Sciatica is a general term describing nerve pain that starts in the low back and travels down one or both legs. Some people also experience muscle spasms, tingling, numbness or weakness in the affected leg or foot.
A herniated disk is a common cause of a pinched or irritated nerve. Bone spurs, fractures and tumors also can compress nerves in the spine and cause sciatica.
Although the pain can make daily activities such as sitting, walking and standing painful, bed rest isn’t recommended, said Dr. Andrea Peterson, a Marshfield Clinic Health System physical medicine and rehabilitation physician. Prolonged bed rest and lack of activity can slow recovery.
Physical therapy, medication can help
When symptoms first start, apply heat or ice and take over-the-counter pain medication like Aleve, Tylenol or ibuprofen for pain. Relative rest, or protecting the painful area, is helpful.
Talk to your doctor if pain persists
See a doctor if the pain doesn’t improve in 7-10 days or if you experience numbness or weakness.
“The most important treatment is beginning a good physical therapy program,” Dr. Peterson said. “Physical therapy improves sciatica for most patients.”
You’ll learn to strengthen back and core muscles that support your spine and prevent future low back pain. A physical therapist will teach you proper posture, lifting techniques and home exercises to help prevent and manage pain.
Options for ongoing pain
If you’re still in pain after physical therapy and medication, you may need imaging tests such as an X-ray or MRI to further evaluate what’s causing the problem. An EMG (electromyogram) test can evaluate nerve function and help determine if a specific nerve in the back is being damaged.
Your doctor may recommend an epidural steroid injection to help relieve pain.
Surgery is a last resort. About 80-90 percent of patients can recover from sciatica without surgery, Dr. Peterson said.
Early chiropractic care or osteopathic manipulation may help.
“Some research shows manual manipulation including chiropractic care and osteopathic manipulative medicine can be helpful within the first four weeks of symptom onset,” she said.
Reduce your risk for back pain
People often develop sciatica without any specific injury or known cause, but you can reduce your risk for back pain by:
- Avoiding smoking.
- Maintaining a healthy weight.
- Using proper lifting techniques.
- Avoiding extreme heavy lifting that causes you to strain your back.
- Keeping core muscles strong. Yoga and Pilates are good core-strengthening exercises.
Pregnancy can worsen sciatica
Pregnancy has been associated with sciatic. Ben Faustich, M.D., Obstetrics and Gynecology physician with Marshfield Clinic Health System, said if you have a pre-existing sciatica, you are more likely to have this condition during pregnancy. Dr. Faustich said it will often worsen as pregnancy progresses into the third trimester.
“The shifting center of gravity with a growing uterus puts more strain on the lower back and makes sciatica worse,” he said.
Dr. Faustich advises that pregnant women will need to avoid non-steroidal anti-inflammatory drugs and should talk to their women’s health provider immediately for a referral to physical therapy.
“Acetaminophen and cyclobenzaprine are safe to take in pregnancy, and steroid injections can be used as well,” Dr. Faustich said. “Start the physical therapy early as the sooner it begins, the less severe the symptoms become. For my OB-GYN patients, the condition usually gets worse until delivery without physical therapy.”