Jeffrey R. Carlson, MD
In Part Two of this article series on Sciatica, I will now discuss the non-surgical treatment options I recommend for my patients.
Treatment for sciatica is focused on addressing the cause of symptoms rather than just the symptoms. Treatment is usually non-surgical, but for severe pain and dysfunction it may be advisable to consider surgery. The goal is to relieve pain and any neurological symptoms caused by a compressed nerve root.
Physical Therapy (PT) – When you work with a physical therapist for sciatica, you can expect a combination of strengthening and stretching while in the clinic. They will encourage you to participate in low impact aerobic exercise as well, such as walking or swimming. Committing to a regular program to address your sciatica will enable you to recover more quickly and you are less likely to have future episodes.
Heat/Ice – For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some find more relief with heat. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn.
Pain Relievers – Over-the-counter medications are often effective in reducing or relieving sciatica pain. Nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen), or oral steroids can reduce the inflammation that is usually part of the cause of pain.
Epidural steroid injections – If the pain is severe, an epidural steroid injection can reduce inflammation. The injection goes directly into the painful area around the sciatic nerve to address the inflammation that may be causing pain. While the effects tend to be temporary (providing pain relief for as little as one week or up to a year), and it does not work for everyone, an epidural steroid injection can be effective in relieving acute sciatic pain. Most importantly, it may provide enough relief to allow a patient to continue with a conditioning and exercise program.
Alternative Sciatica Treatment – Several alternative treatments have also been shown to provide effective sciatica pain relief for many patients. Some of the more common forms of alternative care for sciatica include chiropractic manipulation, acupuncture, cognitive behavior therapy, and massage therapy. We encourage patients to explore options and find out what works best for you.