What should you do first if you have sciatica?
Apply ice for the first 48-72 hours, then switch to heat. Take over-the-counter anti-inflammatory medication like ibuprofen, and avoid prolonged sitting or bed rest.
The first step is managing acute pain while keeping the body moving. Complete bed rest was once standard advice but is now discouraged — studies show that staying moderately active leads to faster recovery than bed rest. Gentle movement prevents muscle stiffness and promotes healing.
Over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) or naproxen can reduce inflammation around the compressed nerve root. If pain is severe, your doctor may prescribe a short course of oral corticosteroids or muscle relaxants.
- Ice packs for 15-20 minutes several times daily during the first 72 hours
- Switch to heat therapy after initial inflammation subsides
- Gentle walking for 10-15 minutes several times a day
- Avoid heavy lifting, twisting, and prolonged sitting
What is sciatica and what does it feel like?
Sciatica is pain that radiates along the path of the sciatic nerve — from the lower back through the buttock and down the back of the leg. It typically affects only one side of the body.
The sciatic nerve is the longest and thickest nerve in the body, running from the lower spine through the buttock and down each leg. When this nerve is compressed or irritated, it causes pain that can range from a mild ache to sharp, burning, or excruciating discomfort. Some people describe it as an electric shock sensation.
Common symptoms include shooting pain that worsens with sitting, numbness or tingling in the leg or foot, weakness in the affected leg, and pain that makes standing up difficult. The pain typically follows a specific path along the nerve — from the lower back through the buttock and down the outer or back of the leg.
What causes sciatica?
The most common cause is a herniated lumbar disc pressing on the sciatic nerve root. Spinal stenosis, degenerative disc disease, spondylolisthesis, and piriformis syndrome are other frequent causes.
Herniated discs account for approximately 90% of sciatica cases (Source: American Academy of Orthopaedic Surgeons). When the soft inner material of a spinal disc pushes through the outer ring, it can compress nearby nerve roots. The L4-L5 and L5-S1 disc levels are most commonly affected.
Risk factors include age (most common between 30-50), obesity, prolonged sitting, diabetes (which increases nerve damage risk), and occupations requiring heavy lifting or prolonged driving. Smoking reduces blood supply to spinal discs, accelerating degeneration.
- Herniated disc — 90% of cases, most common at L4-L5 and L5-S1
- Spinal stenosis — narrowing of the spinal canal, common after age 60
- Piriformis syndrome — muscle in the buttock compresses the nerve
- Spondylolisthesis — one vertebra slips over another
- Degenerative disc disease — age-related disc breakdown
How is sciatica diagnosed?
Diagnosis typically involves a physical exam including the straight-leg raise test. MRI is the gold standard imaging study if symptoms persist beyond 4-6 weeks or if red flag symptoms are present.
Your doctor will perform a neurological examination testing reflexes, muscle strength, and sensation in the affected leg. The straight-leg raise test — where the doctor lifts your extended leg while you lie flat — is positive if it reproduces your sciatic pain between 30 and 70 degrees of elevation.
Imaging is not routinely needed for initial episodes. MRI is ordered if symptoms persist beyond 6 weeks, if neurological deficits are worsening, or if surgery is being considered. MRI shows soft tissue detail including disc herniations, nerve compression, and spinal stenosis with high sensitivity.
What are the best treatments for sciatica?
Physical therapy is the cornerstone of sciatica treatment. Most people improve within 4-6 weeks with a combination of targeted exercises, anti-inflammatory medication, and activity modification.
Physical therapy focuses on core stabilization, nerve gliding exercises, and McKenzie-method directional preference exercises. A 2020 Cochrane review found that structured exercise programs significantly reduce pain and improve function compared to no treatment. Specific exercises depend on the underlying cause — extension exercises for disc herniations, flexion exercises for stenosis.
Epidural steroid injections may provide temporary relief for severe cases. A systematic review in the Annals of Internal Medicine found moderate evidence that epidural injections provide short-term pain relief (2-6 weeks) but limited evidence for long-term benefit. Surgery (microdiscectomy) is considered when conservative treatment fails after 6-12 weeks or when progressive neurological deficits develop.
Can exercises help relieve sciatic pain?
Yes — specific exercises can significantly reduce sciatic pain. Core strengthening, nerve gliding techniques, and gentle stretching are particularly effective when performed consistently.
The McKenzie method, which uses repeated directional movements to centralize pain, is one of the most studied approaches for disc-related sciatica. Nerve gliding exercises (also called neural flossing) help the sciatic nerve move more freely through surrounding tissues, reducing irritation.
Core strengthening exercises protect the spine by improving stability. Focus on transverse abdominis activation, bird-dogs, modified planks, and bridges. Avoid exercises that increase pain — particularly sit-ups, toe touches, and heavy squats during acute episodes. A gradual return to full activity is recommended once acute symptoms resolve.
- Knee-to-chest stretches — hold 30 seconds, 3 repetitions each side
- Piriformis stretch — figure-4 position, hold 30 seconds
- Press-up extensions (McKenzie) — 10 repetitions, 3 sets daily
- Sciatic nerve glides — 10-15 repetitions, gentle and controlled
- Bridges — 10 repetitions, 3 sets, progress to single-leg
When does sciatica require surgery?
Surgery is considered when conservative treatment fails after 6-12 weeks, when there are progressive neurological deficits, or in emergency cases like cauda equina syndrome. Only about 5-10% of sciatica patients need surgery.
Microdiscectomy is the most common surgical procedure for sciatica caused by disc herniation. It has a success rate of approximately 85-90% for pain relief. The SPORT trial, one of the largest studies comparing surgery to conservative care, found that both approaches led to significant improvement, but surgery provided faster relief.
Recovery from microdiscectomy typically takes 4-6 weeks, with most patients returning to work within 2-4 weeks for desk jobs. Recurrence rates range from 5-15% over 10 years. Newer minimally invasive techniques offer shorter recovery times and smaller incisions.
How can you prevent sciatica from coming back?
Regular core strengthening, maintaining a healthy weight, using proper lifting mechanics, and avoiding prolonged sitting are the most effective prevention strategies.
Building a strong core is the single most important preventive measure. Research shows that people who maintain a regular exercise program after recovering from sciatica have significantly lower recurrence rates. Focus on exercises that strengthen the transverse abdominis, multifidus, and gluteal muscles.
Ergonomic adjustments are equally important — use a lumbar support cushion when sitting, take standing breaks every 30-45 minutes, and set up your workstation so your screen is at eye level. When lifting, bend at the knees (not the waist), keep the load close to your body, and avoid twisting while carrying heavy objects.
