Myths about sciatica treatment options

There is one best treatment for the causes of sciatica

The causes of sciatica must be treated on an individualized basis

Because of the many conditions that can compress nerve roots and cause sciatica, one patient’s treatment options may be very different than those of another. A combination of treatment options is often the most effective course, and many patients will try some combination of the following treatment options:

• Physical therapy and chiropractic treatments can help relieve pressure on the sciatic nerve. 

• Alternating heat therapy and ice massage therapy can help to relieve acute pain from sciatica.

• Anti-inflammatory medications like non-steroidal anti-inflammatory drugs (NSAIDs, i.e. ibuprofen, naproxen or cox-2 inhibitors) or oral steroids may be used to help relieve inflammation.

• Epidural steroid injections can reduce inflammation around the nerve root and the associated low back pain.

• To help control the low back pain and leg pain while undergoing other conservative treatments, patients may take pain medications.

• Surgery may also be considered as a treatment option, usually (but not always) following a course of conservative treatments.

It is important to note that what works for one patient may not work for another, even if they have the same back problems. For example, a patient who has sciatica from a herniated disc may not find relief from conservative treatments and then will choose to undergo lumbar surgery. Another patient with sciatica from a similar type of herniated disc may find sufficient low back pain and leg pain relief through conservative treatments, including physical therapy, chiropractic, heat and ice therapy, injections and/or medications.

Sciatica can last for much longer, depending on the cause

Many cases of sciatica go away within a few weeks using conservative treatment methods. However, this is not the case for all patients. For some, sciatica can last much longer, even for several months. After back problems are diagnosed, the duration and intensity of treatment will need to be adjusted on a patient by patient basis.

Surgery may be the best treatment option for some patients

Patients should avoid having surgery too soon or too late. Although many patients hope to avoid surgery, for some, surgery might be the best (and quickest) option for pain relief. If the conservative (non-surgical) treatments (such as exercise and physical therapy, chiropractic, injections, etc.) have not helped, the patient’s pain is severe, or if the patient has lost a significant amount of function, surgery may be considered as the most effective treatment.

The appropriate surgical procedure depends on the condition causing the sciatica. For example, microdiscectomy (microdecompression) may be useful for a herniated disc, while lumbar laminectomy (open decompression) is a common surgical treatment for spinal stenosis. These two procedures have high success rates for relieving patients’ pain.

Exercise will make sciatica worse, so patients should avoid exercising

Exercise is usually critical to help heal the problem causing sciatica

Some patients believe that staying in bed and avoiding physical activity is the best idea when sciatica occurs. For the initial flare-up of sciatica, bed rest is usually fine for a day or two. However, avoiding activity any longer can typically lead to a downward spiral where episodes of pain lead to inactivity, leading to more pain, and so on.

Without proper exercise, low back muscles become weak and deconditioned, leaving them less able to support the back and the spine. Keeping the hamstrings flexible by stretching is particularly important for sciatica patients, because tight hamstrings add stress to the low back, which can aggravate low back problems. Exercise also helps exchange nutrients within the spinal discs, keeping them healthy and preventing injury that can cause sciatica.

Patients should develop a gentle exercise program that includes stretching, strengthening and low-impact aerobic exercise. Even after sciatica is relieved and other back problems have been treated, the exercise routine should be maintained to keep the back healthy and to help avoid future problems. See Sciatica exercises for more specific information.

Before beginning an exercise program, patients should always consult a health professional. Once the cause of sciatica is diagnosed, the professional can advise the patient about which exercises will be most appropriate and which should be avoided.