Sciatica, or sciatic nerve pain, presents as pain in the legs that result specifically from the irritation of the sciatic nerve. This usually presents as a sharp, shooting, or electrocuting pain that is felt from the lumbar (lower back) area, to behind the thigh, and radiating down below the knee.
The sciatic nerve is the body’s largest nerve, and originates from nerve roots that are found in the lumbar portion of the spinal cord, and extend through the posterior area near the buttocks, eventually winding up as nerve endings in the lower limb. Conditions such as herniation of the lumbar disc, loose bone fragments, infections, injury, and others cause the compression of the sciatic nerve, irritation and inflammation of the sciatic nerve results, leading to the symptoms of sciatica.
Most commonly, sciatica comes from a disc herniation, usually at L4-5 or L5-S1. The symptoms experienced depend on which nerve root is being pinched.
Definitive treatment of sciatica may require surgical decompression of the sciatic nerve as a last resort. This invasive option, while affording relief of symptoms in most cases, should only be considered after the failure of initial management with more conservative and non-operative options. There are always risks to surgery, and these include infection of the surgical site, localized pain and bleeding, hematoma formation, and intraoperative damage to the surrounding muscles, nerves and tissues.
Eight of the best ways to non-operatively achieve sciatica pain relief include:
1) Bed rest
One of the traditionally recommended initial management interventions for patients suffering from sciatica includes bed rest. This relieves the irritation of the sciatic nerve, providing relief from symptoms. Bed rest should only be performed for 48 hours, as longer than that can present more problems than help.
2) Prevention and Lifestyle modification
Certain behaviors and activities may be identified as trigger factors for sciatica pain. If you are able to identify specific activities that trigger, or aggravate, the pain of sciatica, you can achieve pain relief by simply avoiding these triggers. Obesity is a known trigger, and weight loss and exercise has been shown to reduce risk for the condition.
3) Chiropractic Manipulations
Chiropractors can perform manipulations that may decompress the pinched nerve. Treatment may be able to provide significant relief and help patients avoid surgery.
4) Spinal Decompression Therapy
Spinal decompression treatment involves intermittent traction and can help trick the muscles into not going into spasm. The treatment may provide months of relief and has been shown to work well over 85% of the time.
Recent studies have shown the effectiveness of acupuncture and alternative medications in the treatment of chronic pain conditions, particularly those involving pain from the nerves. Treatment with acupuncture will not interfere with the metabolism of other medications, but be sure to consult with your physician and acupuncturist first.
6) Physical Therapy
Physical therapy can strengthen the muscles and leg, leading to greater stability. This may relieve the sciatic nerve from the pressure. Additionally, PT may involve electrical stimulation, ice, heat and ultrasound.
7) Oral Medications
Oral medications such as NSAIDs and opioid medications have been proven to reduce the severity of pain, particularly from mild to moderate cases. Severe cases still need to be assessed by a physician prior to operation. Other medications for neuropathic pain, such as pregabalin, have been used with great effectiveness.
8) Anesthetic/Corticosteroid injection
The injection of anesthetic or a corticosteroid into the area near the sciatic nerve interferes with the transmission of pain signals, providing relief of pain symptoms. Epidural steroid injections have been shown to work well over 75% of the time. A series of injections may be necessary for optimal relief, and this series can be repeated every few months as necessary.