Sciatica: Causes & Treatments
Sciatica is the term used when the sciatic nerve becomes irritated or compressed, causing pain in the buttocks and legs (usually only in one leg rather than both). It’s not a condition as such, but a symptom of a condition (see What causes it? below).
The sciatic nerve is the largest single nerve in the body. It starts as a collection of individual nerve fibres starting on either side of the lower part of the spine. These nerve fibres come together to form a single nerve – one on the left and one on the right of the spine. Each of these large single nerves – which are as thick as a man’s thumb at their widest point – runs from the lower back through the buttock and down the back of the leg right down to the foot and toes.
Depending on what’s causing the compression or irritation of the sciatic nerve – including where the irritation occurs – the symptoms can include one or more of the following:
Pain – usually sharp rather than dull – down one side of one buttock or leg that can get worse when you sit for a long time or if you sneeze or cough (the pain can affect part or all of your leg, and sometimes even your foot).
A tingling or even burning sensation that can start at the lower back and travel down the back of one leg.
Muscle weakness or numbness that can affect your ability to move your leg, foot and/or toes.
General back pain – though sciatica is more commonly associated with pain in the buttocks and legs.
In most cases, sciatica pain is acute, which means it lasts up to a few weeks then goes away. But it can also be chronic, and some people may experience sciatica for months or even years. The level of pain can also vary from mild to extreme.
According to the NHS, GPs have an easy way of finding out if you have sciatica. This is called the passive straight leg raise test, which involves lying on your back with your legs straight and lifting one leg at a time. If lifting one of your legs is painful, it usually indicates that you have sciatica.
What causes it?
While sciatica usually causes pain in the buttocks and legs, the cause usually originates with a problem in the back. The NHS claims the most common cause of sciatica is a slipped disc, where one of the discs sitting between two vertebrae (bones of the spine) becomes damaged and irritates or pinches the roots of the nerves.
Also known as a lumbar herniated disc or a pinched nerve, slipped discs are thought to be more common in men than women, especially those who do physically demanding work. Obesity may also be a risk factor, because the extra weight may increase the pressure on the spine.
Other causes of sciatica include the following:
Degenerative disc disease
As you get older, some degree of spinal disc degeneration is natural as a result of general wear and tear, but in some people it can also irritate a nerve fibre in the spine.
If one vertebra slips out of position over another – because of a small stress fracture, for example – the result is known as spondylolisthesis. When this happens, the nerve can get pinched.
Cauda equina syndrome
A rare condition, this is caused when the nerves in the spinal cord become compressed and damaged.
A growth, such as a tumour, on the spine can also cause sciatica, as can a spinal injury or infection.
How is sciatica treated?
Sciatica pain isn’t a laugh a minute, but according to the NHS the good news is most cases clear up in around six weeks without the need for any special treatment. In the meantime there are lots of things you can do yourself to relieve your symptoms until things get better. These include the following:
Doctors these days are advised not to prescribe bed rest for back pain and sciatica. Instead, you should try and stay as active as possible. So keep moving – in particular, try not to sit for too long – and take part in simple activities such as swimming, stretching and walking. This will help prevent your muscles becoming tight and weak, which could cause further problems in the long term. Indeed, the British Association of Spine Surgeons claims inactivity can make the symptoms of sciatica worse.
Also see below for some examples of specific stretching exercises you could do to help reduce and speed up the recovery of sciatica pain.
Non-prescription medicines such as paracetamol and ibuprofen may help if you need pain relief. These are available over the counter at pharmacies.
Heat and ice packs
Using heat and/or ice packs can be useful, particularly when your symptoms start. You may find one more useful than the other – try starting with an ice pack, apply it to the painful area for about 15 - 20 minutes and repeat every two hours. If that doesn’t give you any relief, try a heat pack in the same way. Some people also find alternating hot and cold packs works best for them.
