7 ways to help nix sciatica pain

Pinching. Burning. Stabbing. Sciatica has been described in many different ways, but there’s one thing everyone agrees on: sciatica hurts.

Sciatica is pain that radiates down the sciatic nerve, which runs the length of your lower back to your lower legs. The sciatic nerve is the largest nerve in your body, and it supplies feeling to many of the muscles in your butt, thighs, calves and feet. 

Any twist, pinch or injury along this nerve is enough to trigger the ouch. Often this happens when a disk in your spine moves out of place (also called a herniated disk) and puts pressure on your spine. Another common cause is a narrowing of the spaces within your spine. This is called spinal stenosis, and it can put pressure on the nerve. Usually the pain radiates down one leg at a time.

“Sciatica is a very common problem,” says Nadya Dhanani, M.D., a pain management specialist at the University of Texas Health Science Center at Houston. “Generally, the older you get, the more wear and tear you have on your spine.”

In fact, as many as 40% of adults will experience sciatica at some point, reports the Cleveland Clinic. While it’s possible for sciatica to go away on its own, the causes of the pain — bulging disks, pinched nerves — often linger, so it can flare up again later, says Dr. Dhanani. But that doesn’t mean sciatica pain is inevitable.

“What really causes the pain is the inflammation from the disk bulging or the pinched nerve,” she explains. “The goal of conservative, nonsurgical treatment is to decrease that inflammation and therefore decrease the pain.” 

Here are 7 ways to help ease sciatica pain.

Relief strategy #1: Strengthen your core

Think about what the sciatic nerve has in common with your core muscles: Both are closely connected to your spine. When you take steps to strengthen all the muscles that run alongside your spine — your abdominals, back, hips, buttocks and pelvis — you’re doing your spine a huge favor.

The idea, says Dr. Dhanani, is to set up a “guard” around your spine, to help prevent further wear and tear on your body and warding off future injuries. Tai chi, yoga and Pilates are all gentle, effective ways to help strengthen your midsection and stabilize your spine. 

But you can also include a few simple moves into your daily routine:

• Bird dog. Get down on all fours with your hands directly below your shoulders. Tighten your ab muscles to keep your spine neutral. Lift your right arm and extend your left leg. Try to keep your arm and leg parallel to the floor. Pause for a count of two; then lower them. Repeat with your left arm and right leg. Do 3 sets of 8 repetitions per side.
• Clamshell. Lie on your side with your legs stacked and knees bent. Rest your head on your bottom arm and place the opposite hand in front of you for support. Tighten your abs and lift your top knee toward the ceiling. (Your legs will look like a clam opening.) Pause for a count of two, and then lower your knee. Do 3 sets of 8 to 10 reps per side.
• Pelvic tilt. Lie on your back with your knees bent and feet flat on the floor. Press your lower back into the floor, tighten your abs and tilt your pelvis up slightly. This is a small movement. Hold at the top of the movement for a count of 10, then release. Do 3 sets of 8 to 10 reps.

Relief strategy #2: Go for a walk

As much as you may want to hang out on the couch when the pain flares, resist the urge. Movement actually helps reduce inflammation in the area, says Dr. Dhanani. Brief walks a few times a day can help keep sciatica pain at bay.

In general, try to avoid long periods of sitting, she says. Your body was not designed to be in a sitting position for hours at a time. When you sit too much, the discs and ligaments of your lower back are forced to sustain the pressure. 

The next time you’re watching TV, get up during the commercials (or just set a timer) to move around the house or do one of the core exercises above. 

Relief strategy #3: Take a stretch break

Tight muscles can also aggravate the sciatic nerve, says Dr. Dhanani. Doing a few targeted stretches can help open up the muscles surrounding the nerve, in turn relieving some of the pressure.

