Sciatica: treatment

Sciatica is the name for a syndrome which is characterised by pain that radiates along the path of the sciatic nerve. The sciatic nerve is the longest and largest nerve in the body — it is as thick as one of your fingers where it arises in the lower spine. It then travels from your lower back through your hip and buttock and down your leg where it divides into two branches at the knee. Each leg has its own sciatic nerve.

sciatic nerve

How is sciatica treated?

Most sciatica gets better within a few weeks and doesn't result in permanent damage. If your pain doesn't settle down after a few weeks, see your doctor. If you lose control of your bladder or bowels, or you have severe pain, weakness of your muscles or numbness, seek medical attention immediately.

Pain control

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, may be useful in reducing inflammation, however, if the sciatica is due to a herniated disc then studies seem to show that NSAIDs are no better than placebo (a dummy treatment). Paracetamol and other pain relievers may help to reduce back pain in the short term and help you keep active.

Stay active

Once pain has been controlled, your doctor may recommend physical therapy or an exercise programme to strengthen your back or improve your posture. Prolonged bed rest isn't a good idea for sciatica and lower back pain, and can worsen the problem. A couple of days of rest at the beginning may be necessary for pain relief, but any longer than that and the muscles that support the spine will start to weaken. For sciatica associated with a herniated disc, doctors generally encourage continued activity, providing it doesn't provoke severe pain.

Stretching and strengthening

Gentle passive stretching exercises may help to relieve compression in the spine. Many of the exercises focus on strengthening the muscles which support the spine. However, note that suitable stretches for sciatica differ depending on the cause of the sciatica. For example, there are specific stretching exercises which are almost always necessary to relieve piriformis syndrome and these differ from the stretches to ease sciatica caused by spinal stenosis. Exercises such as pilates are useful to correct poor muscle tone and posture and improve core strength and stability. Pilates can help improve back pain and also help to prevent future episodes.

Massage

There doesn't appear to be any scientific evidence regarding massage as a treatment for sciatica, but some people have found it helpful, for example in releasing muscles that have gone into spasm.

Osteopathy

People with sciatica commonly consult osteopaths to deal with their condition and some people find it helpful to alleviate their symptoms. In terms of scientific studies, most studies to date have looked at osteopathy to treat low back pain in general, not specifically sciatica, so the evidence supporting its use in sciatica is not abundant. However, some doctors do recommend consulting an osteopath or physiotherapist to relieve the pain of sciatica and to undertake a programme to strengthen and condition the lower back.

Physiotherapy

Your doctor may refer you to a physiotherapist for an exercise prescription to strengthen and stabilise your back, and also for help in relieving the pain of sciatica.

Spinal manipulation

There is some evidence that spinal manipulation may be useful in treating sciatica associated with a herniated disc. However, there are some safety concerns and a possibility of doing further damage to herniated discs by manipulating the spine. In addition, people who have osteoporosis or rheumatoid arthritis should avoid spinal manipulation.

Acupuncture

Acupuncture is the insertion of fine needles into the skin at traditional acupuncture points which are believed to sit on meridians which run through the body. At present there is not enough evidence to recommend acupuncture in the treatment of sciatica, although some people do gain relief. The lack of evidence may be due to the difficulty in conducting trials into the effectiveness of acupuncture. Because acupuncture involves the insertion of needles into the body it is difficult to compare it with a dummy treatment. Acupuncture is usually compared with dummy acupuncture which uses non-traditional acupuncture points, however, some people believe that any needling has a beneficial effect on the body.

Heat or ice packs

There does not seem to be any definitive evidence supporting the use of heat or ice packs in the treatment of sciatica.

TENS — Transcutaneous Electrical Nerve Stimulation

TENS is a treatment that uses low voltage electrical currents to relieve pain. More scientific evidence is needed to show if TENS is an effective treatment for sciatica.

PENS — Percutaneous Electrical Nerve Stimulation

PENS is similar to TENS, but with PENS the electrical stimulation is passed through the skin into the soft tissue using probes similar to acupuncture needles. Again, there isn't enough scientific evidence to state that PENS is an effective pain relief for sciatica.

Epidural steroid injections

Cortisone injections may be used to treat sciatica by helping to suppress inflammation around the irritated nerve. Epidural corticosteroid injections may provide significant short-term pain relief for people with a herniated lumbar disc. However, the evidence to support the effectiveness of steroid injections is conflicting.

Surgery

In severe cases, spinal surgery may be necessary to make more room in the spinal canal for the nerves. A discectomy is an operation done through a small incision in the back to remove the herniated disc that's pressing on a nerve. A laminectomy involves spinal surgery to remove the lamina and sometimes part of the facet joint in order to make more room for the nerve roots.

Last Reviewed: 20 December 2012
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References

1. Symptomatic lumbar disc herniation (revised October 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Jun 2013).
2. Jordan J, Konstantinou K, O’Dowd J. Herniated lumbar disc. Clinical Evidence [online] 2011 [cited Jun 28]. URL: http://clinicalevidence.bmj.com/ (accessed 2013 Jun 17).
3. Symptomatic spinal canal stenosis (revised October 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Jun 2013).
4. Low back pain (revised October 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Jun 2013).
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