A hot water bottle is ideal, but be careful with ice packs – you can use ice or a bag of frozen peas from your freezer, but never put them next to your skin (wrap them in a tea towel or cloth first). You can also buy heat and ice packs over the counter at pharmacies.
Chronic sciatica treatments
If, however, you have more persistent, long-lasting sciatica (chronic sciatica), your GP may recommend one or more treatments, such as:
Depending on the severity of your symptoms you may be prescribed stronger painkillers or muscle relaxant tablets. Your GP may also want you to try a type of antidepressant that’s thought to help with nerve pain. Certain medicines originally used to treat epilepsy are sometimes used for nerve pain too.
Injecting a corticosteroid directly into the inflamed area around the nerve is another treatment for some cases of chronic sciatica. You may also be given an injection of local anaesthetic if your GP thinks it would help.
Many experts believe physiotherapy is an effective treatment for musculoskeletal disorders such as sciatica, and may help speed up your recovery if your symptoms are taking a long time to settle down.
Cognitive behavioural therapy
Being in constant pain can affect you not just physically but emotionally too. In such cases, cognitive behavioural therapy (CBT) may help, as it can change the way you deal with pain.
Surgery to correct a problem that’s causing sciatica can also be effective, but according to the NHS it’s rarely performed.
The best way to learn how to do stretching exercises that can help relieve the symptoms of sciatica – as well as make your recovery faster – is to speak to your GP. In the meantime, here are a few recommended by the NHS that you can try yourself at home:
Sciatic mobilising stretch
Regular stretching of your hamstring muscles – the muscles in the backs of your thighs – is thought to help with most types of sciatica, since very tight hamstrings put extra pressure on your lower back:
Start by lying on your back with a small cushion or book supporting your head. Bend your knees and keep your feet flat on the floor, hip-width apart and pointing forwards.
Bring one knee towards your chest, grasping the back of your thigh with both hands. Then try to straighten your leg as much as you can, bringing your foot towards you and keeping your spine natural (don’t press your lower back into the floor). Hold for up to 30 seconds, return to the starting position and repeat on the other leg. Do two or three stretches on each leg.
Standing hamstring stretch
Another good way to keep your hamstring muscles flexible:
Stand normally in front of a step or low stool and place one leg on it. Keep that leg straight and toes pointing up.
Placing your hands on the elevated knee or thigh, lean forward slightly – or as far as is comfortable – while keeping your back straight and spine long (you should feel the stretch in the back of the thigh). Hold for up to 30 seconds, then repeat on the other leg. Do two or three stretches on each leg.
You can also do this stretch while sitting down. Sit upright on the edge of a firm chair with one knee bent, foot flat on the floor, and the other stretched in front of you, with your heel on the floor and toes pointing upwards. Then hinge at the hips and lean forward, again keeping your back straight and spine long. The more you lean forward, the deeper the stretch (only lean as far as you feel comfortable, however – it shouldn’t be painful). Hold and repeat on the other side.
This exercise stretches one of the gluteal muscles – or buttock muscles – called the piriformis muscle (the sciatic nerve passes alongside or through the piriformis muscle):
Lie on your back with a small cushion or book supporting your head. Bend your left leg and put your foot flat on the floor. Then bend your right leg and put the foot on your left leg’s thigh, near the knee.
Using both hands, grasp the back of your left thigh and pull it towards you (your foot should lift up but your tailbone should stay on the floor). If you can’t reach your hands around your thigh, use a towel (put the towel around your thigh and hold on to the towel). Your pelvis should be straight (neutral). Hold for up to 30 seconds, then repeat on the other side. Do two or three stretches on each leg.
Anyone who’s experienced the pain of sciatica knows it’s a good idea to try and make sure it doesn’t happen again. Thankfully there’s a lot you can do to reduce the chances of having another episode – try the following:
Exercising regularly isn’t just good for you when you have sciatica, it can help keep sciatica at bay when you don’t have it too. Don’t forget to keep doing your stretching exercises as they also help – try to get into the habit of stretching before and after exercising.
