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The sciatic nerve is the longest and largest nerve in the human body. It originates from spinal nerves in the lower back and runs down the buttocks and leg on each side. Sciatic nerve pain or sciatica refers to pain or discomfort that occurs when the sciatic nerves are irritated, inflamed, pinched, or compressed. This condition affects about 10-40% of the population over their lifetime. Possible complications of sciatic nerve irritation and inflammation include leg weakness, foot drop, and problems with bowel or bladder control. 

Common Causes of Sciatic Nerve Pain

The most common cause of sciatic pain is pressure on the nerve roots in the lumbar spine from herniated disks. In addition to a herniated disc, spinal stenosis (narrowing of the spinal canal) can lead to radiculopathy (pinched nerves in the spinal cord). Other causes include bone spurs (bony overgrowths) on the spinal bones and tight muscles (for example, piriformis syndrome). Less commonly, the underlying cause can be a tumor or spinal bone fracture that triggers sciatica symptoms. 

There are also several other conditions that can cause sciatica, including pregnancy, injury, osteoarthritis, foraminal stenosis, cauda equina syndrome, and degenerative disk disease.

Risk factors for sciatic pain include: 

• Herniated or slipped disk - These are the most common risk factors for those between 20 and 50 years of age.   

• Bone spurs are more common with age.

• Obesity - Excess body weight can put pressure on the sciatic nerves. 

• Lack of physical activity - A sedentary lifestyle involving prolonged sitting

• Occupations - Jobs that involve carrying heavy loads, twisting the back, or sitting for prolonged periods, such as truck drivers, can lead to sciatic pain.

• Pregnancy - Hormonal changes during pregnancy that relax the ligaments to prepare the body for childbirth can shift the body’s center of gravity, pinching the sciatic nerve. 

• Type 2 Diabetes - Diabetic patients are at increased risk of nerve damage.

• Tobacco Use - Smoking cigarettes can affect circulation and contribute to sciatic pain.

Symptoms of Sciatica

The main symptom of sciatic nerve inflammation is pain along the course of the nerve from the lower back to the buttock and lower leg. The severity of sciatic pain can vary widely from person to person. It usually involves one side and maybe a dull ache down the back of a leg. In others, sciatica pain can feel like an electric-shock-like sensation, a sharp pain, or a burning sensation along the path of the pinched nerves. The pain is usually worse after sitting for a long time, such as a long car ride or flight.

Other sciatica symptoms can include numbness, tingling, and weakness in the leg and foot muscles. There may be pain in one part of the affected leg and numbness in another part.

Self-Care Treatments for Sciatica Symptoms

Hot and Cold Packs

Alternating ice and heat application on the painful area can help to relieve sciatic pain. Ice numbs the area, thus relieving pain, and heat increases blood flow to the area, bringing oxygen and nutrients to support healing. You can alternate cold packs and hot compresses on the affected area for 20 minutes every few hours throughout the day. Make sure you use the heating pad on the lowest setting and end with a cold application. 

As mentioned, a cold pack can ease sciatica pain by reducing swelling and having a numbing effect. The application of ice can, therefore, be used on its own for sciatic pain relief. However, heat should only be used in conjunction with an ice pack. Using heat alone can increase blood flow to the area and increase swelling, pinching the sciatic nerve even more. Find out: “Is Heat or Ice Better for Back Pain?”

Over-the-Counter Medications

Over-the-counter pain relievers such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) can help to manage mild sciatic pain. Make sure you don’t exceed the recommended daily maximum dose of these nonprescription drugs as mentioned on the package.

You should always check with your doctor before self-treating with an over-the-counter pain reliever. OTC medications can be harmful if you have certain health conditions. Specifically, if you have heart disease or kidney problems, taking NSAIDs can lead to dangerous adverse effects. On the other hand, acetaminophen (Tylenol) and acetaminophen-containing products can worsen liver injury. Your doctor can guide you regarding which type of OTC pain medication is safe and their recommended dosages. 

Stretching Exercises

Exercises such as hamstring and piriformis stretches, back flexion exercises, and knee to opposite shoulder can help to reduce tension on the sciatic nerve and relieve pain.

Physical Therapy

Working with a physical therapist or sports medicine specialist can help people with sciatic pain by:

• Relieving lower back, buttock, thigh, and leg pain. 

• Restoring pain-free movement.

• Reducing muscle spasms.

• Improving mobility.

• Preventing future flare-ups of sciatica.

Find out when to get physical therapy for lower back pain.

Long-Term Strategies for Sciatica Management

Regular Exercise Routine

Regular exercise can help strengthen the muscles in your lower back and abdomen (core), which are necessary for maintaining spinal posture and alignment. 

Posture Correction

A good posture, especially while sitting, can support your lower back and prevent sciatic nerve irritation. Choose a chair with a swivel base, armrests, and good support for your lower back. It may help to place a pillow or rolled towel on the small of your back to maintain the normal curvature of your spine. Your knees and hips should be level while sitting with your feet flat on the ground.

Preventative Measures to Avoid Sciatic Pain Recurrence

During periods of prolonged standing, rest one foot on a stool or small box periodically to prevent sciatica. While lifting heavy objects, lift with your legs rather than your lower back. Hold the object close to your body. Avoid twisting while lifting heavy loads. Get someone to help you if the item is heavy or awkwardly shaped.

