It is advisable to treat sciatica as early as possible in order to avoid the progression of symptoms. Sciatica treatment may include both nonsurgical and surgical methods. Typically, nonsurgical methods are tried first. Surgery may be indicated when the underlying cause is severe and/or progressive neurological deficits such as leg weakness occurs.
Video: Sciatica Treatment
Sciatica treatment usually starts with nonsurgical methods and includes some combination of physical therapy, medications, therapeutic injections, and alternative therapies. Watch Now
Nonsurgical Treatment for Sciatica
First line treatments of sciatica typically include some combination of physical therapy, medications, therapeutic injections, and alternative therapies.
Acute sciatica usually gets better with 4 to 6 weeks of nonsurgical treatment. For chronic sciatica with pain lasting over 8 weeks, treatment time may take longer and may depend on the underlying cause.1,2
Physical Therapy for Sciatica
Physical therapy incorporates a combination of strengthening, stretching, and aerobic conditioning and is a central component of almost any sciatica treatment plan. Therapeutic exercises may also be added to a physical therapy program.
The goals of physical therapy and exercises for sciatica include:
- Strengthen the spine and muscles of the lower back, abdomen, buttocks, and hip.
- Increase core strength
- Stretch tight and inflexible muscles, such as hamstrings
- Encourage the exchange of fluids and nutrients in the body by light aerobic exercises such as walking, swimming, or pool therapy
While some rest or activity modification may be necessary, it is important to maintain as much activity as possible and avoid prolonged periods of physical inactiveness or bedrest.
Certain exercises to treat sciatica may be specific to the underlying cause. Trained health professionals, such as physiatrists, physical therapists, chiropractors or qualified certified athletic trainers can help formulate an effective treatment plan to relieve sciatica pain through exercise and physical therapy.
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Medication for Sciatica Pain
Both prescription and over-the-counter (OTC) medications may be used to relieve sciatica pain. A few examples of medications used to treat sciatica pain include:
- Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen
- Oral steroids, such as prednisone
- Anticonvulsant medications, such as gabapentin
- Tricyclic antidepressants, such as amitriptyline
- Opioid analgesics, such as tramadol or oxycodone
These drugs are usually taken in order to obtain pain relief and allow the patient to participate in physical therapy. Drugs such as opioid analgesics are generally prescribed for short durations to avoid addiction.
Manual manipulation, typically performed by a chiropractor, aims at improving the alignment of the spine. This technique may help address the underlying conditions that can cause sciatic nerve pain, such as herniated discs or spinal stenosis. Manual manipulation can also create a better healing environment and should not be painful.
Certain forms of massage therapy, such as deep tissue massage, may have benefits for pain relief. The benefits of massage therapy include:
- Improving blood circulation, which in turn creates a better healing response in the body
- Relaxing tight muscles, which may be contributing to the pain
- Releasing endorphins, which are hormones in the body that function as natural pain relievers
Lumbar Therapeutic Injections for Sciatica
Lumbar therapeutic injections may help treat pain stemming from conditions that affect the sciatic nerve.
Injections are used with the goal of providing enough pain relief to allow the patient to fully participate in, and benefit from a physical therapy program. Injections also serve a function in diagnosing the source of the pain and may be used to identify the target nerves.
The most common types of injections for sciatic pain relief include:
Epidural steroid injections
Epidural steroid injections may help relieve sciatic pain stemming from conditions such as spinal stenosis, disc herniation, or degenerative disc disease. The primary goals of this treatment include:
- Control the inflammatory response around the sciatic nerve from chemical and mechanical sources of pain, such as a herniated disc or a degenerated disc.
- Reduce the activity of the immune system to decrease the production of inflammatory cells in the body.
The steroids injected in the epidural space disperse into the nerve endings and other tissues, dissipating the anti-inflammatory effect throughout the pain-transmitting structures.
Selective nerve root blocks
This type of injection is administered near the spinal nerve as it exits the intervertebral foramen (bony opening between adjacent vertebrae). The medication reduces inflammation and numbs the pain transmitted by the nerve. Selective nerve root blocks may be given on one or more nerve roots from L4 to S3 to control sciatica pain.
For most therapeutic injections, results vary widely. Some people may experience immediate and sustained pain relief, some may have pain relief for only a few weeks or months, and some may experience no pain relief at all.
The above list of potential treatments is by no means exhaustive. For anyone experiencing sciatica pain, it is advisable to consult a qualified medical professional for treatment. As a general rule, if nonsurgical methods fail to provide relief after 6 to 8 weeks of treatment or if neurologic deficits (such as leg weakness) increase, surgery may be considered.2