What's the Treatment for Sciatica?

Sciatica is pain that starts in your lower back and shoots down through your legs and sometimes into your feet. It happens when something in your body -- maybe a herniated disk or bone spur – compresses your sciatic nerve. Some people experience sharp, intense pain, and others get tingling, weakness, and numbness in their legs.

It causes pain and discomfort, but there are many effective treatments for it. Most people with sciatica don’t end up needing surgery, and about half get better within 6 weeks with only rest and medication.

So what do you need to do after your doctor makes a diagnosis of sciatica?

Nonsurgical Options

Most people with sciatica get better in a few weeks with at-home remedies. If your pain is fairly mild and it isn’t stopping you from doing your daily activities, your doctor will first recommend trying some combination of these basic solutions.

Physical therapy. A physical therapist can develop a stretching and exercise routine for you, and also help improve your posture to take pressure off the sciatic nerve.

Stretching. You can help relieve your sciatica pain with lower-back stretches.

Exercise. Inflammation can improve when you’re in motion, so short walks can be a good idea. Your physical therapist can make sure your form is correct so you don’t injure yourself any further.

Limited bed rest. Three days off your feet usually does the trick, and it’s important to be on a firm mattress or the floor. After that, it’s best to return to your normal activities.

Hot and cold packs. Apply each for several minutes on your lower back, a few times a day. Cold packs first for a few days, then heat packs.

Alternative therapies. Many people believe that alternative therapies like yoga, massage, biofeedback, and acupuncture help with sciatica.

Medicines. Your first option should be over-the-counter pain relievers. Acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin, ibuprofen, and naproxen are very helpful, but you shouldn’t use them for extended periods without talking to your doctor.

If the over-the-counter options don’t help, your doctor might prescribe stronger muscle relaxants or anti-inflammatories. Tricyclic antidepressants such as amitriptyline (Elavil) and anti-seizure medications sometimes work, too. Steroid injections directly into the irritated nerve can also provide you with limited relief.

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Surgery

When all else fails, surgery is the last resort for about 5% to 10% of people with sciatica. If you have milder sciatica but are still in pain after 3 months of resting, stretching, and taking medicine, you and your doctor probably will have to talk about surgery.

In rare cases, sciatica can cause cauda equine syndrome, a condition that makes you lose control of your bowels and bladder. That’s a straight-to-surgery situation.

The two main surgical options for sciatica are diskectomy and laminectomy.

Diskectomy. During this procedure, your surgeon removes whatever is pressing on your sciatic nerve, whether it’s a herniated disk, a bone spur, or something else. The goal is to remove only the piece that’s actually causing the sciatica, but sometimes surgeons have to remove the entire disk to fix the issue. You’ll have general anesthesia for a diskectomy, and you may be able to go home the same day.

Laminectomy. The lamina is part of the ring of bone that covers the spinal cord. During a laminectomy, your surgeon removes the lamina and any tissue pressing on the nerve that’s causing you pain. You will get general anesthesia, meaning you will not be awake during the operation, which can last up to 2 hours. You’ll be released from the hospital that day or the next with instructions to start walking around the day after you get home.

WebMD Medical Reference Reviewed by Lisa Bernstein, MD on October 14, 2016

Sources

SOURCES:

American Academy of Orthopaedic Surgeons: “Sciatica.”

Cleveland Clinic: “Diseases and Conditions: Sciatica,” “Treatments and Procedures: Laminectomy.”

Harvard Medical School: “Sciatica.”

Mayo Clinic: “Sciatica,” “Tests and Procedures: Diskectomy.”

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