Introduction to sciatica

Sciatica, or pain along the sciatic nerve and in the lower back, can be overwhelming. It can send shooting or burning pain from the lower back, into the hip, and all the way to the feet. It hurts to sit, to walk, and even to lie in bed.

Sciatic pain can be caused by damaged discs, inflamed tissues surrounding the nerve, and a chronically tight piriformis muscle that compresses the nerve. Long-term compression can lead to nerve damage, so it’s best to treat this early.

Once you have found the cause of your back pain, you can use the right natural treatments to find pain relief.

Personal experience

I was diagnosed with sciatica when I was 11 years old, after having extreme pain trying to jump hurdles during my usual little athletics.

Althoough, much later, in my 40s, I was diagnosed with undifferentiated spondyloarthritis, which they now believe was the original cause of the sciatic inflammation - and indeed, most of the inflammatory problems I have had throughout my life.

Note: I am not a doctor or physical therapist, although I have had chronic sciatica since I was a young teenager. I understand the frustrations when searching for pain relief.

Please see your doctor to identify the actual cause of your pain, and determine which of the following treatments are appropriate for you.

What is sciatica?

Sciatica occurs when the sciatic nerve is compressed due to inflammation or physical damage. It can occur on one side only, or on both sides, and may cause numbness and weakness in addition to muscle and joint pain.

Sciatica can have a number of causes:

• bulging or herniated disc
• narrowing of the spinal column
• inflammation of the soft tissues in the surrounding areas
• short or spasming piriformis muscle in the buttock (piriformis syndrome)

Over 80% of people in industrialized countries will have lower back pain during their life. This is one of the greatest causes of employees being unable to work. Most acute sciatic pain cases recover within 6 weeks, however a small number develop chronic sciatica.

A standard western medical treatment for back pain is paracetamol or low-dose non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. However, they highly recommend that you keep moving, gently: no bed rest.

Medications commonly prescribed for sciatica work to calm the pain and inflammation in the short term, but they don’t stop it from recurring.

Diagnosing sciatica

This is yet another condition which is diagnosed by elimination, though the pinched nerve and/or inflammation may show in xrays or CAT scans of the lower back. Usually inflammation can be detected by physically probing the are (though it is usually too painful!)

A bone scan may show inflammation around the lower back, and will detect if sciatica is caused by a bulging disc or spine deterioration.

Natural relief for sciatic pain

Many natural and physical therapies, and simple lifestyle changes, can provide pain relief and prevent it from returning.

• A healthy diet improves your body’s ability to heal. Use citrus fruits and juices, such as lime juice - vitamin C boosts your immune system, prevents serious illnesses, and reduces the swelling around the nerve.
• Proper posture, healthy weight, ergonomic working environments and an active lifestyle all play important roles in treating and preventing pain.
• Physiotherapy exercises may help recover and maintain range of movement in the spine and hips, and prevent the pain from recurring.
• Relaxation techniques help you manage and reduce the psychological impact of chronic pain.

Relaxing the muscles around the irritated nerve

Rest at regular intervals, in postures chosen to relieve pain. Intentionally relax all the muscles in your body in these positions:

1. Lay on your stomach with a pillow or rolled towel underneath your hips.
2. Lay on your stomach with one leg bent and out to one side - the first aid recovery pose. Put a pillow under the knee to remove any strain on your back.
3. My favorite: Lay on your back with a pillow under your head. Rest your feet on a chair so that your knees are bent and your lower back is flat against the floor.

Heat, ice, and massage

• Ice: If you have acute pain after an injury, apply ice to the lower back for 10 minutes every few hours. Ice reduces inflammation and provides temporary pain relief in the first few days after your injury.
• Heat: If you have longer-term pain, apply heat to the lower back and hips to encourage circulation and tissue repair, relax the surrounding muscles and reduce pain. A hot bath or shower relaxes the muscles and calms the nerve.
• Menthol-and capsaicin-based sports rubs or plasters may provide short term relief of chronic back pain.
• Massage and spinal manipulation may provide some short term relief, but should only be performed on sciatica patients by qualified and experienced practitioners.
• Ultrasound therapy performed by trained physiotherapists can also help warm and relax the tendons and muscles around the sciatic nerve.

Gentle movement

• Staying active has been shown time and time again, to have better results than bed rest for back pain. Staying in one position or doing one activity for a long time makes back pain worse. Take regular breaks and move around.

• Walking gently with good posture can provide pain relief from acute back pain. When my sciatic flares: I stop, gently stretch my hamstrings, do some gentle standing twists, forward bends, and lightly massage the sore areas. I can then keep walking carefully until I get home to my trusty heat pack.

See also this post about exercise therapies spcecifically for sciatic pain

Posture, ergonomics and body position

• Correct posture and ergonomics: Use a balanced posture in all activities to prevent pain.
• Walking and standing: Use smooth, gentle and relaxed movements - tense muscles increase the pain. Stand tall, and make sure your lower back is not curved. Keep your buttocks tucked in.
• Carrying: Never carry a bag on one shoulder, or all the shopping bags in one hand. Distribute weight evenly on both shoulders, and in both hands. Use backpacks, not shoulder bags. My doctor and physiotherapist believe that my heavy, single-shoulder school bag was a trigger for the sciatica starting in my teens. I wish my school had allowed backpacks!
• Lifting, reaching, bending, and twisting: Avoid heavy lifting if possible. If you must lift something, don’t bend over or twist your back. Use your knees to lift and your feet to turn. Avoid twisting when reaching for something above your head or below your waist. Try not to pick up children. Kneel down if you need to reach something low.
• Sitting: Use a chair which supports your lower back. Position your knees at the same level as your hips, with your feet flat on the ground. A lower back pillow, or rolled towel will support your lower back. Use the arms of the chair to help you sit or stand.
  Note: Constantly sitting tightens the piriformis muscle. Get up and stretch regularly. I prefer to sit with my feet up, sometimes with a towel or pillow under my knees.
• Driving: Avoid driving when the pain is severe. Use a pillow or lumbar roll to support the lower back and maintain a correct sitting posture.
• Sleeping: A firm mattress with one supportive pillow under your head encourages good sleeping posture. An extra, soft pillow between the knees may provide sciatic relief. Be careful not to twist or place strain on your back when getting into or out of bed.

Unproven therapies for sciatica

Many therapies have been suggested for sciatic pain, but few have been proven to work scientifically.

Acupuncture, acupressure, herbs, TENS, ultrasound, and traction have had mixed or poor results in studies, and are not usually recommended by doctors. Most of these physical therapies aren’t likely to worsen your condition, but check with your doctor before trying one.

If you do find an alternative therapy that does provide relief, then continue to use it! Be aware that herbs (both eastern and western) are processed in your body. Make sure the ingredients are not dangerous to your kidneys, liver, stomach, and that you aren’t allergic to anything.

Avoid back braces—they have longer-term drawbacks, such as encouraging poor posture and weakening muscles.