Prevention

Once the pain of sciatica passes, there are exercises, stretches and other measures that may prevent it from returning. A physical therapist can develop a complete, personalized program. Here are some steps you can take in the meantime:

• Practice good posture. Stand up straight with your ears aligned with your shoulders, your shoulders aligned with your hips and your buttocks tucked in. Your knees should be bent slightly.

• Do abdominal crunches. These exercises strengthen the abdominal muscles that help to support your lower back. Lie with your back on the floor, hands behind your head and knees bent. Press your lower back to the floor, lift your shoulders up about 10 inches off the floor, then lower them. Repeat 10 to 20 times, once a day.

• Walk/swim. Walking and swimming can help to strengthen your lower back.

• Lift objects safely. Always lift from a squatting position, using your hips and legs to do the heavy work. Never bend over and lift with a straight back.

• Avoid sitting or standing for extended periods. If you sit at work, take regular breaks to stand and walk around. If you must be on your feet, prop one foot on a small block or footrest, and then switch feet throughout the day.

• Use proper sleeping posture. Take pressure off your back by sleeping on your side or on your back with a pillow under your knees.

• Stretch. Sit in a chair and bend down toward the floor. Stop when you feel just slight discomfort, hold for 30 seconds, then release. Repeat six to eight times.

• Avoid wearing high heels. Shoes with heels that are more than 1½ inches high shift your weight forward, throwing the body out of alignment.

Treatment

Sciatica usually can be treated successfully by a brief period of resting and limiting activity, followed by exercises to improve mobility and strengthen the back. If symptoms persist, physical therapy can be helpful. To ease inflammation around the nerve, your doctor may recommend that you alternate using hot and cold compresses.

You also may need to take acetaminophen (Tylenol) for pain, or anti-inflammatory drugs, such as naproxen (Aleve, Anaprox), ibuprofen (Motrin, Advil and others) or aspirin for pain and inflammation. Medications used to treat chronic nerve pain may be helpful. They include amitriptyline (Elavil, Endep) or gabapentin (Neurontin). In severe cases, an injection of a long-acting anesthetic with a steroid medication can provide relief. These injections typically are done in centers specializing in pain management. Rarely, surgery is required, such as when sciatica is caused by a bulging disc.