Ryan Smith was 23 when he felt a pop in his back while performing a heavy dead lift at the gym. That pop led to an immediate, radiating pain from his spine all the way down the back of his leg and into his foot. A physical therapy student at the time, he quickly recognized it as a possible sign of sciatica.
“The pain was debilitating,” said Dr. Smith, now a physical therapist in Maryland. “I couldn’t sit, I couldn’t drive long distances, and I had to stop exercising. All my P.T. common sense went out the window, and I began throwing everything at it, because I needed relief.”
Sciatica is pain resulting from irritation or injury to the sciatic nerves that start in your lower back and branch down your legs. The pain is often accompanied by a burning or pins-and-needles sensation.
An estimated 13 to 40 percent of the population will experience sciatica in their lives, most often during their 30s, 40s or 50s. The most common cause is a herniated disc, a condition that actually becomes less frequent as you age.
Unlike with muscles or other soft tissues, there is no consistent way to prevent nerve injury. But there are steps you can take to jump-start the healing process after you experience it.
Identifying sciatica
Sciatica has some unique distinctions from other back, butt or leg pain and only affects 5 to 10 percent of people who suffer from lower back pain.
“People often use the term to describe almost any pain traveling down the leg,” said Amy Benton, a physical therapist in Portland, Ore. But true sciatica starts from the bottom of the lumbar spine, just above the gluteal muscles and usually radiates past the knee.
When the pain stays above the knee, it might feel like sciatica, Dr. Smith said, but it usually isn’t.
How to find relief
There’s no easy fix for sciatic pain, and the best healer is time. What eases one person’s pain might not work for the next. Whereas muscles, tendons or ligaments respond well to rehabilitative exercises, the evidence for physical therapy’s effectiveness on sciatica is mixed.
Still, it’s important to find ways to move.
“The worst thing you can do is to keep limiting your life and activity,” said Tom Jesson, a Houston-based physical therapist and author of “Understanding Sciatica.” “If you can tolerate the pain, keep moving as much as possible.”
Most experts agree that gentle exercise, like walking and swimming, is the best place to start. “This will get blood flowing around the tissues and the nerve pathway,” said Dr. Benton, who also recommends gentle massage or manual therapy.
Avoid stretching your back in the early stages, especially bending forward. It might seem like a logical way to get relief, but it can aggravate the nerve even more. Likewise, said Dr. Benton, don’t massage the space around the nerve in your back with a tennis ball or similar object, and don’t twist through the lower back while carrying weight.
There are a few targeted exercises that can help once the pain has calmed down, usually after the first couple of weeks.
Pain relieving exercises
Doing a prone press-up, which is a gentle version of a cobra pose, can ease nerve pain. Lie face down on the floor with your palms on the floor parallel to your chest. Gently press up, lifting your upper body off the floor but keeping your hands and hips on the floor. Hold for a couple of seconds, then release back to the floor. Repeat this 10 times.
Nerve flossing
Another option is nerve flossing, which gently slides the nerve within its sheath and can help alleviate short-term pain.
There are several flossing techniques for sciatic pain. These are not muscle stretches, so be gentle and focus on ease of movement. One common variation: Lie on the floor with your knees bent, feet on the floor. Place both hands behind the knee on the affected leg, and pull it toward your chest, with your chin tucked. Hold for about five seconds and then slowly lower the foot back to the starting position. Try once or twice a day for 10 to 20 repetitions, but stop immediately if pain increases.
Moving forward
Exercises and physical therapy can help sciatica, but repair still takes time. “When you compare healing time to something like a calf strain, you’re in for a much longer process,” said Dr. Smith.
Most people will begin to feel some pain relief after the first two to four weeks, Dr. Jesson said, and more in the first three months. For some, sciatic pain can linger a year or more. Progress often isn’t linear, and you should expect occasional flare-ups.
In Dr. Smith’s case, that initial pop was a herniated disc. The most severe pain lasted for only a few weeks, but it was three full years before he returned to his regular strength training.
While there’s no foolproof method for preventing sciatic pain, core stability exercises may help, as does keeping your cardiovascular system healthy. Dr. Benton recommends her patients work with a physical therapist or trainer to check their form on major movement patterns, like squats, dead lifts, pull-ups and push-ups.
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