Many people get better without surgery. Pain from a herniated disc often eases on its own within about six weeks, though recovery can take longer. Here’s what experts recommend trying, what to avoid, and when to see a doctor.
Typically, irritation or pressure on a nerve root in the lower spine triggers the pain. It can feel burning, shooting, or electric, traveling through the buttock and down the leg, sometimes into the foot. It can also make finding a comfortable position difficult. “It bothers people at night, and it bothers people in the day,” Chen says. “It can be very, very disruptive.”
Another common cause, particularly among older adults, is spinal stenosis, or a narrowing of the space where spinal nerves travel. Arthritis and other changes over time can put pressure on those nerves, Chen says. People with this problem may be able to sit comfortably, then notice “pain or sometimes heaviness” in their legs when they walk.
What are the best exercises for sciatica?
Even mild exercise can feel unbearable when you’re in pain. For some people, sciatica is “absolutely debilitating,” Burns says. They “can’t stand, can’t move.”
People with spinal stenosis may respond to the opposite approach: bending forward. Bringing the knees toward the chest while lying on the back, or leaning forward while seated, can provide relief for some people, Burns says.
Whatever you try, don’t just assume that the routine that helped your friend will work for you. “What helps one person may actually make someone else’s symptoms worse,” Burns says.
Several short walks throughout the day can be more manageable than one long outing. The goal is to stay active without repeatedly setting off the pain. Dr. Wellington Hsu, a spine surgeon at Northwestern Medicine, also suggests considering low-impact aerobic activity, such as using an elliptical, if it feels comfortable. Running and jumping can be harder to tolerate during a flare.
Can stretching make sciatica worse?
Yes. If the back of your thigh feels tight, you might assume your hamstrings need a good stretch. But sometimes, Burns says, what feels like a tight muscle is actually tension along an irritated nerve. Patients “stretch harder, hoping to loosen things up, and end up making their leg pain worse,” he says. “More stretching doesn’t necessarily mean more improvement.”
It might be normal to feel sore after exercising, but some symptoms are a sign to stop. “A little muscle soreness during exercise is acceptable,” Burns says. “However, increasing radiating leg pain, worsening numbness, or new weakness aren’t things I want patients trying to push through.”
A physical therapist can help you figure out which exercises ease your pain—and which make it worse—and then build a routine that helps you get stronger without repeatedly irritating the nerve.
“Nerves need to move as we bend, straighten, and change positions,” Burns says. “When a nerve becomes irritated or inflamed, that movement can become uncomfortable.” A physical therapist can teach you exercises to help the nerve move more comfortably—and show you how to avoid pulling too hard.
Hsu often recommends physical therapy before other treatments, like medication or injections, because it has fewer risks. But finding a program a patient is comfortable with matters most. “If their body doesn’t feel good afterwards, they’re not going to do it,” he says.
What else helps relieve sciatica pain?
Heat or cold may provide relief, too, although people differ in which they prefer. Massage can help soothe muscle tightness or spasms around the lower back and buttocks, Burns adds.
Burns also sometimes recommends anti-inflammatory medication, such as ibuprofen or naproxen. These drugs aren’t right for everyone: Evidence of benefit for sciatica is limited, and they can cause side effects, including stomach bleeding and kidney problems.
If you’ve tried other treatments and pain is still making everyday life difficult, surgery may offer relief, Burns says. Depending on what’s pressing on the nerve, a surgeon can remove the piece of herniated disc causing the problem or create more room for the nerves.
When should you see a doctor for sciatica?
If your pain is getting worse or keeping you from your usual activities, see your doctor, Burns says. They can check your strength, sensation, and reflexes to help figure out the best treatment path.
“If someone suddenly has difficulty lifting their foot, begins tripping because of weakness, or notices their leg becoming progressively weaker, they need an urgent medical evaluation,” Burns says. Trouble lifting the front of your foot is called foot drop, which can make your toes drag as you walk. It can signal nerve compression severe enough to cause lasting weakness, he says.
For many people, getting better takes weeks to months, and the first few weeks can be especially hard. If treatment isn’t helping, let your doctor know so you can discuss what to try next. Burns doesn’t want patients to assume they simply have to live with the pain. “There is a light at the end of the tunnel, and there are treatment options.”
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