Sciatica tends to be short-lived, but sometimes it persists for years. Even simple daily activities—like bending over, sneezing, or having a bowel movement—can trigger attacks. Once the nerve has been irritated or damaged, the pain can persist even when you’re lying still. Because so many things can cause sciatica, and because the nerve can be permanently damaged without prompt treatment, it’s essential to see a doctor at the first sign of symptoms. Surgery is sometimes required, but sciatica treatment can usually be managed with a combination of medications and home care. Here are a few ways to stop sciatica pain and protect the nerve from additional harm.
Ice It Quickly
At the first sign of pain, apply a cold compress (a small bag of ice cubes wrapped in a thin cloth) to the lower back for 15 to 20 minutes at a time, every 2 to 3 hours. Keep it cold for 24 to 48 hours. Cold reduces inflammation and helps prevent painful muscle spasms, says Andrew J. Cole, MD. The easiest approach is to use a gel pack, available at sporting goods and medical supply stores. The packs remain flexible even after they’re chilled in the freezer. They mold themselves to the contours of your lower back, putting the cold right where you need it. In a pinch, you can even apply a bag of frozen vegetables. Wrap either one in a thin towel first to protect your skin.
Use A Heating Pad
After applying cold for a day or two, switch to heat, advises John J. Triano, DC, PhD. Apply a hot-water bottle or a heating pad to your lower back for 15 minutes at a time. Repeat the treatment every hour, and keep doing it as long as it seems to help. Heat relaxes muscles and helps prevent painful spasms. It also increases circulation and helps flush pain-causing toxins from around the nerve. No matter how much better heat makes you feel, don’t use it for more than 15 minutes at a time. “Applying heat for longer can result in rebound swelling, which will make the pain worse later,” says Triano.
Take Anti-Inflammatory Drugs
When you first feel the pain of sciatica, take aspirin, ibuprofen (Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs), Cole advises. They inhibit the body’s production of prostaglandins, inflammatory chemicals that increase pain and swelling. Take the medications four times daily, following label instructions. If aspirin or ibuprofen upset your stomach, it’s fine to take acetaminophen (Tylenol). But keep in mind that it mainly works as a pain reliever. It has little effect on inflammation. “I usually recommend naproxen,” says Triano. “It’s a good anti-inflammatory and is somewhat less likely than aspirin or ibuprofen to cause stomach upset.” (Here’s more tips for sciatica pain relief.)
Go For A Swim
Or simply walk in water. The combination of warm water and gentle exercise will often loosen muscles and help relieve spasms and pain. Plus, water supports the body, which may relieve painful pressure on the back. “Swimming and aquatic exercises are among the best rehabilitation tools available,” says John G. Heller, MD. It is especially effective for people who find other types of exercise initially too painful. Most health clubs offer aquatics classes, he notes, and local arthritis associations often sponsor aquatics classes at community centers or YMCAs. The movements used in the classes are perfect for those with a history of back pain or sciatica, says Heller. Swimming isn’t recommended at the peak of an attack, but it’s fine once the pain diminishes somewhat, Heller says. It’s also a good preventive strategy for those who have had sciatica in the past. (Here are more ideal sciatica exercises.)
Walk If It’s Comfortable
Walking is one of the best exercises for relieving and preventing sciatica. It keeps muscles limber and improves circulation throughout the body, including the area of the damaged nerve. If you’re in the acute stage of sciatica and walking causes sharp, stabbing pains, don’t do it, Triano says. “But if you’ve had the pain for more than a few days and it’s mainly a dull, aching feeling, it’s important to gently push through the discomfort with walking or other forms of gentle exercise.” (Here are the incredible results you get from walking daily.)
Strengthen Your Trunk Muscles
Also called the pelvic girdle, these are the muscles that surround and support the spine. “The basic crunch is a good exercise for strengthening the muscles,” says Cole. Crunches are easy to do. Lie on your back with your knees bent at about a 90-degree angle and your feet flat on the floor, your arms at your sides. Using your upper abdominal muscles, raise your head and shoulders off of the floor. Your arms should be extended out in front. Then lower your shoulders to the floor in a slow, controlled motion. You don’t want to raise your shoulders more than an inch or two, because that overstrains the muscle that links the lumbar spine to the legs and increases tension on the lower back, Cole says.
Get A Massage
It won’t reverse underlying nerve or disk damage, but it can reduce muscle spasms and increase flexibility. “Massage makes people feel better, and that can allow their rehabilitation to advance,” says Cole.
Let Your Legs Do The Work
Whether you currently have sciatica or have had it in the past, proper body mechanics—the ways you move every day—are essential. Bending from the waist, for example, is about the worst thing you can do. If you’re doing anything more strenuous than picking up a sock, kneel or squat and use your leg muscles to push back up. Bending can trigger sciatica because it puts tremendous strain on the lower back, says Cole.
Hold Things Close To Your Body
Whether you’re carrying a bag of groceries or a laundry basket, hold it as close to your body as possible, Cole advises. Holding weight close to your body takes some of the pressure off the lower spine.
Support Your Lower Back
Sciatica can take weeks or even months to improve. In the meantime, giving your back extra support—place a pillow or a rolled-up towel behind you when you’re sitting—reduces pain and helps the injured area heal more quickly, says Triano. Even better are pillows that inflate automatically with the turn of a valve. Available at sporting goods stores and stores that specialize in back care, they allow you to easily change the firmness every 15 to 20 minutes. “They’re a superb way of inexpensively minimizing back pain,” says Triano. Just don’t think of back supports as a substitute for exercise and strong supporting muscles of the back, says Heller. Such muscles derived through disciplined exercise become your internal back support.
