How can I treat sciatica and prevent it from recurring?

DEAR DOCTOR K:

My sciatica is so bad I can barely walk. Please help.

DEAR READER:

Sciatica is a particular kind of low back pain. It’s a persistent aching or burning pain felt along the sciatic nerve. This nerve runs from the spine in your lower back, down through the buttock and into your lower leg. You feel pain (and perhaps numbness or weakness) because your sciatic nerve is compressed or injured.

Most cases of sciatica, and indeed most cases of low back pain, do not have serious causes. What a person with sciatica should do depends a lot on whether this is the first attack of sciatica you have had.

If it is, call your doctor. He or she will make sure you don’t have a more serious cause of your sciatica and will prescribe medicine if you need it. The doctor will ask you questions about your symptoms and perform a physical examination of your back and legs. He or she may order imaging tests to help reveal what may be irritating or compressing your sciatic nerve, although this is unnecessary most of the time.

If you’ve had sciatica before, and it has been checked out and treated by your doctor, you don’t necessarily need to see the doctor again. If the new attack feels like past attacks, do the exercises and take the treatments that have worked in the past. (Your doctor can order a refill of any expired medicines.)

Sciatica usually responds well to a brief period of rest and limited activity. (Prolonged bed rest can make sciatica worse.) Start gentle exercises as soon as you can. These will help improve mobility and strengthen your back. (See back strengthening exercises below.)

Over-the-counter anti-inflammatory drugs, such as naproxen (Aleve), ibuprofen (Motrin, Advil) or aspirin, can help relieve pain and inflammation. Prescription medications used to treat chronic nerve pain may also help. They include amitriptyline (Elavil) and gabapentin (Neurontin).

I’ve also had patients respond well to chiropractic manipulation, acupuncture, massage and yoga.

In severe cases, an injection of a long-acting anesthetic with a steroid medication can provide relief. In rare cases, you may need surgery.

Once the pain of sciatica passes (usually within six weeks), these steps may prevent it from returning:

  • Practice good posture. Stand up straight with your ears aligned with your shoulders. Align your shoulders with your hips. Keep your buttocks tucked in and your knees slightly bent.
  • Do the exercises shown on my website.
  • Walk and/or swim. Walking and swimming can help to strengthen your lower back.
  • Lift objects safely. Always lift from a squatting position. Use your hips and legs to do the heavy work.
  • Avoid sitting for extended periods. If you sit at work, take regular breaks to stand and walk around.
  • Use proper sleeping posture. Sleep on your side or on your back. Put a pillow under your knees.

I know from personal experience that it’s no picnic when you have back pain. But it should get better if you follow this advice.


Back strengthening exercises

 

1. Lie on the floor on your back. Bend your knees and keep your feet flat on the floor. Squeeze your buttocks and pull your abdomen in toward your back. Your lower back should be pressed flat on the floor. Now raise your buttocks about an inch off the floor. Your lower back will lift slightly off the floor while your upper back remains flat. Hold for a few seconds before relaxing. Repeat 10 times.

 

2. While lying on the floor on your back, with your head and neck supported, grasp your leg just below your knee. Pull your leg gently toward your chest. Hold for 20 seconds. Repeat on other side. Repeat 10 times.

 

3. Stand with your feet slightly apart and your hands on the top of your buttocks. While looking up, push your hips forward slightly and gently bend backward. Keep your knees straight. Hold for 10 seconds. Relax. Repeat 10 times.

 

4. Lie on your back and bend your knees. With your arms crossed in front of your chest, slowly lift your shoulders a few inches off the floor as you pull your abdomen in and tighten your buttocks. Lower your back gently to the ground. Repeat 8–20 times.