Up to 40% of people will suffer with sciatica in their lifetime and after the common cold, back pain is the most common cause of days lost at work. However, even though it’s a common problem, back pain treatment is often badly managed.
So what is sciatica? And what can you do to treat sciatica nerve pain?
Have I got sciatica?
Sciatica is also known as ‘lumbar radicular syndrome’, ‘ischias’ and ‘nerve root entrapment’.
- It is a pain felt in the thigh, calf and often the foot of one leg.
- Sciatica nerve pain can feel like a burning, aching, stabbing, tingling, weakness or numbness in the leg.
- It is often made worse by coughing, straining, sneezing or sitting for long periods.
- Pain that is not felt below the knee isn’t sciatica.
- It is most common in people aged 30-50 years old.
- About 5-10% of people with low back pain have sciatica.
What is sciatica?
The spine is made up of a column of bones which protects the spinal nerves running through it. So that the back can bend easily, there are firm disc cushions between each of the bones in the column.
Also degeneration of the spinal bones because of osteoporosis or an infection in the disc can cause it to put pressure on the nerves that feed the leg from the lower back area. This pressure on the nerve causes the symptoms.
Most low back pain is self-limiting and easily treated. Like other low back pain, sciatica may come on suddenly and can persist for days or weeks, or it may come and go.
How can I get rid of sciatica nerve pain?
Sciatica treatment includes pain killers and gentle physical therapy/physiotherapy or surgery in severe cases.
Pain killers bought from the chemist are a good place to start with sciatica treatment. Look for non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and add paracetamol if you need to. Be careful in taking NSAIDs if you have a history of peptic or duodenal ulcer or asthma and ask the chemist for advice if you’re unsure. Also, take them with food or a milky drink.
Be careful in taking paracetamol if you have a liver problem and, again, ask for advice if you’re not sure.
You can take painkillers every 2 hours to treat sciatica nerve pain by alternating which analgesia you take. For example, take NSAIDs at 8am, then 2 paracetamol at 10am, NSAIDs at 12 midday, 2 paracetamol at 2pm etc. Read the labels on the drug bottles to make sure you’re not taking 2 lots of paracetamol- or NSAIDs-containing meds.
There is no harm in doing this in the short term, and taking regular analgesia is recommended if the pain is ongoing as it avoids highs and lows in the blood concentration of the drugs. I.e. there is always some pain relief in your body working for you.
If meds bought over the counter aren’t working then see your doctor for stronger painkillers.
Physical therapy/physiotherapy for sciatica pain relief and lower back pain relief can be effective too. Combine it with regular painkillers so that you feel comfortable and confident to move freely.
Ask your doctor to recommend a therapist or ask advice.
Physical therapy can help to correct any postural problems that cause your lower back pain or make it worse. In addition a therapist will make sure you are doing the exercises correctly so that they are of most benefit.
Back pain exercises that will help relieve and prevent lower back pain are at described the bottom of the page.
Steroid injection or steroid medication may be given by the doctor to help reduce the inflammation.
Surgery for sciatica is usually a last resort when painkillers and physical therapy haven’t worked or if symptoms have progressed.
Spinal cord stimulation for chronic back pain relief is a procedure using an electrical current to treat chronic pain. A small pulse generator is implanted in the back and sends pulses to the spinal cord. These pulses interfere with the nerve messages that make you feel pain.
You will be taught how to use the stimulator and the doctor will set the strength of the electrical pulse. Typically you would use it for 1-2 hours 3-4 times a day
It is done under a local anaesthetic and is for people who have had back surgery but severe pain has returned or for people with chronic pain syndromes. You will feel a tingling sensation rather than the pain.
Success varies but up to 50% of people have some pain relief with this method of treatment.
When should I see the doctor with my sciatica pain?
There are several ‘red flags’ for back pain that mean you should see the doctor sooner rather than later. These include:
- Numbness over the mid to lower back (‘saddle’ area)
- Bladder problems – needing to go more often, incontinence or unable to go
- Bowel incontinence
- Sudden central pain in the spine which goes when you lie down
- Back pain after major trauma like a fall from height or a car accident
- Back pain after minor trauma (like lifting something heavy) if you have osteoporosis
- If you have a history of cancer
- If you also have a fever, chills or unexplained weight loss
- Immune suppression for example with chemotherapy or AIDS
- Back pain that doesn’t go when you’re lying down, that wakes you from sleep or pain in the mid-upper back.
Lower back pain exercises
Most people who have back pain naturally feel better when doing certain movements. Exercise that moves you toward your more comfortable position is usually better in treating your back pain.
- Do your exercises for lower back pain after you’ve taken painkillers.
- Talk to your doctor before you start an exercise program, and only do exercises that do not make your symptoms worse.
- Try to exercise a little bit every day.
- Get some type of aerobic exercise (such as walking) every day also. Gradually increase the time you spend doing it.
- Choose a couple of stretching and strengthening exercises that you enjoy and vary them from day to day.
Back pain exercises:
1. Press-up back extension
Lie on your stomach, supporting your body with your forearms.
Press your elbows down into the floor to raise your upper back. As you do this, relax your stomach muscles and allow your back to arch without using your back muscles. As your press up, do not let your hips or pelvis come off the floor.
Hold for 15 to 30 seconds, then relax.
Repeat 2 to 4 times.
Author Shannon Erstad, MBA/MPH
2. Alternate arm and leg extensions
Do this exercise slowly. Try to keep your body straight at all times, and don’t let one hip drop lower than the other.
Start on the floor, on your hands and knees.
Tighten your stomach muscles.
Raise one leg off the floor and hold it straight out behind you. Be careful not to let your hip drop down, because that will twist your trunk.
Hold for about 6 seconds, then lower your leg and switch to the other leg.
Repeat 8 to 12 times on each leg.
Over time, work up to holding for 10 to 30 seconds each time.
If you feel stable and secure with your leg raised, try raising the opposite arm straight out in front of you at the same time.
Author Shannon Erstad, MBA/MPH
3. Knee to chest exercise.
Do not do the knee-to-chest exercise if it causes or increases back or leg pain.
Lie on your back with your knees bent and your feet flat on the floor.
Bring one knee to your chest, keeping the other foot flat on the floor (or the other leg straight, whichever feels better on your lower back). Keep your lower back pressed to the floor. Hold for at least 15 to 30 seconds.
Relax and lower the knee to the starting position. Repeat with the other leg.
Repeat 2 to 4 times with each leg.
To get more stretch, put your other leg flat on the floor while pulling your knee to your chest.
Exercises’ Author Shannon Erstad, MBA/MPH
See www.WebMd.com for more information on back pain exercises.