Sciatica FAQs about treatment and approaches

By Donell Irungo

The pain and other symptoms caused by sciatica can be debilitating. Here we answer some key questions about treatments and possible adjustments that may help you cope and recover from sciatic nerve pain.

Best immediate relief for sciatica Rest or exercise with sciatic pain What to avoid doing with sciatica Lift correctly to avoid making sciatica worse Top 3 exercises for sciatica Reduce the risk of sciatica in pregnancy Using a back brace for sciatica A physio, chiropractor, or osteopath best for sciatica treatment

What’s the best immediate relief for sciatica?

For immediate relief:

Apply ice packs. This can help reduce inflammation. However, note that sciatica typically involves deep nerve pain rather than superficial inflammation, so while ice may help with some pain relief, it may not address the deeper nerve pain directly.

Take over-the-counter pain medications. These can help manage the pain but should be used as part of a broader pain management strategy.

Gentle movement. Engaging in gentle movement can help alleviate nerve pressure and prevent stiffness.

Should you rest or exercise with sciatica pain?

Although it might seem like resting is the best option, too much rest can make sciatica worse. While rest is important during severe flare-ups or immediately after an injury, it’s crucial to begin gentle activity as soon as possible to prevent muscle weakness and stiffness, which can make your symptoms more severe.

It’s important to take a balanced approach to movement. Here are some tips:

Start with gentle activity: Instead of complete rest, modulate your activity levels. Engage in gentle, guided exercises that improve flexibility and strengthen the muscles supporting the spine. This can help alleviate pressure on the sciatic nerve without causing further irritation. Try walking and gentle stretching.
Get to understand your pain: Understanding your pain and how it works is crucial. Pain does not always mean harm. By learning about pain, you can reduce the fear you may have of doing certain movements and avoid the common trap of becoming less and less active due to pain. Fear of movement can be a significant barrier to recovery. A physio can help you understand more about your condition, the pain and how to engage in safe, controlled exercises.
Don’t hold your breath: When doing exercises, it's essential to focus on steady, rhythmic breathing to maintain your stability and reduce strain and resistance to movement. Avoid holding your breath, as this can increase pressure in your abdomen and strain the spine. Focus on breathing steadily and calmly as you move.
Return to your normal movement and sleeping positions as soon as you can: As your pain improves, it’s important to return to normal movement patterns and sleeping positions. If you keep avoiding movement or adopt an overly protective posture, this can hinder your recovery because temporary coping strategies become long-term habits. For instance, avoiding a movement entirely due to fear of pain can lead to muscle atrophy and increased pain sensitivity. The goal should be to gradually return to normal activities as pain the decreases.

What should you avoid doing with sciatica?

Certain activities can exacerbate sciatica pain, but the duration of avoidance and the correct techniques are key:

Activities to avoid: Activities that aggravate sciatica pain include prolonged sitting, heavy lifting, and high-impact exercises. Avoid these during the acute phase of the condition.

How long should you avoid these activities? As your symptoms improve, you can gradually reintroduce these activities. Before you do, it can help to run through these activities with a physiotherapist. They can check if you are compensating for any muscle weakness or overloading a particular parts of your body when you do them, which could be aggravating your sciatica or causing back pain.

How do you lift things correctly to avoid making sciatica worse?

Using your back instead of your legs to lift things, twisting while lifting, or lifting objects that are heavy, all put extra stress on the spine and can worsen sciatica.

Correct lifting for heavy objects involves bending at the knees to reach down for the object, holding the object close to your body and pushing through your legs to return to standing up straight.

It’s not just about the technique when lifting heavy objects, but also about avoiding overloading the muscles, which can lead to strains. That’s why it’s important to always lift within your capacity and ask for help lifting objects that are beyond it.

For picking up light objects, it’s absolutely fine to bend from your hips and use your back muscles to initiate returning to standing up straight.

Top 3 exercises for sciatica

Instead of focusing on stretches, here are three exercises you can start with that can improve mobility in the trunk and posterior aspect of the legs without irritating the sciatic nerve through prolonged holding:

1. Cat-Cow Stretch (Dynamic Mobility): This gentle movement helps mobilise the spine and pelvis and improve flexibility without putting undue stress on the sciatic nerve. It involves arching and rounding the back in a controlled manner, promoting spinal and pelvic mobility.

2. Pelvic Tilts: This exercise strengthens the lower back and abdominal muscles while improving the flexibility of the lower spine. It involves gently tilting the pelvis forward and backward while lying on your back, helping to relieve pressure on the sciatic nerve.

3. Bridging: This exercise strengthens the gluteals and lower back muscles. Lying on your back with your knees bent, lift your hips towards the ceiling, hold for a few seconds, and then lower them back down. This exercise supports the spine and reduces pressure on the sciatic nerve without prolonged holding.

How can you reduce the risk or pain of sciatica in pregnancy?

Pregnancy can increase the risk of sciatica due to added weight and pressure on the spine and pelvic region, as well as hormonal changes that loosen ligaments. To reduce the likelihood of developing sciatica or to manage sciatica during pregnancy:

Maintain good posture: As your baby gets larger, your pelvis can tilt forward causing you to place more strain on your back and pelvis. By trying to reduce this tilt in your pelvis you can maintain a more natural posture. Avoid standing for long periods, and when sitting, use a chair with good support to help with this.
Do regular exercise: Gentle exercises, such as walking, swimming, and prenatal yoga, can strengthen the muscles supporting the spine and improve flexibility, reducing pressure on the sciatic nerve.
Stay active: Avoid prolonged bed rest unless medically advised. Keeping active helps maintain muscle tone and prevents stiffness.
Use support: Maternity belts can support the lower back and abdomen, alleviating some of the pressure on the spine and pelvis.
Seek physiotherapy: A women’s health physiotherapist can provide specific exercises and treatments tailored for pregnancy.

Can a back brace help sciatica?

A back brace can provide temporary support and relief by stabilising the lower back and reducing pressure on the sciatic nerve. However, it should be used alongside other treatments and not as a sole solution.

Over-reliance on a back brace can lead to muscle weaknesses and stiffness because it immobilises the back and reduces the need to use your muscles. It’s essential to use a back brace as part of a broader treatment plan that includes exercise and mobilisation to maintain muscle strength and flexibility.

Is a physio, chiropractor, or osteopath best for treating sciatica?

Choosing between physiotherapy, chiropractic care, or osteopathy to treat sciatica depends on your individual preferences and symptoms.

Physiotherapists focus on exercises and manual therapy for pain relief and rehabilitation, chiropractors on spinal adjustments, and osteopaths on a holistic approach to musculoskeletal health. A combination of care from the above health professionals can also be beneficial.

Learn more about the symptoms and causes of sciatica and what physiotherapy for sciatica involves.