Alternative Therapies and Complementary Remedies

Yoga and Mindfulness Practices

The mindful practice of yoga asanas (postures) can gently stretch, strengthen, and align the lower back and muscles, such as the piriformis and hamstrings. It is important to proceed slowly because aggressive stretching can worsen sciatica symptoms.

Acupuncture 

Acupuncture treatment involves placing thin, sterile needles at specific points in the body. This therapy works by stimulating the central nervous system, relaxing tight muscles, improving blood circulation, and releasing neurotransmitters (natural chemicals) that reduce pain. Acupuncture can be a safe, non-drug remedy for sciatica and may be effective for some people. 

Chiropractic Care

Spinal manipulation and other manual therapies, such as stretching and massage therapy during chiropractic treatment, can be part of a holistic treatment approach for sciatic pain. Chiropractic therapies remain controversial, but there is some evidence that they can provide relief for back pain and sciatic pain.

Dietary Adjustments

Dietary recommendations for people with sciatic nerve symptoms include eating a healthy, balanced diet with plenty of fresh fruits and vegetables, whole grains, and healthy fats. This anti-inflammatory diet can help to reduce pain and inflammation. Foods to avoid include pro-inflammatory ultra-processed foods, fried and fatty foods, and foods with added salt and sugar.

You can also talk to your doctor about taking dietary supplements such as omega-3 fatty acids to reduce inflammation and magnesium to help with muscle spasms.

Treatment Options for Sciatic Pain

When to See a Doctor

Mild sciatica usually improves with lifestyle changes and home remedies. A typical flare can last a few weeks. However, you should make an appointment to see your primary care doctor if your sciatica lasts longer than six weeks and/or there is:

• Persistent or worsening sciatic pain despite self-care measures.

• Sudden numbness or muscle weakness in a leg.

• Sciatic pain following a severe injury, such as a fall from a height or motor vehicle accident.

• Trouble with bowel or bladder control. 

Your healthcare provider can make a diagnosis of sciatic nerve pain based on a physical exam, imaging tests (X-ray, MRI, CT scan), and electromyography.

Prescription Medications

Some of the medications that your healthcare provider may prescribe for treating sciatica include:

• Prescription-strength NSAIDs such as diclofenac and celecoxib to decrease pain during severe flare-ups.

• Corticosteroids such as prednisone to reduce inflammation.

• Antidepressants such as amitriptyline, a tricyclic antidepressant (TCA), have been used off-label to treat sciatic pain. It is believed that amitriptyline works to relieve sciatic pain by increasing the levels of the two brain chemicals: serotonin and norepinephrine. Other antidepressants that are used as off-label for the treatment of nerve pain include venlafaxine and duloxetine. However, these are not first-line treatments. 

• Anti-seizure medications such as gabapentin and pregabalin that are effective in treating nerve pain.

• Opioid pain relievers for short-term use for severe pain.

Other Treatments: Steroid Injections

A steroid injection in the area of the nerve root causing sciatic nerve irritation and pain can help to control symptoms and restore function for several months. You can get another steroid shot when the nerve starts getting irritated again. However, due to the risks associated with corticosteroids, you can only get 3-4 shots in a year.

Surgical Options for Severe Sciatica

Surgery is reserved for severe sciatica that does not respond to conservative treatments. Surgery may also be the last resort if your sciatica causes leg or foot weakness or loss of bowel or bladder control. A surgeon can remove part of a herniated disk or bone spur to relieve pressure on the nerve. 

FAQs on Sciatic Nerve Pain

How do I get my sciatic nerve to stop hurting?

You can get your sciatic nerve to stop hurting by applying an ice pack several times a day for 2-3 days, followed by alternating ice and heat therapy. Other things that may help include gentle stretching exercises and over-the-counter pain medications.

How to stretch the sciatic nerve?

Here are 3 exercises to stretch the sciatic nerve:

• Knee to opposite shoulder spinal stretch: Lie down flat on your back with your legs extended. Clasp your right knee with your hands and slowly raise and pull your right leg across your torso towards your left shoulder. Hold the stretch for 30 seconds and repeat 3 times with each leg.

• Seated glute stretch: Sit on a chair with your feet flat on the ground. Place your right ankle on your left knee and bend forward so that your upper body touches your thigh. Hold the stretch for 15-30 seconds and repeat 10-15 times, then repeat with the other leg.

• Scissor hamstring stretch: Stand with your right foot in front of your left foot. Make sure your right hip isn’t placed more forward than your left hip. Keep your leg straight. Put your hands on your hip or hold a chair for balance. Bend forward at the waist, keeping your back straight. Hold for 10 seconds and repeat 3-5 times on each side.

How should you sit to relieve sciatica pain?

Here are some tips on a good posture while sitting to relieve sciatic pain:

• Sit straight with your lower back resting against the back of the chair.

• Make sure your feet are resting flat on the ground.

• Keep your hips at an open or wide angle. 

• Raise the painful leg slightly from time to time to relieve pressure on the sciatic nerve.

• Get up and walk around periodically.

How do you stop a sciatic flare fast?

Here are some ways to stop a sciatic flare fast:

• Stay active and avoid bed rest.

• Modify your activities. For example, if you feel pain while standing to do the dishes, place the foot of the leg that has sciatic pain on a stool to relieve pressure on the nerve.

• Do gentle stretches.

• Apply an alternating hot and cold pack to the affected area.

• Try relaxation activities like deep breathing, yoga, tai-chi, and meditation to manage sciatic pain naturally.