Sciatic nerve pain: Any advice?

March 20, 2015 1:27 PM

YANMD; I am seeing my doctor about this, but I'd be grateful for any wisdom from the hivemind. For a long time, I've been fairly physically active without suffering any significant problems or injuries. I'm 38 and have been going to the gym about 3 times a week since my 20s, and I go hillwalking regularly. In January of this year, I started to experience pain and stiffness in my lower back. I went to my doctor, who referred me to a physiotherapist. After a couple of sessions with the physio, the stiffness went and I got a good range of movement back, but I started to experience much sharper pain in my right thigh, of the classic sciatic nerve variety.

I'm okay when walking, standing or lying down, but sitting for long periods and especially driving a car is causing me quite a lot of discomfort. (I have an office job and sit a lot at work, although I am able to get up and walk around as much as I need to.) After a few sessions with the physio, it's not improving much, and the physio thinks I should go back to my doctor and get a prescription for pain relief. I have tried acupuncture, although it's probably too soon to tell if that's helping or not (I only had the treatment this morning).

My questions are:
(1) Is light exercise likely to aggravate the problem or will it have no impact? Basically, can I do some light exercise without making it worse?
(2) If you've experienced this, is there anything you've found that helped, or did you have to put up with it until it went away on its own?

posted by meronym to Health & Fitness (23 answers total)

I had issues after surgery on one of the nerves in my neck. Supposedly SSRIs are very helpful in treating nerve pain. I ended up going on an SSRI for unrelated reasons but it's helped with the issues.
posted by mermily at 1:31 PM on March 20, 2015

I had TERRIBLE sciatic pain up until I started barre classes. Completely gone now, as long as I keep up with the barre. I think it's because barre really intensely works your core (abs), which improves posture and takes pressure off the sciatic nerve. I noticed improvement within a month.
posted by joan_holloway at 1:34 PM on March 20, 2015 [1 favorite]

Swimming. Start because it's the best exercise for your back; stay for no injuries; continue up until your final days.
posted by Jesse the K at 1:36 PM on March 20, 2015 [3 favorites]

Oh ouch I feel your pain, 10 years ago I battled sciatic pain for a year and now in my pregnancy I feel the odd flare up.

This is what worked for me:

My physio gave me some stretches to do at home in sets, if yours has not I recommend youtube and google to find some. This helped so much took a good month of doing it consistently to finally see a result.

Once I saw my physio again after a solid month of me doing stretches, he recommended light cardio like an elliptical, so I did it twice a day for about 15 minutes each slowly increasing as the pain got better.

Walking, even for 10 minutes helps. The worse thing you can do is sit or lie around, trust me.

Aquafit! This was great exercise, especially when everything else was so painful, you're able to do way more in the water because of the range of motion.

I would hesitate to get pain meds without trying stretching/exercising for a long period first. Sciatia sucks, it's something you have to wait out.

I've been seeing a chiropractor during my pregnancy (mostly for pregnancy related pain) and it's helped with sciatic flare ups, I recommend trying this before the pain med route as well.

Good luck!
posted by bluehermit at 1:36 PM on March 20, 2015

I had problems with pain related to sciatica and was going through the things my doctor thought may help when an unseasonably early cold snap made me change shoes which resulted in an immediate cessation of acute symptoms. The shoes I had been wearing were all open backed and something about how I walked was causing the trouble. Now I am a much more careful shoe purchaser. I do wear cute shoes, but limit them to certain occasions. Most of the time I wear shoes that support well. When ever the sciatica flairs up I realize I have been wearing less supportive shoes too often.

The pain I was having is like the pain you describe, might not be the same but worth a try.
posted by readery at 1:37 PM on March 20, 2015

Mrs. Advicepig went through this. After a few years of chiropractic visits, she finally went back to the medical model. An MRI found that she had a slipped disc that was a good candidate for a microdiscectomy. That surgery was a night and day change.
posted by advicepig at 1:52 PM on March 20, 2015 [1 favorite]

I had a couple bad bouts of sciatica. Pain meds helped me get back to normal activity, including exercise under the supervision of physical therapists. The narcotics made me nauseated and very drowsy for a couple weeks, but that went away. I haven't had any other treatment for my herniated disc, but there has been no recurrence of sciatica for some years.
posted by in278s at 2:07 PM on March 20, 2015

A relative had sciatica pain that was the result of a bulging disc that had gone untreated for 4+ years and surgery cleared it up. They had tried chiropractic visits and even epidurals (all treating the nerve and not the disc), to no avail. It seems important to rule out disc problems when sciatica persists, especially when it came after an injury of unknown cause and you weren't sedentary before. Though under three months might not be considered persistent, I would ask your doctor to check for damage.
posted by soelo at 2:11 PM on March 20, 2015

I had sciatic pain for a long time due to an undiagnosed bulging disc. My physical therapist used the McKenzie method to treat it. You can read about it in Treat Your Own Back.

