If you’ve ever experienced the tell-tale shooting pains, tingling, and numbness caused by sciatica, you know how truly uncomfortable the condition can be. We tapped experts to share sciatica pain relief treatments that can have you moving comfortably again.
Meet the Experts: David Hughes, P.T., D.P.T., a physical therapist at Midwest Orthopaedics at Rush; Gordon McMorland, D.C., clinic director of Momentum Health National Spine & Wellness; Jingduan Yang, M.D., founder and medical director of the Yang Institute of Integrative Medicine; Tieraona Low Dog, M.D., founding director of the fellowship of integrative and functional medicine at the University of California-Irvine’s Susan Samueli Integrative Health Institute
Sciatica is a common condition in which a pinched or irritated nerve in the lower back causes pain to radiate from your lower back down through the buttocks and the legs. The sciatic nerve can be compressed by the “piriformis, which is a deep hip muscle,” explains David Hughes, P.T., D.P.T., a physical therapist at Midwest Orthopaedics at Rush. “The compression can also be in the spine, such as with arthritic changes, bone spurs, herniated discs, and abnormal curvature of the spine.” According to the Cleveland Clinic, it can also be caused by pregnancy.
The good news is that many cases of sciatica improve without medical treatment. Simple strategies like stretching, icing the painful area, and taking OTC medications may provide relief. Ahead, healthcare providers share ways to ease sciatic nerve pain.
Additional expert sources include James W. Carson, P.h.D., a clinical psychologist at the Comprehensive Pain Center at Oregon Health & Science University; Jeff Smoot, former president of the American Massage Therapy Association; A. Nick Shamie, M.D., professor of orthopaedic surgery and neurosurgery at UCLA School of Medicine; and Raj Rao, M.D., professor of orthopedic surgery and neurosurgery at the George Washington University School of Medicine and Health Sciences
Sciatica Pain Relief Treatments
Chiropractic Care
Sixty percent of people with sciatica who didn’t get relief from other therapies and then tried spinal manipulation experienced the same degree of pain relief as patients who eventually had surgery, found a 2010 study in the Journal of Manipulative and Physiological Therapeutics. The 120 people in the study saw a chiropractor about 3 times a week for 4 weeks and then continued weekly visits, tapering off treatment as they felt better. In people who responded to chiropractic care, benefits lasted up to a year. “Spinal manipulation may create a response in the nervous system that relieves pain and restores normal mobility to the injured area,” says study researcher Gordon McMorland, D.C., clinic director of Momentum Health National Spine & Wellness. “It also reduces inflammation, creating an environment that promotes the body’s natural healing mechanisms.”
Acupuncture
“You can get relief as soon as the first session, though it takes about 12 sessions to see improvement,” says Jingduan Yang, M.D., founder and medical director of the Yang Institute of Integrative Medicine. A small study in the Journal of Traditional Chinese Medicine found that of 30 people with sciatica, 17 got complete relief and 10 saw symptoms improve with warming acupuncture, in which the needles are heated.
Yoga
A study in the journal Pain reported that people with chronic back pain who practiced Iyengar yoga for 16 weeks saw pain reduced by 64% and disability by 77%. Although yoga’s effects on sciatica are less clear, gentle forms may be beneficial. By strengthening muscles and improving flexibility, a yoga practice can help sciatica sufferers “move and function better so they don’t fall into a posture that aggravates the sciatica,” says James W. Carson, Ph.D., a clinical psychologist at the Comprehensive Pain Center at Oregon Health & Science University.
Trigger Point Massage
Don’t expect a chilled-out spa massage if you have sciatica. In this instance, trigger-point therapy is best, says Jeff Smoot, former president of the American Massage Therapy Association. The sciatic nerve sits underneath a muscle called the piriformis, which is located beneath the glutes. “When the piriformis muscle gets tight, it pinches the sciatic nerve, causing tingling and numbness down into the leg,” says Smoot. He applies pressure to irritated and inflamed areas, or trigger points, in the piriformis muscle, as well as in muscles in the lower back and glutes. Typically, Smoot schedules treatments 7 to 10 days apart. If patients don’t see progress by the fourth visit, “they need to try another form of therapy,” he says.
Topical Preparations
St. John’s wort oil is “one of my favorites for nerve pain,” says Tieraona Low Dog, M.D., founding director of the fellowship of integrative and functional medicine at the University of California-Irvine’s Susan Samueli Integrative Health Institute. One animal study suggests that St. John’s wort may have potential as a treatment for neuropathic pain, but more research is needed. According to the Mayo Clinic, St. John’s wort can interact with other medications, so check with a healthcare provider if you’re currently taking anything else. That said, most of the known interactions relate to taking St. John’s wort orally rather than as a topical application.
Another option: an OTC cayenne pepper cream. Capsaicin, found in chiles, hinders the release of pain-causing compounds from nerves. For severe cases, Low Dog uses the prescription chile patch Qutenza, designed for shingles pain. “One application is effective for weeks,” says Low Dog.
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Ice or Heat
Because the sciatic nerve is buried deep within the buttock and leg, ice or heat on the surface of the body won’t ease that inner inflammation. But ice can work as a temporary numbing agent that can reduce discomfort when the pain first arises. After the worst of the pain has subsided, you can use heat to relieve stiffness.
Devil’s Claw
The herbal medication devil’s claw is “quite a potent anti-inflammatory, working like ibuprofen and similar drugs to inhibit substances that drive inflammation,” says Low Dog. For low back pain, there is some evidence that Devil’s Claw may help reduce pain more than placebo.
Low Dog generally starts patients on 1,500 to 2,000 mg twice a day. Look for a brand that has a standardized extract of roughly 50 mg of harpagoside, the active compound. Safety reviews show that the supplement is well tolerated by most people but should be avoided by patients with peptic ulcers or on blood-thinning medications.
Pain Relievers and Muscle Relaxants
Taking a nonsteroidal anti-inflammatory drug, either OTC (like ibuprofen) or prescription, can ease the distress. Because painful muscle spasms may also accompany a disc herniation, doctors sometimes prescribe muscle relaxants or pain-reducing tricyclic antidepressants. A caveat: “These won’t help with the pain caused by pressure on the sciatic nerve,” says A. Nick Shamie, M.D., professor of orthopaedic surgery and neurosurgery at UCLA School of Medicine.
Epidural Steroid Injections
People whose pain doesn’t lessen within about a month and who aren’t helped by other therapies may find their pain remedied by an x-ray-guided injection of steroid into the lower back near the sciatic nerve, says Raj Rao, M.D., professor of orthopedic surgery and neurosurgery at the George Washington University School of Medicine and Health Sciences. “The hope is to reduce inflammation within that nerve branch,” explains Rao. Because of concerns about side effects, such as loss of bone density, the epidural shots are limited to three a year.
Exercise and Physical Therapy
Moving is usually the last thing people struggling with sciatica want to do, but it’s important to be physically active. It may also be worth seeing a physical therapist, who can prescribe stretching exercises to restore flexibility to the back or moves that strengthen core muscles, helping to stabilize the spine and reduce the likelihood of a similar injury.
“Physical therapists often prescribe ‘nerve glides’ to free up the nerve, and either extension-based exercises such as press-ups or flexion-based exercises such as ball roll-outs or double knee to chest may be of assistance,” says Hughes.
Surgery
After 4 to 6 weeks of unremitting symptoms, patients may qualify for surgery.
The Spine Patient Outcomes Research Trial (SPORT) enrolled people who had persistent symptoms after six weeks and found that those who had surgery for a herniated disc had greater decreases in pain and disability 3 months afterward than patients who did not. The benefits lasted up to 4 years.
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