Sciatica: treatment
Sciatica is the name for a syndrome which is characterised by pain that radiates along the path of the sciatic nerve. The sciatic nerve is the longest and largest nerve in the body — it is as thick as one of your fingers where it arises in the lower spine. It then travels from your lower back through your hip and buttock and down your leg where it divides into two branches at the knee. Each leg has its own sciatic nerve.
How is sciatica treated?
Most sciatica gets better within a few weeks and doesn't result in permanent damage. If your pain doesn't go away after a couple of weeks, see your doctor. If you lose control of your bladder or bowels, or you have severe pain, weakness of your muscles or numbness, seek medical attention immediately.
Pain control
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, may be useful in reducing inflammation, however, if the sciatica is due to a herniated disk then studies seem to show that NSAIDs are no better than placebo (a dummy treatment). Paracetamol and other pain relievers may help to reduce back pain in the short term and help you keep active.
Stay active
Once pain has been controlled, your doctor may recommend physical therapy or an exercise programme to strengthen your back or improve your posture. Physical therapy is important if you have a herniated disk. Doctors now know that prolonged bed rest isn't a good idea for sciatica and lower back pain, and will generally worsen the problem. A couple of days of rest at the beginning may be necessary, but any longer than that and the muscles that support the spine will start to weaken. Maintaining activity has been shown to provide a beneficial effect on pain, the rate of recovery from low back pain, and function, compared with bed rest.
Epidural steroid injections
Cortisone injections may be used to treat sciatica by helping to suppress inflammation around the irritated nerve. However, the evidence to support the effectiveness of steroid injections is conflicting.
Surgery
In severe cases, spinal surgery may be necessary to make more room in the spinal canal for the nerves. Chemonucleolysis is an operation that involves an enzyme being injected into a herniated disk to dissolve the leaking soft centre of the disc. A partial discectomy is an operation done through a small incision in the back to remove part of a herniated disk that's pressing on a nerve. A laminectomy involves spinal surgery to remove the lamina and sometimes part of the facet joint in order to make more room for the nerve roots.
Stretching and strengthening
Gentle passive stretching exercises may help to relieve compression in the spine. Many of the exercises focus on strengthening the muscles which support the spine. However, note that suitable stretches for sciatica differ depending on the cause of the sciatica. For example, there are specific stretching exercises which are almost always necessary to relieve piriformis syndrome and these differ from the stretches to ease sciatica caused by spinal stenosis. Exercises such as pilates are useful to correct poor muscle tone and posture and improve core strength and stability. Pilates can often improve back pain and also help to prevent future episodes.
Massage
There doesn't appear to be any scientific evidence regarding massage as a treatment for sciatica, but some people have found it helpful, for example in releasing muscles that have gone into spasm.
Osteopathy
People with sciatica commonly consult osteopaths to deal with their condition and some people find it helpful to alleviate their symptoms. In terms of scientific studies, most studies to date have looked at osteopathy to treat low back pain in general, not specifically sciatica, so the evidence supporting its use in sciatica is not abundant. However, some doctors do recommend consulting an osteopath or physiotherapist to relieve the pain of sciatica and to undertake a programme to strengthen and condition the lower back.
Physiotherapy
Your doctor may refer you to a physiotherapist for an exercise prescription to strengthen and stabilise your back, and also for help in relieving the pain of sciatica.
Spinal manipulation
The evidence is not clear whether spinal manipulation, such as that carried out by chiropracters, is useful in treating sciatica. Doctors are concerned, however, that there is a possibility of doing further damage to herniated disks by manipulating the spine. In addition, people who have osteoporosis or rheumatoid arthritis should avoid spinal manipulation.
Acupuncture
Acupuncture is the insertion of fine needles into the skin at traditional acupuncture points which are believed to sit on meridians which run through the body. At present there is not enough evidence to recommend acupuncture in the treatment of sciatica, although some people do gain relief. The lack of evidence may be due to the difficulty in conducting trials into the effectiveness of acupuncture. Because acupuncture involves the insertion of needles into the body it is difficult to compare it with a dummy treatment. Acupuncture is usually compared with dummy acupuncture which uses non-traditional acupuncture points, however, some people believe that any needling has a beneficial effect on the body.
Heat or ice packs
There does not seem to be any definitive evidence supporting the use of heat or ice packs in the treatment of sciatica.
TENS — Transcutaneous Electrical Nerve Stimulation
TENS is a treatment that uses low voltage electrical currents to relieve pain. More scientific evidence is needed to show if TENS is an effective treatment for sciatica, however, one 1999 study found that TENS was significantly more effective than sham treatments in decreasing pain scores in sciatica.
PENS — Percutaneous Electrical Nerve Stimulation
PENS is similar to TENS, but with PENS the electrical stimulation is passed through the skin into the soft tissue using probes similar to acupuncture needles. Again, there isn't enough scientific evidence to state that PENS is an effective pain relief for sciatica. However, in the 1999 study mentioned above, PENS was also significantly more effective than sham treatments in decreasing pain scores in sciatica and PENS was significantly more effective than TENS in improving physical activity and quality of sleep. In addition, 71 per cent of the patients stated that they would be willing to pay extra to receive PENS therapy.
Last Reviewed: 30 June 2008
