Sciatica can send pain shooting down your leg and make it hard to find a comfortable way to sit, stand, or sleep. Finding relief starts with figuring out what’s irritating the nerve. A herniated disc, a spinal canal that’s become too narrow and puts pressure on the nerves, and other problems can cause the pain—and what helps one person may make another feel worse.
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.
What causes sciatica pain?
Sciatica is a symptom, not a diagnosis—a distinction that matters when you’re trying to find relief. “Everybody’s like, ‘This is what I have. I have this,’” says Dr. Allen Chen, a physical medicine and rehabilitation specialist at UCLA Health. But the term describes pain traveling down your leg, without explaining what’s causing it.
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.”
One common cause is a herniated disc. The discs that cushion the bones in your spine have a tough outer layer and a softer center—think of “a jelly donut,” Chen says. If some of that inner material pushes through the outer layer, it can press on a nerve and trigger inflammation. Sometimes people can pinpoint when things went wrong: “I was moving my kid into college,” or “I was moving a couch,” Chen says. Other times, there’s no memorable moment to blame.
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?
The best exercise for your sciatica depends on what’s causing it. “There really isn’t one exercise program that’s best for everyone,” says Dr. Keven Burns, an orthopedic spine surgeon at the Spine Institute of Arizona in Scottsdale.
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.”
If you have a herniated disc, exercises that gently bend the back backward may help—but only if moving in that direction eases your symptoms. One example is a prone press-up. “You lie on your stomach and gently push your upper body upward while keeping your hips on the floor,” Burns says. Some people find it easier to start by simply resting on their elbows. A physical therapist can help determine whether these movements are right for you and how to progress.
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.
As the pain eases, you can start working on getting stronger, too. “Your core is your internal back brace,” Burns says. That includes your back muscles and the muscles along the sides of your trunk, as well as your abs. He often recommends bridges, bird dogs, and modified planks, adjusted to what you can tolerate. “I generally prefer these stabilization exercises over traditional sit-ups or crunches, especially early in recovery,” he 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.
Is walking good for sciatica?
Often, yes—and you don’t need to turn it into a fitness project. “Everyone wants to think about, ‘OK, I gotta do some exercises or stretching,’” Burns says. “Well, just don’t stop moving. Get up and walk. Take short walks.”
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.
How far you walk, however, should depend on how you feel, Burns says. People with spinal stenosis may find that walking triggers leg pain or heaviness, so work with your clinician or physical therapist to find an amount and type of activity you can tolerate. You don’t need to finish your usual loop if your leg keeps hurting more with every step.
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.”
An exercise can also change how far down your leg the pain travels. “If pain that was previously traveling into the calf or foot begins moving back toward the buttock or lower back, that’s generally a favorable sign,” Burns says. Physical therapists call this centralization. If an exercise instead sends pain farther down your leg, it may be aggravating the nerve.
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.”
Everyday tasks can aggravate the pain, too. Chen cautions against lifting and twisting at the same time, especially with a herniated disc. Think of turning to grab your suitcase and hoisting it into an airplane’s overhead bin. Use your legs to help lift, he advises, and avoid twisting your back as you raise the bag.
Does physical therapy help sciatica?
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.
One technique they might teach you is nerve gliding, which is also called nerve flossing.
“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.
The goal of PT is to make moving more comfortable while your body recovers, Burns says. “They give you tools to cope and compensate,” he says. “But also they allow your body to get back to normal movement while your body’s healing itself.”
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?
Sitting in the same position for hours can be uncomfortable when you have sciatica, Hsu says. Try breaking up that time by standing between tasks or taking a short walk during a break. A physical therapist can also help you find ways to sit more comfortably.
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.
Foam rolling might ease surrounding muscle tightness, but there isn’t strong evidence that it directly treats sciatica, Burns says. Keep the pressure gentle, he advises, and back off if it triggers nerve pain.
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’re still in a lot of pain, your doctor might suggest an epidural steroid injection, Chen says. It puts medication near the irritated nerves to help reduce inflammation. Some people get relief for weeks or months; others don’t notice much difference. The injection doesn’t remove whatever is pressing on the nerve, though. “They don’t make the disc go away. They don’t open up the space. They don’t take pressure off of the nerve,” he says.
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.
For someone struggling to get out of bed or get through the day, that relief can make a big difference. “What surgery does offer is the ability to get better quicker,” Hsu says. Many people with a herniated disc improve without an operation, but surgery can shorten that painful wait for some patients. Results aren’t guaranteed, though—and though not everyone improves, most do, he says. A spine surgeon can help you weigh whether the likely benefits outweigh the risks.
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 symptoms aren’t improving after about six weeks of treatment, Burns often considers an MRI to help figure out what’s pressing on a nerve and what to try next. But certain symptoms mean you shouldn’t wait that long to be evaluated.
“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.
New bladder or bowel problems—like trouble starting to pee, being unable to pee, or losing control of your bladder or bowels—are also reasons to go to the ER immediately. So is new numbness around your genitals, groin, or anus. These can signal cauda equina syndrome, a rare condition in which compressed spinal nerves affect bladder and bowel function.
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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