Sciatica is a back disorder that involves the sciatic nerve—which is actually a group of nerves (the body’s longest) bound in one nerve sheath that runs from the lower back through the buttock and thigh to the knee, where it branches, and down into the foot.
When pressure is placed on this nerve, pain may be felt from the lower back to the toes. The pain from sciatica most often strikes people in their 40s and 50s, but may occur at any age.
Symptoms of Sciatica
- Pain—which can be dull or intense—that often starts in the hip or buttock and radiates down through the leg, sometimes reaching the foot. The pain is frequently only on one side, and often becomes worse at night.
- Pain may also be aggravated by laughing, sneezing, straining on the toilet, and coughing.
- Weakness and numbness in the leg
- The feeling of pricking and tingling in the legs
What Causes Sciatica?
It’s not age that causes sciatica, but probably a combination of other factors: work that requires repetitive lifting, sudden strain in lifting a heavy object, or constant exposure to mechanical vibrations (for example, long hours behind the wheel of a car or truck). Severe low-back pain, including sciatica, also shows a high correlation with job dissatisfaction and depression—though whether depression aggravates the back pain or is the result of it is hard to determine. Some studies have also suggested that cigarette smoking may be a risk factor.
You can also have sciatica without any of these risk factors. You may be a healthy, happy person who never lifts anything and yet, for no apparent reason, suffer a sudden attack when you bend or turn slightly.
Some experts blame slipped, or herniated, disks for irritating the sciatic nerve. Disks are the fibrous padding between the vertebrae; when a disk “slips,” or herniates, it bulges and can press on the sciatic nerve. Other researchers blame the piriformis muscle in the buttocks—the muscle that allows you to lift your leg sideways. If inflamed by injury or overexertion, the piriformis muscle can press against the sciatic nerve.
What If You Do Nothing?
In about half of all cases, the pain from sciatica resolves spontaneously within four weeks.
Home Remedies for Sciatica
Sciatica often improves with only the simplest self-care measures. As the pain diminishes, it’s all right to sit up and begin to move around as long as you avoid bending or any strenuous activity. Let your own discomfort level be your guide.
- Relieve the pain. You may want to try an over-the-counter NSAID—aspirin, ibuprofen, or naproxen—or acetaminophen for five to seven days.
- Rest. If the pain is severe, a day or two in bed may bring welcome relief by helping calm down an angry nerve root. Two days in bed, studies have shown, will usually do as much good as a week. Lie on a firm mattress with your unaffected side facing down and your legs slightly bent. Place a pillow or two between your knees to support the affected leg.
- Try heat. Apply a heating pad to the affected buttock. A hot bath, shower, sauna, or whirlpool may also provide some relief.
- Try cold. Apply an ice pack to the sore buttock for 15 minutes several times a day.
- Avoid heavy lifting. When your back is sore or painful, avoid lifting anything heavier than 10 pounds. When you do lift, make sure your knees are bent and that you lift with your arms, not with your back muscles, keeping the object close to your body.
- Use acupressure and acupuncture.
- Strengthen your muscles. Though poor posture is not known to cause sciatica, strong abdominal and back muscles—which can be developed through exercise—can help keep your back healthy.
- Exercise regularly. A regular exercise routine might be particularly important if your job puts you at risk for back pain.
Beyond Home Remedies: When To Call Your Doctor
Contact your physician if the pain is severe, or if it doesn’t start to improve after several days of self-care measures. In addition, contact your doctor if you develop any leg or foot numbness. This may indicate a more serious problem.
What Your Doctor Will Do
Typically, after diagnosing sciatica, the first step a physician will try is bed rest and painkillers. Your doctor may prescribe a painkiller stronger than aspirin or ibuprofen.
If you don’t get better, your doctor may need to determine whether your problem comes from a herniated disk, an inflamed piriformis muscle, or other causes. X-rays may be needed if the diagnosis is uncertain, but since they don’t show soft-tissue problems, magnetic resonance imaging (MRI) may be ordered. An MRI reveals spinal architecture accurately and in great detail, though it is usually only useful if surgery is being considered.
Surgery may be an option in some persistent cases, but it is expensive, requires a long period of recuperation, and may not produce a cure. Before you consider back surgery, you should exhaust all other forms of treatment.
If your doctor suggests surgery, always get a second opinion. Whatever the diagnosis, ask for the most conservative treatments first—rest, exercise, painkillers, and physical therapy. And be patient.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media