The following have helped me: doing exercises from the McKenzie book religiously, exercise regularly (anything cardiovascular, long walks when my back hurt too much for vigorous exercise) and planks/core work. "Motion is lotion" is the kinda gross but very true thing my PT says. She is right.

Perhaps you need a new physical therapist/physiotherapist? Or an MRI to see what's going on as recommended by advicepig?
posted by purple_bird at 2:15 PM on March 20, 2015

38, male, above-average activity and athleticism. I had what I long assumed to be "classic" sciatica - shooting pains up and down my left leg, discomfort when sitting for long periods of time, sharpness in my left glutes - and it turned out to be a more specific issue with my piriformis. Just another consideration.
posted by mykescipark at 2:24 PM on March 20, 2015

My sciatica pain was also piriformis related. Stretching, muscle relaxants and acupuncture worked for me.
posted by kbuxton at 3:05 PM on March 20, 2015

My crippling sciatica and back pain turned out to be from a bulging disc. I had a microdiscectomy. I'm really glad I had the operation, the pain in my left leg was literally unbearable at times, and having it done made a massive difference. It really relieved the sciatic nerve pain although I still get periods of back pain and stiffness, especially after long drives.

I was advised by a PT that walking is good, but not walking on an incline as that puts pressure on the disc - I'm wondering if the hillwalking might be causing flare ups? Swimming is also good, but avoid breaststroke and stick to front crawl or backstroke. Also make sure your footwear is supportive. But I'd definitely consider an MRI to check your discs.
posted by billiebee at 3:06 PM on March 20, 2015 [1 favorite]

I'm different from everyone else. I also had classic sciatica. I went first to a doctor - helped not at all. I went to a chiropractor. She hit me with the thumpy thing alongside my spine twice, and I was fine. She said "That's thirty dollars. Start weight lifting with emphasis on strengthening your back muscles and you'll never have this problem again." It's been 19 years now and so far she's right. (I really need to get back to the weight-lifting for the back, though - I've slacked off for the past few years and had a twinge this year.)
posted by rednikki at 3:11 PM on March 20, 2015

I had bad sciatica for a while. I called me dad, who is a chiropractor in another state, and described my symptoms.

"That's sciatica. I have one question for you."

"Yes?"

"Do you keep your wallet in your back pocket?"

"Yes..."

"That's what is causing it. Move it to your front pocket."

I did and the pain was gone within a day or two. And it never came back, now that I'm a front-pocket wallet guy.
posted by tacodave at 4:15 PM on March 20, 2015

In January of this year, I started to experience pain and stiffness in my lower back. I went to my doctor, who referred me to a physiotherapist. After a couple of sessions with the physio, the stiffness went and I got a good range of movement back, but I started to experience much sharper pain in my right thigh, of the classic sciatic nerve variety.

My guess is your back locked up in the first place to protect you from sciatic nerve damage that your "range of motion" was beginning to cause, and that when your physiotherapist was able to restore your range of motion but nobody dealt with the underlying problem, the damage to your sciatic nerve proceeded unchecked, and you ended up where you are now.

I think looking for some correctable abnormality in your back as others have suggested is the way to go at this point.

If that doesn't work, or no such abnormality is to be found, you can look further afield -- I tentatively believe that clearing up a chronic sinus infection led to the resolution of my sciatica, but that's another story.
posted by jamjam at 4:38 PM on March 20, 2015 [1 favorite]

Another chiming in for sciatica caused by piriformis issues. Doing the stretches (which are an easy search away) was a miracle for me. There are a couple stretches that you can even do while sitting at an office chair during the day. Run it by your PT and see what they say.

Something else to think about, maybe it isn't sciatica. A few years ago I had awful pain after sitting and especially driving. It was hamstring tendinitis.
posted by chaoticgood at 4:51 PM on March 20, 2015

Do you carry a wallet in a back pocket?

Stop.

If you can't stop for some reason, get a second wallet of the same type for the other pocket and divide the contents between them.
posted by yohko at 5:26 PM on March 20, 2015 [1 favorite]

Former sciatica sufferer here...all fixed....

Sciatica can be relieved by adjusting the way you carry yourself. This makes sense, given that it's the result of compression on the nerve via stance and motion habits. If you can undo and correct those habits, you can eliminate the problem. And you can, though it takes time and effort.