Take Frequent Breaks
Sitting is surprisingly hard on the lower back, especially when the sciatic nerve is inflamed and irritated. In fact, sitting without a back support can put about twice as much pressure on the spine as standing. “If you have sciatica, your enemy is a prolonged, static posture,” Triano says. “The elastic properties of your tissues are used up in about 20 minutes. After that, you’re going to experience increased stress on the area.” If your job requires a lot of sitting, give your back a break and get up every 15 to 20 minutes, or whenever your back starts feeling tense or tired. Walk around for a few minutes. Stretch. Give your muscles a chance to unwind before sitting back down again. “Keep this in mind during lengthy car or plane trips, too,” notes Heller.
Put A Foot Up
The back naturally has a slight curve, but when you’re standing flat-footed, the curve is accentuated, which can aggravate a sensitive sciatic nerve. A more “relaxed” posture affords slightly more room for the nerves. “One of the best things you can do when you’re standing is to alternately prop one foot up and then the other,” says Triano. Elevating one foot slightly increases the “free” space around the sciatic nerve, and shifting from one foot to the other on a regular basis helps maintain elasticity in the spinal disks and surrounding tissues, he explains. Whenever possible, rest your foot on a short stool or a step when standing. At the grocery store, rest one foot on the lower part of the shopping cart. On the street, use a curb or the base of a lamppost. Many people with sciatica find that elevating one foot even a few inches is often enough to temporarily eliminate the pain. MORE: 12 Hip-Opening Yoga Poses
Stay Out Of The Car
Apart from the fact that most car seats are notoriously hard on the lower back, cars vibrate at four to five cycles per second—a frequency that can damage disks, increase muscle inflammation or spasms, and generally increase strain on the sciatic nerve. Until your back is better, spend as little time in the car as possible. Even when your pain is gone, it’s a good idea to limit driving time to 2 hours daily.
Try Stretching And Flexibility Exercises
They are among the best ways to reduce the inflammation and muscle spasms that often accompany sciatica, says Triano. Everyone responds differently to exercises. Some people do best with extension exercises, which include lying facedown, arching your back, and raising up on your elbows. Others require flexion movements—for example, lying on your back and bringing your knees to your chest. You’ll have to experiment a bit to discover what works best for you. “Stretching exercises encourage motion of the spine and associated joints, muscles, and ligaments, which can prevent adhesions or stiffness from scar tissue formation after an injury,” says Heller. “If the exercises make you feel better, keep doing them. But they should never make pain worse or cause it to radiate down one or both legs. If they do cause pain, it’s the wrong exercise for you and you should seek professional advice.” (More ideas for helpful sciatica stretches.)
Get Plenty Of Sleep
It’s hard to do when you’re hurting, but studies have shown that the body undergoes much of its healing during sleep. If pain is keeping you awake, try elevating your knees with a small pillow: It takes some of the pressure off the nerve, says Triano. If you usually sleep on your side, curl up and put a pillow between your knees. (Try these 20 tips to sleep better.)
If You Smoke, Try To Quit
Cigarette smoke weakens the spinal disks and slows recovery if you’re experiencing sciatica. If you need surgery for sciatica, smoking increases the risk that the operation won’t be successful. “Some surgeons won’t operate unless patients quit smoking,” says Cole.
What The Doctor Does To Treat Sciatica
Martha Howard, MD, used this exercise when she had sciatica, and it kept her sister-in-law, who’s in her seventies, pain-free for a decade. Lie on your back on a bed—if you have a firm mattress—or on the floor. Bend your knees, and place your feet flat on the bed. Slowly extend your right leg, keeping your heel down, until it has reached its full length. Your heel should slide along the surface of the bed as you extend your leg. Do not lift or raise your leg throughout the exercise. You shouldn’t feel a stretch or strain. Slowly bring your right leg back to the starting position and repeat the move with your left leg. Do 10 on each side, over time adding 2 at time to reach 30 on each side. MORE: 6 Simple Moves To Ease Sciatica
When To See A Doctor
About the only good thing concerning sciatica is that the pain is usually temporary. It often begins to feel better within 4 to 5 days, and most people will be well on the way to recovery within 6 weeks. “There’s no need to panic if you get sciatica, but it can be extraordinarily painful,” says Heller. Still, it’s important to see a doctor, he adds. For one thing, you’ll probably need medication to control the pain. You’ll also want to be sure that you aren’t risking permanent nerve damage. One of the most serious warning signs is a loss of muscle function—your foot is dragging, for example. Even more serious is a loss of bowel or bladder control. If you have any one of these symptoms, don’t wait to see your regular doctor, Heller advises. Go straight to an emergency room.
Panel Of Advisors
Andrew J. Cole, MD, is a clinical professor in the department of physical medicine and rehabilitation at the University of Washington Medical Center in Seattle and president and medical director of Northwest Spine and Sports Physicians, PC, in Bellevue, Washington. John G. Heller, MD, is a professor of orthopedics surgery at Emory University School of Medicine in Atlanta. Martha Howard, MD, is medical director of Wellness Associates of Chicago, an integrative medicine center. John J. Triano, DC, PhD, is a professor of research at the Canadian Memorial Chiropractic College and associate professor of rehabilitation science at McMaster University in Ontario, Canada. His doctorate is in spine biomechanics. He specializes in prevention, treatment, and rehabilitation of neck and back disorders.
