling on your back or around the spine
- You have an unexplained fever accompanied by back pain
- You are plagued by excruciating pain that gets aggravated when you lie down, and keeps you up at night
- You experience a burning sensation while urinating or notice blood in your urine
- Severe, unflinching pain that fails to diminish despite proper rest, care, treatment and exercise, such that it disrupts your daily routine and keeps you from performing even the most basic activities
How to Relieve Sciatica Nerve Pain Naturally
Although there are many conventional treatments for sciatica, they may only ease the pain temporarily. Plus, most steroid injections can cause serious side effects.
You can use some home remedies and natural therapies as well to reduce inflammation and pressure on the irritated sciatic nerve. Plus, in most cases, the problem goes away with time (around 6 weeks) and rest.
Here are the best home remedies for sciatica.
1. Apply Hot or Cold Compresses
Using hot or cold compresses can help relieve sciatica pain and inflammation.
Heat treatment relaxes tense muscles that may be compressing the sciatic nerve.
Cold treatment reduces swelling around the nerve and also numbs the pain.
You can also alternate heat and cold, starting with the hot compress and ending with the cold compress. When using heat, use moist heat like a steamed towel as it is more effective.
- Place a hot or cold pack on the affected area for 15 to 20 minutes.
- Do this every few hours until you get relief.
2. Low Back Massage
Massage therapy can relieve sciatica pain and also help the body heal itself, especially if the problem is caused by a muscle spasm.
A study points out that massage therapy is effective in reducing chronic low back pain.
Low back pain is a common symptom of sciatica.
A 2014 study reports that deep tissue massage may be as effective as nonsteroidal anti-inflammatory drugs for relieving low back pain.
Plus, massage helps release tension, stimulate circulation and increase the range of motion.
- Massage the affected area with St. John’s wort oil 2 or 3 times a day until you get relief. St John’s wort has anti-inflammatory properties that help relieve sciatica pain and inflammation.
- Another option is to add 3 tablespoons of nutmeg powder to 1 cup of sesame oil. Heat the mixture. Allow it to cool and massage the affected area with it when it is comfortably warm. Do this a few times a day for a few weeks.
- You can also consider trigger-point massage therapy at least once daily. Pain in the lower back, buttocks and side of the thighs is often associated with trigger points in the gluteus medius and minimus muscles.
3. Exercises to Relieve the Pain
In addition to rest, maintaining normal activity is highly beneficial for dealing with sciatica.
A day or two after a sciatica flare up, you can start a regular exercise program to strengthen the abdominal and back muscles. Strengthening the core muscles helps facilitate quick recovery.
A study done on rats suggests that progressive exercise training decreases peripheral neuropathic pain by reducing levels of certain inflammation-promoting factors.
You can do Knee to Chest Stretch to help reduce the irritation of the sciatic nerve and improve flexibility of your lower back.
- Lie on your back on a mat with your feet straight and hip-width apart.
- Keep your upper body relaxed and bend your right knee upwards with an inhale.
- Clasp your hands behind the thigh and gently pull it towards your chest as far as is comfortable.
- Keep the other leg flat on the surface.
- Hold this position for 20 seconds with controlled deep breaths and then lower your leg gently.
- Switch legs and repeat.
- Repeat 3 to 5 times.
- Finally do this exercise with both the legs 3 to 5 times.
You can also do exercises like spinal rolling, knees rocking, floor twists, backblock, back extensions, sciatic-mobilizing stretches and certain yoga poses like the cat-cow pose and pigeon pose to help relieve sciatica and lower back pain. You can try spinal decompression exercises as well.
4. Take Turmeric
Turmeric is another effective natural remedy for sciatica because of its anti-inflammatory properties. It contains a compound called curcumin that helps reduce nerve pain and inflammation.
A study reports that treatment with curcumin during the early stages of peripheral neuropathy can prevent the development of chronic neuropathic pain.
- Add 1 teaspoon of turmeric to 1 cup of milk. You can also add a small cinnamon stick. Boil the solution. Sweeten this healthy drink with honey and drink it once or twice daily until you see improvement.
- Another option is to take 250 to 500 mg turmeric supplements 3 times a day for several weeks. Consult your doctor first.
5. Use Capsaicin Cream
Capsaicin cream can be used for the treatment of sciatica nerve pain.
Cayenne pepper contains an active ingredient called capsaicin that works as a natural pain reliever. It helps deplete the levels of a neurotransmitter called substance P, which transports pain signals.
In fact, a 2011 study suggests that topical use of capsaicin may be beneficial in pain management.
- Buy a cream or ointment containing 0.025 to 0.075 percent capsaicin.
- Apply it on the affected area up to 4 times a day, at least for 1 week.
6. Try Acupuncture
Acupuncture is another effective natural treatment to relieve sciatica pain, relax the muscles and help your body heal itself.
Another theory is that by stimulating certain acupuncture points, the central nervous system is also stimulated, in turn triggering the release of chemicals that either change the perception of pain or produce a sense of well-being.
A study published in the Journal of Traditional Chinese Medicine found that warmed acupuncture with heated needles helped improve sciatica pain. In fact, 17 of the 30 participants got complete relief from sciatica after acupuncture therapy.
Always have acupuncture therapy performed by a skilled and experienced acupuncturist.
7. Spinal Manipulation
Chiropractic care is an increasingly popular natural treatment for neck and back pain. Chiropractic spinal manipulation includes different techniques involving rapid, short thrusts to alleviate nerve irritability responsible for inflammation and other symptoms associated with sciatica.
A 2010 study published in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulation benefited 60 percent of the study participants suffering from sciatica to the same degree as a surgical intervention could have provided.
