Sciatica: Your Treatment Options

From a surge of pain shooting down one leg to burning that feels like you’ve just splashed hot coffee along your backside, sciatica can range from dramatic moments to ongoing, unrelenting discomfort. Sciatica often prompts pain in the gluteal region, as well as radiating pain down one or both legs that can go into the calf, ankle, and foot.

When that happens, it’s more than just an annoying pain in the…you know. It can limit mobility and tank your quality of life, preventing you from sleeping soundly, exercising regularly, and even just doing household chores. Fortunately, there are options for treatment that can help.

Stemming from your lower back and sacrum are nerve roots that eventually become the largest nerve in the human body, the sciatic nerve. The sciatic nerve is like a junction point for nerves that branch down through your buttocks, hips, and legs. When part of this nerve gets compressed through an issue like disc herniation, it causes problems all the way down the line.

Using the train analogy, think of what happens if there’s a serious delay or breakdown at a central station. Some areas might be unaffected, but others could get jammed up. Addressing issues along the route won’t work unless you can fix what’s happening at the main station.

In your body, that problem translates into several potential symptoms:

• Pain that can be sharp or dull

• Burning sensation, especially in the buttocks and along one leg

• Tingling alternating with numbness

• All of these radiating down from the back to the toes on one side

“It’s possible to have pain throughout the back, but it’s more usual to see pain and numbness in the lower extremities,” says Jean-Jacques Abitbol, M.D., an orthopedic surgeon specializing in spinal surgery at California Spine Group in San Diego. “These feelings can come and go, or be constant. It depends on what part of the nerve and its branches are being affected.”

The most common cause of sciatica is herniated discs, but bone spurs and spinal tumors may also be a factor. In many cases, herniation may lead to spinal stenosis, a condition characterized by narrowing of the spaces within the spine, and that can lead to sciatica.

Conditions known to cause sciatic nerve pain include spondylolisthesis (misaligned vertebrae in the lower back), pregnancy and childbirth, and non-spinal disorders such as diabetes, constipation, or sitting on one's back pocket wallet.

Another frequent cause of sciatica is related to piriformis syndrome. This muscle, connecting to the thigh bone and assisting in hip rotation, passes over the sciatic nerve and is susceptible to injury from a slip and fall, hip arthritis, or a difference in leg length. Situations like those can cause piriformis muscle cramping and spasm to develop, pinching the sciatic nerve and causing inflammation and pain.

Less common as causes are spinal infection or tumor.

If you suspect you have sciatica, your doctor or spine specialist will ask you questions about your symptoms and perform some basic exams. This is a way to identify the cause of your pain, tingling, and/or numbness. Your treatment plan will depend on the cause of your pain. For example, if a herniated disc is the culprit, that’s what will need to be addressed.

Being prepped for the appointment can help, so jot down the answers to these standard questions and bring them along for your doctor:

• When did the sciatic nerve pain start?

• Where do you feel pain? Is it all the way down your leg? Is it in both legs? Does it stop at your knee?

• On a scale from 1 to 10, with 10 being the worst pain imaginable, rate your pain.

• Are you experiencing weakness or tingling in your legs and/or feet?

• What activities did you recently do?

• Does walking uphill or downhill increase pain?

• What have you done for this sciatic nerve pain? Have you tried particular medications or exercises?

• Does anything reduce the pain or make it worse?

“A major part of that initial discussion is finding out how long it has been there and how much it affects your daily living,” says Dr. Abitbol. “What kind of impact does it have on your life, and especially, whether it’s gradually getting better or getting worse.”

Your spine specialist will also perform physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion, and physical condition, noting any movement that hurts. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm.

During the neurological exam, your spine specialist will test your reflexes, muscle strength, and other nerve changes. For example, a doctor will have you lie down on your back and lift one leg at a time with the other leg flat or bent at the knee. If sciatica is occurring, you’ll likely feel pain in the lifted leg since the nerve is getting compressed.

To diagnose the cause of your sciatica, you may need to have some imaging tests, such as an X-ray or a computed tomography (CT or CAT) scan. If it's possible a herniated disc or spinal stenosis is causing your sciatica, your doctor may order a magnetic resonance imaging (MRI) test.

Together, these various exams and tests will give your doctor a more complete picture of your sciatic nerve pain. Using this information for a diagnosis will lead to putting a treatment plan together that’s geared toward your specific situation.

Although surgery might be appropriate in some cases (more on that in the next section), it’s likely your doctor will first suggest nonsurgical inventions to see if that will alleviate the issue.

“In the first couple weeks, the point will be to calm down the inflammation that may be contributing to the pain and numbness,” Dr. Abitbol says. “That might involve some restricted activity initially, but with the goal of getting the pain and inflammation down quickly.”