The way I did it was via yoga. The Iyengar system (probably the most popular style) is the only one that really makes a study of this. Iyengar yoga is super didactic - a teacher will really drill you in the fine points of alignment and body mechanics, and show you ways to address the problem via basic movements, stretches, and props (e.g. belts and blocks). It's hard to get Iyengar teaching certification, so any certified Iyengar teacher will be able to help. Google for local classes, or you can try this search engine (look for the more advanced-certified teachers). Note that while there is specific help for the sciatica, simply learning correct body alignment, generally, will, in and of itself, relieve the problem. Sciatica is the result of buildup of bad alignment habits. You can seek relief via drugs, physical therapy, massage, etc, but they will all be temporary unless you undo those habits. Many doctors say they can't be unlearned. Yogis say otherwise. And the pain of sciatica is certainly helpful negative feedback for unlearning poor habits!

You may find you really like yoga, in which case, great, just keep studying. But if you're simply using it to get help with the sciatica, I'd suggest starting with a couple private lessons (if you can afford it). But even in group classes, the teacher will ask new students to recount any special physical issues, so you'll be able to ask for help on the sciatica. PM me if you want further info.

(1) Is light exercise likely to aggravate the problem or will it have no impact? Basically, can I do some light exercise without making it worse?

That's not as simple a question as it seems. Remaining sedentary may offer some relief, because postural issues will have less opportunity to aggravate the condition. But at the same time, sedentary behavior locks you into a narrower range of motion, which can compound the issue. I.e. when you're physically active, doing lots of different dynamic activities, there's a more diverse set of forces/impacts on and around the nerve, which can be good and/or bad). So until you adjust your alignment habits, you're sort of damned if you do and also if you don't. Best thing is to take control, and consciously learn not to do actions which aggravate/compress. It's possible, I promise, though it takes work.
posted by Quisp Lover at 6:09 PM on March 20, 2015 [2 favorites]

As far as I can tell from what you've written, NOBODY you've seen has yet figured out WHY you have this sciatic pain, which seems ass-backwards to me, and could make a HUGE difference in what treatments are effective and needed.

Lots of people above have mentioned some kind of spinal disc problems, which would give you one set of answers to your questions and possible treatments.

My sciatica was a result of strained muscles that eventually went into more-or-less constant spasm, plus some bad physical movement habits, like Quisp Lover mentions. So for me even light exercise just made everything worse, since I was never really giving the muscles a chance to heal.

Mild yoga was about as far as I could go, plus some yoga-like very mild exercises that my physical therapist had me do in between sessions. The main treatment was heat plus muscle relaxers plus several sessions (about an hour each) of spinal traction to get everything stretched and aligned properly. The whole process took about a month.

I think you need your doctor to make a more thorough examination to discover the true cause of your pain, and a different physical therapist.
posted by soundguy99 at 11:11 PM on March 20, 2015 [1 favorite]

I'll second soundguy99 and suggest you get more help in locating the actual source of the problem.

I used to have a lot of sciatica problems. Moving my wallet to my front pocket (mentioned above) worked wonders. When that wasn't the problem, I got relief -- immediate and lasting relief -- from acupressure. The GB 30 point did it for me. You said you had tried acupuncture, but this at-home treatment might do better for you.
posted by bryon at 3:47 AM on March 21, 2015

Hope you don't have a severe problem and can get this fixed easily with some of the suggestions above.

If not, however... My mom has fairly severe sciatica pain which is helped but not fully resolved by the various medical treatments she uses for it. For the remaining pain, she's been using a TENS device at home.

They're available without a prescription, aren't too expensive, and, despite sounding like quackery, actually seem to work -- Mom says after a 20 minute TENS session her sciatica will be better for 2-3 days.
posted by duoshao at 6:12 AM on March 21, 2015

Two pieces of advice:
1. Lower your car seat way down, so that you can sit with the non driving leg upright, so your thigh does not actually touch the seat. (This won't work, obviously, if it's the driving leg that has the pain, but works wonders if it's the other leg.)

2. Get a yoga ball, and as many times per day as you can, sit with your legs on top of it like it's a footstool.

Hope these help.
posted by wittgenstein at 9:41 AM on March 21, 2015

QuispLover's experience is like mine, though I started yoga when Anusara was in the ascendant. That school imploded but teachers who had Anusara certification are going to be competent to help you with alignment too. If you are new to yoga it is important to have teachers good enough to keep you out of trouble (you can get into it innocently).

The sciatic pain I had came from pinching the sciatic nerve with the piriformis muscle. There is even an identified "piriformis syndrome" that can cause sciatica. Getting subtle core strength and some more mobility into my hips allowed things to re-settle in some way, and the sciatic pain stays at bay when I keep my practice up.

The "blame" doesn't attach just to the piriformis. In order to have muscles, bones and organs move back to better relative positions your *whole body* has to get stronger and you have to pay attention to your alignment all the time - though it gets to be a habit after a couple years. That's about when you find that your shoes wear out differently and your preferences in furniture, monitor height and steering wheel position have changed.
posted by jet_silver at 8:00 AM on March 22, 2015