What are my sciatica treatment options?
(If you want to skip ahead to our view on sciatica pain – and getting healing through a gentle touch to the spine, then click here.)
Sciatic nerve pain can be caused by anything putting pressure on the sciatic nerve. If you have read this article on sciatica symptoms, you know that pressure can happen up in the spine….Or down in the leg.
(Remember, sciatica is a symptom of a problem – not the actual cause of the problem.)
If you are looking for sciatica relief, your sciatic nerve pain will probably be diagnosed as a disc problem. Sometimes sciatica is only considered true sciatica if a disc is actually swollen.
(The disc is pad of cartilage between the spinal bones. The spinal disc between the lower spine bones will be considered ruptured or herniated. You may even get an MRI showing swelling of the disc.)
With or without disc swelling, sciatica may go away on its own. In this case your sciatica relief may take a few weeks, or even months, waiting for the swelling to decrease.
Because it is known to reduce over time, medical doctors often treat sciatica with conservative care. For many patients, sciatica pain relief means rest and pain killers, and a little bit of home care.
Your conservative care options for sciatica Pain relief
The following are a few things you can do to try get sciatica relief at home. (Only do any of the following after seeking the opinion of your health care provider of choice. This information isn’t for home treatment or diagnosis.)
These are the most common medical treatment recommendations you will hear for sciatica pain relief…
1. Apply ice or cold packs – applied to the painful area, several times per day for 10 to 20 minutes of time.
2. Use hot packs or heating pad – applied to the painful area, several times per day, for 10 to 20 minutes of time. Most doctors would recommend waiting a few days after a flare-up before you start with any heat.
Keep in mind, with any heat or ice, you are not actually speeding up any healing of the body. You are using heat or ice as a temporary pain control for the sciatica. It is medication free. But your pain will not go away any faster. You still have to wait for the tissue to heal.
3. Try gentle stretching for relaxation during a disc issue. Called the press up position, this places the spine in extension and may help relieve disc pressure.
4. Try gentle stretching for release of piriformis muscle. If the piriformis muscle in the buttock is really what is causing the sciatica pain, then more aggressive stretching may be helpful. There are a number of stretches for this area of the body that you could learn, like the piriformis stretch.
5. Reduce the pain with over the counter medications. Often the following pain relievers are recommended. You can buy them without a prescription: ibuprofen (Advil, Motrin) and naproxen (Aleve).
A few more points about conservative care
The general recommendation is to try to stay as active as possible. Even when you are still experiencing some pain. Although bed rest may be unavoidable at first, regular movement, stretching, and some exercise is better in the long run.
Any movements that involve twisting or bouncing should be avoided. They generally put additional stress on the lower spine. There are a number of other exercises you should avoid as well.
Doctors usually allow several weeks for the pain to improve on its own before recommending more aggressive options.
Medications for sciatic pain relief
6. If conservative care isn’t helping, your doctor may prescribe one or more of the following medications for sciatica pain:
- Nonsteroidal anti-inflammatories (NSAIDs)
- Muscle relaxants
- Tricyclic antidepressants
- Anti-seizure medications
The goal of most of these medications is pain relief. They are not treating the underlying cause, just helping you manage the pain.
Be aware that all medications have potential side effects, and should only be a short term solution for sciatica pain relief.
Injections near sciatic nerve roots
7. If your pain has not improved after a reasonable trial of conservative care, your doctor may recommend local steroid injections.
This involves injecting corticosteroid medication directly into the inflamed area around the nerves of your spine.
Corticosteroids are strong anti-inflammatory drugs, so they reduce the inflammation that may be putting pressure on the sciatic nerve or nerve root.
The pain relief from a steroid injection only lasts a few months. The number and frequency of steroid injections you can receive is limited, because there are potential side effects.
In the case of sciatica that is caused by piriformis syndrome, BOTOX may be an option. Injections of botulinum toxin (BOTOX) into the piriformis muscle may help reduce pain by inhibiting muscle contraction.
Surgery is generally considered a last resort for treatment of sciatica pain. The goal of surgery is to remove whatever is putting pressure on the sciatic nerve.
Surgery is most appropriate if the sciatica pain is caused by an abscess, tumor or bone spur that is pressing on the sciatic nerve or nerve root. Or if the disc is so broken down that pieces of it are floating around the spinal cord.
8. In the case of sciatica caused by disc herniation, surgery may be necessary if you have:
- extreme weakness,
- loss of bowel or bladder control,
- or pain that is getting worse over time even after other therapy options.
Physical therapy may be recommended at any point during your sciatic flare-up. It just depends on the experience and philosophy of the doctor. Some doctors wait for the flare-up to calm down before writing a physical therapy prescription.
9. Physical therapist have other pain control options, like electrical stimulation. Like medication, these modalities are there to relieve sciatica pain temporarily, while waiting for the swelling to go down. Unlike medication, there are few side effects.
10. Physical therapist will usually use exercise to help prevent future sciatica. Exercise will be used to
- improve your posture,
- strengthen the muscles that provide back support (including those abdominal “core” muscles)
- and increase increase flexibility
If you count exercise and modalities like stim, then you have learned about 10 different options you may encounter looking for sciatica nerve relief.
And this doesn’t include other providers, like movement therapists, acupuncturists, or massage therapists.
Many of these things work for patients. However, many more patients will benefit and find lasting sciatica relief by correcting the alignment of the spine.
Learn why in the next sciatica resource article. Or go back to the article on sciatica symptoms.
(Disc herniation image courtesy of Blausen Gallery).