Here are some commonly used strategies after those first few weeks:

Physical Therapy and Activity

If you have significant pain and muscle spasms, it’s likely your doctor won’t prescribe physical therapy (PT) right away, says Dr. Abitbol. But if you don’t have intense symptoms, or they’ve abated, PT can be a good way to strengthen muscles, lower inflammation, and reduce pain—which can all help sciatica resolve itself if it solves an issue like nerve compression, he notes.

In terms of home remedies, Dr. Abitbol says exercises that focus on strengthening back and core muscles can be helpful as long as there isn’t significant pain. Movement, in general, can be a boon—a switch from advice doctors used to give, which was to get ample bed rest.

While research has suggested that bed rest alone will not offer relief for those suffering from nerve pain such as sciatica, that doesn’t mean you need to tackle marathon training. Instead, activity means being up and mobile for periods of time that are not enough to cause further pain and aggravation to your back. Some physicians may prescribe specific exercises, or some may simply suggest walking.

Noninvasive Treatments

PT and activity are a great start, but sciatica really needs a multipronged treatment approach. A sciatica treatment plan may include several different treatments such as:

• Ice/cold therapy reduces inflammation and helps to control sciatic pain.

• Ultrasound produces gentle heat created by sound waves that penetrate deep into muscles. Ultrasound increases circulation and helps reduce muscle spasms, cramping, swelling, stiffness, and sciatic pain.

• TENS (transcutaneous electrical nerve stimulation) is a small box-like, battery-powered, portable muscle stimulating machine. Variable intensities of electrical current control acute pain and reduce muscle spasms. Larger versions of the home-use TENS units are used by chiropractors, physical therapists, and other rehab professionals.

• Adjustments (spinal manipulation) are the core of chiropractic care. Manipulation frees restricted movement of the spine and helps restore misaligned vertebral bodies (subluxation) to their proper position in the spinal column. Spinal adjustment helps reduce nerve irritability responsible for inflammation, muscle spasm, pain, and other symptoms related to sciatica. Adjustments should not be painful. Spinal manipulation is safe and effective when done properly, on people without serious preexisting health problems.

Injections and Medications

In some cases a cortisone-like drug may be injected into the epidural space surrounding the spinal column. This procedure is similar to the epidural used during childbirth, and it's called an epidural steroid injection.

A course of this type of treatment may offer temporary relief, and even though it doesn’t address the root of the problem, it could give your sciatic nerve time to heal on its own, says Dr. Abitbol.

For pain, your best bet is non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. If you have significant pain, your doctor may refer you to a pain specialist who can assist with other medications.

Some patients with sciatica may find significant relief from minimally invasive spine surgery. There are two main types:

• Microdiscectomy. This procedure removes portions of the disc as a way to relieve the pressure on the spinal column. Microdiscectomy is sometimes called microdecompression.

• Laminectomy: In a laminectomy, a portion of the vertebral bone is removed, which relieves nerve compression by creating more space for the spinal cord and nerves.

“If other approaches haven’t worked and you’ve had symptoms for under three months, these can be very successful,” says Dr. Abitbol. “The improvement rate in symptoms is about 90%.”

Surgery is not for everyone. However, for those who have shown no sign of improvement in four to six weeks and who have had CT scans (computed tomography) or MRI that show a herniated disc or spinal stenosis, surgery may offer significant relief.

Many people find that having sciatica is a pain in the butt literally and figuratively. It can stop you from doing everything you want to do, and that often limits activity and can lead to being more sedentary—a ripple effect that can have negative impacts on all aspects of your health. If you’re experiencing even minor symptoms, get checked by your doctor, suggests Dr. Abitbol.

“The longer it goes on, the more difficult it is to treat, so there is no point in waiting to see if it gets better even though your symptoms are worsening,” he says, adding that if you’ve gone for six months or longer, and your symptoms are getting worse, even surgery may not be as gratifying as it could have been at an earlier point.” Dr. Abitbol suggests that to prevent issues related to prolonged compression, address the problem as soon as you can.

What’s better for sciatica diagnosis, CT or MRI?

According to Jean-Jacques Abitbol, M.D., an MRI is a superior strategy for diagnosis, since it can show alignment of vertebral discs along with muscles and ligaments, so it’s easier to see what may be impinging on the sciatic nerve.

What will a doctor do for sciatic nerve pain?

Initial treatment will depend on the severity of your symptoms and whether you also have spasms and/or numbness, but in general, you will likely be given anti-inflammatory medication to “calm down” the irritated nerve, says Dr. Abitbol.

Will sciatica go away on its own?

Not all sciatica will resolve itself, but many cases can go away on their own with proper care and treatment. Almost all cases of sciatica can be treated without surgery.