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.

One way to find out if you have sciatica is to do the passive straight leg raise test – also called the Lasegue test – which involves lying on your back with your legs straight and having someone lift one of your legs at a time. If having one of your legs lifted is painful, it usually indicates that you have sciatica (i).

What causes it?

While sciatica usually causes pain in the buttocks and legs, the cause usually originates with a problem in the back that compresses one or more nerve roots in the lumbosacral spine. 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 (ii).

Also known as prolapsed or herniated discs, slipped discs are thought to affect twice as many men as women, and most often develop between the ages of 30 and 50 years (iii). 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:

• Spinal stenosis
  This is a narrowing of a part of your spine called the spinal canal, which is where the nerves pass through.

• Spondylolisthesis
  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. Discover more on Ankylosing Spondylitis causes and treatments

• Infection
  Infections such as discitis, vertebral osteomyelitis and spinal epidural abscesses can cause sciatica, but this is rare.

• 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.

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 (iv). And according to the British Association of Spine surgeons, if an episode of sciatica settles there’s about a 90 per cent change it won’t happen again in the next 10 years (v).

In the meantime there are lots of things you can do yourself to relieve your symptoms until things get better. These include the following:

Physical activity

Doctors these days advise against bed rest for back pain and sciatica (vi). 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. Regular exercise may also reduce the risk of sciatica, or at least delay it, says the British Association of Spine surgeons (v).

Also see below for some examples of specific stretching exercises you could do to help reduce and speed up the recovery of sciatica pain.

Over-the-counter painkillers

Non-prescription anti-inflammatory medicines such as ibuprofen may help if you need pain relief, though doctors believe another popular pharmacy painkiller, paracetamol, may not be effective for sciatica when taken on its own (vi). Ibuprofen is available over the counter at pharmacies.

Heat packs

Using heat packs can be useful, particularly when your symptoms start. Apply one to the painful area for about 15 - 20 minutes and repeat every two hours. A hot water bottle is ideal, but you can also buy heat over the counter at pharmacies

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:

Prescription medicines

Depending on the severity of your symptoms you may be prescribed stronger painkillers or muscle relaxant tablets to treat muscle spasms, such as diazepam. Your GP may also suggest you try a medicine that helps with nerve pain.

Steroid injections

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.

Physiotherapy

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

Surgery to correct a problem that’s causing sciatica can also be effective, but it’s only performed if non-surgical treatments haven’t worked and your symptoms are affecting your quality of life.

Sciatica stretches

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 (vii):

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:

1. 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.

2. 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:

1. Stand normally in front of a step or low stool and place one leg on it. Keep that leg straight and toes pointing up.

2. 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.

Glute stretch

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):

1. 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.

2. 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.

Preventing sciatica

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:

Stay active

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.

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.

Turmeric

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, with studies suggesting they may be effective painkillers without the side effects of anti-inflammatory drugs (viii).

Fish oils

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 (ix).

If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3, which is sourced from plant organisms called microalgae rather than fish oils.

 

Magnesium

This mineral is found naturally in the body and is needed for more than 300 different biochemical reactions, including muscle and nerve function. It is thought that many people in the UK don’t get enough magnesium in their diet. There’s also evidence that low magnesium levels may cause chronic inflammatory stress (x).

B complex

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.
 

PEA

Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xi), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xii) with no known side effects (xi).

Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xi). When this happens, PEA supplements may be helpful. In fact a review of clinical trials evaluating PEA as a means of relieving the pain of nerve compression syndromes including sciatica found it was both effective and safe, and should be considered as a treatment option (xiii).

Managing sciatica can be difficult and at times frustrating, but these steps should help to ease the symptoms a little. For more articles like this, why not visit our health library?

 

References:

1. Available online: https://www.ncbi.nlm.nih.gov/books/NBK539717/

2. Available online: https://www.nhs.uk/conditions/sciatica/

3. Available online: https://patient.info/bones-joints-muscles/back-and-spine-pain/slipped-disc-prolapsed-disc

4. Available online: https://www.nrshealthcare.co.uk/articles/condition/sciatica

5. Available online: http://www.spinesurgeons.ac.uk/patients-area/patient-information/nerve-root-pain-treatment-options/

6. Available online: https://patient.info/doctor/low-back-pain-and-sciatica

7. Available online: https://www.nhs.uk/live-well/exercise/exercises-for-sciatica/

8. Lakhan. SE, Ford. CT, Tepper. D. Zingiberaceae extracts for pain: a systematic review and meta-analysis. Nutr J. 2015 May 14;14:50.Available online: https://www.ncbi.nlm.nih.gov/pubmed/25972154

9. 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. Yan Y. et al., Omega-3 fatty acids prevent inflammation and metabolic disorder through inhibition of NLRP3 inflammasome activation. Immunity. 2013 Jun 27;38(6):1154-63. Available online: https://www.ncbi.nlm.nih.gov/pubmed/23809162

10. Nielsen FH. et al., Effects of magnesium depletion on inflammation in chronic disease. Curr Opin Clin Nutr Metab Care. 2014 Nov;17(6):525-30. Available online: https://www.ncbi.nlm.nih.gov/pubmed/25023192

11. Clayton P. et al., Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci. 2021 May;22(10): 5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/

12. Clayton P. et al., Palmitoylethanolamide: A Potential Alternative to Cannabidiol. J Diet Suppl. 2021 Nov;28;1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733

13. Keppel Hesselink . JM., Kopsy DJ., Palmitoylethanolamide, a neutraceutical, in nerve compression syndromes: efficacy and safety in sciatic pain and carpal tunnel syndrome. J Pain Res. 2015;8: 729–734. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631430/

 

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Disclaimer: The information presented by Nature's Best 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.

 

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