Sit or stand up straight
The way you sit and stand can help reduce your risk of having sciatica. For starters, stop crossing your legs, whether at the ankles or at the knees. Some experts think that constantly crossing your legs can stretch the ligaments that stabilise your pelvis, and that an unstable pelvis can cause a problem with the sciatic nerve.
Get a good chair
Sitting for long periods of time may be linked with sciatica (it can certainly make sciatica worse when you have it), so take plenty of breaks when you’re at work or while driving.
Also try to keep your posture as healthy as possible when you are sitting by choosing a seat with good lower back support. If you need to, put a cushion or rolled-up towel behind the small of your back to help your back keep it’s natural position. Try to concentrate on keeping your shoulders back when you’re sitting too.
Whenever possible keep your knees slightly higher than your hips, as this also helps to keep your spine in a good natural position (sit on a cushion if necessary).
Watch how you lift
If you have to lift heavy objects during the course of your day, make sure you use the right technique. Think about using the power in your hips and legs to do the lifting, while bending your knees and keeping your back in a neutral position. Keep the load close to your waist for as long as possible, and avoid twisting while you’re lifting, as it puts too much pressure on the discs in your lower back.
Sleep on your back or side
Some people like to sleep on their front, but it’s generally thought to be a bad idea and may even contribute to the development of arthritis of the lower back. Sleeping on your back is the best position for your spine – but if you can’t sleep on your back, sleep on your side.
Strengthen your core
Strong abdominal muscles can help protect your sciatic nerve by reducing pressure on your spine. Try to think about keeping your stomach muscles tight whenever you can, whether you’re at work or at home, sitting, standing or moving. Eventually you should be able to engage your abdominals for a good length of time – try going for a walk with your tummy muscles tightened the entire time.
Natural support for sciatica pain
As well as taking over-the-counter painkillers and applying heat and/or ice, there are a few natural supplements that may be useful when you’re having a bout of sciatica or to keep sciatica at bay.
Possibly best known as the spice that colour and flavour to curry dishes, turmeric is a widely-used remedy in the traditional Indian system of herbal medicine called Ayurveda. It contains an antioxidant compound called curcumin that’s thought to block the action of an enzyme called cyclooxygenase-2 (COX-2 speeds up the production of prostaglandins, hormones that play an important role in promoting inflammation). This may suggest that turmeric – or rather curcumin – could be useful for a variety of pain conditions.
The omega-3 fatty acids EPA and DHA found in oily fish such as salmon, sardines, pilchards, herring and mackerel are also used to relieve inflammation. Like turmeric, these omega-3 fatty acids are thought to affect the body’s production of prostaglandins. One study suggests fish oils may even be a safer alternative to conventional painkillers called NSAIDs (non-steroidal anti-inflammatory drugs) when used to treat nonsurgical back or neck pain (i).
This mineral is found naturally in the body and is needed for more than 300 different biochemical reactions, including muscle and nerve function. One animal study even suggests it may help regenerate damaged sciatic nerves, as well as reduce inflammation (ii). However, there’s evidence that many people in the UK don’t get enough magnesium in their diet (seven out of 10 women and four out of 10 men aged between 19 and 50 are getting less magnesium than they need).
B vitamins have many important functions in the body, with some being essential for keeping the nervous system healthy. Vitamin B12, for instance, is needed for normal nerve cell activity. But some people – including those who are older – have often been found to have a B12 deficiency, which may lead to nerve damage. A good-quality vitamin B complex supplement may therefore be useful to help maintain healthy nerves.
Maroon. JC, Bost. JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr:65(4):326-31.
Pan. HC, Sheu. ML, et al. Magnesium supplement promotes sciatic nerve regeneration and down-regulates inflammatory response. Magnes Res. 2011 Jun;24(2):54-70.
Disclaimer: The information presented by Nature's Best The Pharmacy is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.