Consult a doctor of chiropractic medicine for proper treatment, depending on the exact cause of your sciatica pain.
8. Yoga and Stretching
Sciatica patients often report experiencing pain after prolonged sitting or standing as well as after sudden and abrupt movements. Moreover, the discomfort is made worse by scrunching or shortening the spine caused by movements like elevating the legs up, bringing the knees toward the chest or squatting.
Quite to the contrary, stretching exercises, yoga and the simple act of laying down can help lengthen your spine and thereby reduce the sciatica-induced stiffness, inflammation and pain in the back.
Yoga, in particular, was found to be especially productive in mitigating pain and disability in sciatica patients. A study further attested to the safety and credibility of yoga in alleviating chronic back pain.
The best yoga and stretching exercises for sciatica patients aim at working out the back muscles, and are designed to simultaneously build muscle strength as well as relax the stiffness in the affected areas. Owing to the efficacy of such core strengthening exercises, they are routinely incorporated in the rehabilitation settings for post-surgery sciatic nerve patients.
- Stretching exercises for your low back can help relieve nerve root compression.
- Do not make sudden twists or jerks that can affect the spine.
- Adopt a good posture to relieve pressure on your lower back.
- Practice proper lifting techniques with your back straight and knees bent.
- Sleep on a mattress that is neither too firm nor too soft.
- Get regular exercise, but do not engage in intense exercise.
- Avoid cigarette smoking as it promotes disc degeneration.
- Try other herbal remedies, such as devil’s claw (1,500 to 2,000 mg twice daily). An alcohol-based extract prepared from the leaves of parijat, also called harshiangar (scientific name, Nyctanthes arbor tristis), has also been found useful in treating sciatica. These herbs have anti-inflammatory and tranquilizing properties. Devil’s claw may interfere with certain medications and may not be suitable for those suffering from peptic ulcers. Before taking an herbal remedy, check with your doctor for advice on dosage and suitability.
- Consider taking vitamin C, calcium and magnesium supplements after consulting your doctor.
- Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are sometimes helpful for sciatica.
- The best approach to preventing further exacerbation of pain involves preventative conditioning involving the modalities explained above. It is important to regularly perform these exercises even long after the pain has subsided.
- Surgery for sciatic pain should be considered as a last resort treatment. Given the proper indications for an operation have been met, surgery can be expected to effectively treat the pain quickly. However, it is important to recognize that even without surgery, the pain is very likely to improve, over a 6-8 week period (not as quickly).
Expert Answers (Q&A)
Answered by Dr. Martin M. Mortazavi, MD (Neurosurgeon)
How long does it normally take for sciatica pain to subside?
Sciatica pain is a common name for shooting pain from the back or hip down and deep in the leg to the knee, below the knee to the ankle or the toes, a result of the irritation of the sciatic nerve. The irritation usually originates from a herniated disk in the lumbar spine.
Usually, the pain subsides within 6 months. As it gives significant pain, the patient usually needs to have strong pain medication and anti-inflammatory medication and sometimes even need short term steroids. If these do not help, the patient might benefit from epidural steroid injections to the nerve root that is causing the pain.
None of these treatments are curative but palliative. Surgery is a curative treatment, which removes the herniated disk. As a majority of the sciatic cases resolve within 6 months of onset, if the pain does not resolve, or if the pain is not responding to non-surgical methods within the first 6 months, surgery is a good option. A majority of patients undergoing surgery will have their pain resolved.
Is walking beneficial for sciatica nerve pain?
Yes, unless walking worsens the symptoms. We usually recommend patients to stay mobilized. Often the pain also causes muscle spasm in the back, so walking often worsen the back pain and prevents patient from walking. In order to relieve back muscle spasm, we usually prescribe muscle relaxants.
Can sciatica affect both the legs at once?
Yes. A large, centrally located herniated disk can push both nerves of the sides. Also, a chronic disease called spinal stenosis that usually occurs with age and makes the spinal canal small can affect both sides.
Can sciatica cause bowel and bladder problems?
Yes, a large, centrally herniated disk can cause leg pain, weakness, and bowel and bladder dysfunction. This syndrome is called Cauda Equina Syndrome and is a surgical emergency.
The herniated disk needs to be removed immediately to restore function. Patient with bowel or bladder dysfunction should not wait to be treated with medicines or epidural injections.
What is tennis ball therapy for sciatica nerve pain?
There is no scientific data behind this therapy.
Can constipation lead to sciatica nerve pain?
Not directly. But theoretically, constipated people might bear down too much causing pressure on the spine. However, there is no scientific data about this.
Please provide some important care tips in regards to sciatica nerve pain for the benefit of our readers.
When the sciatic nerve is irritated, any action that can stretch it would need to be avoided. Many patients experience increased pain while sitting. Sitting stretches the nerve. I would recommend, avoid sitting for long durations and especially avoid driving.
I also recommend being active and seeing a physician, usually a neurosurgeon or an orthopedic spine surgeon for assessment and treatment. Avoid heavy lifting.
About Dr. Martin M. Mortazavi, MD: Dr. Mortazavi is the Founding Chairman of the National Skull Base Center. He is also the Founding Chairman of the California Institute of Neuroscience and the Director of its Cerebrovascular, Skull Base and Tumor program.
Dr. Mortazavi pursued a Postdoctoral Research Fellowship in Neurotrauma and Regeneration at Barrow Neurological Institute. In addition to treating the full panorama of Brain and Spine diseases, Dr. Mortazavi treats complex tumors and vascular lesions of the brain and the spinal cord.
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