Two stretches to try:

• Knee to chest: Lie on the floor, either with your legs straight or with your knees bent and feet flat on the floor, whichever is more comfortable. (You can also do this while seated in a chair.) Raise one knee toward your chest until you feel a gentle stretch in the back of your hip. You can place your hands on top of your knee or behind your thigh. Hold in this position for 30 seconds. Release, switch legs and repeat.
• Seated figure 4: Sit tall in a chair and cross one leg on top of the other, placing your ankle over the opposite knee. Place your hand on the knee of the crossed leg. Lean forward, keeping your back straight, and gently press on the crossed knee until you feel a stretch in your hips and butt. Hold for 30 seconds. Release, switch legs and repeat.

Relief strategy #4: Try physical therapy

Any exercise that you can do regularly and that you enjoy is going to help your sciatica — especially if your episodes aren’t too frequent. But if you have ongoing sciatica, Dr. Dhanani recommends scheduling a few visits with a physical therapist. 

“It’s not going to be an immediate fix,” she says, “but it can help people with chronic sciatica manage their pain and prevent their flare-ups from being as severe or frequent.”

A trained physical therapist not only understands anatomy but can give you a personalized treatment plan and demonstrate how to do the exercises. “You don’t want to go to the gym and throw out your back even more,” she says.

Relief strategy #5: Go cold, then hot

During a flare-up, applying ice packs and/or heat can help bring on-the-spot relief, according to the Cleveland Clinic. At the first jab of pain, reach for a bag of frozen vegetables or an ice pack. Wrap it in a towel and place it over the area for 20 minutes to ease the pain and inflammation. Do this every two hours.

If the cold isn’t bringing you the relief you were hoping for, try a heating pad or hot compress. Again, keep it on the affected area for 20 minutes every two hours. Some people also find relief by alternating between cold and heat. 

Relief strategy #6: Give acupuncture a go

The list of ailments that acupuncture is thought to help is long — and it includes sciatica.

If you’re not familiar with acupuncture, a trained and certified practitioner places tiny sterilized needles at specific points to spark a response from your body’s peripheral nervous system. Blood flow to the affected area is increased while muscles around the nerve start to relax. 

The National Institutes of Health (NIH) recognizes acupuncture as a safe therapy to complement conventional treatments for sciatica and other lower back pain. If you’re considering acupuncture, check to make sure the practitioner is licensed, certified and registered to practice acupuncture in your state. Most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine, the NIH claims. 

Relief strategy #7: Discuss medications with your doctor

Over-the-counter NSAIDs are often recommended for sciatica flare-ups, says Dr. Dhanani. If your pain is more severe, your health care provider may prescribe muscle relaxants to help get rid of the muscle spasms that occur with sciatica. 

If your sciatica is chronic, drugs to help relieve nerve pain may be prescribed. These non-narcotic medications  tend to be taken over the long term and are usually well-tolerated, Dr. Dhanani says. 

Steroid injections are another common treatment for chronic sciatica, says Dr. Dhanani. Using X-ray guidance, doctors guide a very small needle around the nerve that’s being pinched and deposit the steroid medicine (a potent anti-inflammatory) in that space. 

“The goal is to try to decrease inflammation,” she says. Steroids are not addictive, but they do come with side effects, including insomnia and increased blood sugar levels.

No matter what medication you decide to take — even if it’s just an over-the-counter NSAID — make sure you understand the potential risks and expected benefits. “All drugs have potential side effects and risks,” says Dr. Dhanani, “so talk to your provider to make sure you’re safe to take them.”

Good news — the lifestyle changes mentioned above and/or first-line medication options bring relief for about 80% to 90% of people with sciatica, according to the American Academy of Orthopaedic Surgery. But if you’re experiencing debilitating pain that lasts for months, you may be a candidate for surgery to relieve pressure around the pinched nerve, says Dr. Dhanani. 

“There are people who have such a significant problem — the disc is bulging so far out, or the nerve is being pinched so greatly — that no matter how much we try to decrease the inflammation, we can’t fix the problem,” says Dr. Dhanani. 

In that case, someone might want to consider having surgery, she says. Ask your doctor to go over all of the benefits and risk of surgery, to make sure that you’re a good candidate.