Sciatica and nerves
Sciatica usually improves with self-care and time
Sciatica usually gets better in a few weeks to a few months, though it can last longer [1]. Staying active and simple home care can help, and injections or surgery are options when pain stays severe [1][2].
Key points
- Staying active and avoiding long stretches of sitting or lying down can help you recover [1].
- Most people with sciatica from a herniated disk improve without surgery [2].
- Numbness around the genitals or anus, or bladder or bowel changes, need emergency care [1].
- Injections often give short-term relief, and evidence for lasting benefit is limited [3].
- Surgery is considered when disabling leg pain continues after months of other treatment [2].
Sciatica treatments move from home care toward surgery in stages
| Step | What it involves | What the evidence says |
|---|---|---|
| Home care | Staying active, gentle exercise, heat or cold [1][2] | Often enough, since most people improve over time [2] |
| Medicines and therapy | Painkillers, muscle relaxants, physical therapy [1][2] | May offer relief, and benefit from ibuprofen is unclear [1][2] |
| Injections | Epidural or cortisone-like injections [2][3] | Short-term pain relief, limited lasting benefit [3] |
| Surgery | Removing the disk or bone spur pressing on the nerve [2] | Usually very successful for leg pain, with risks [2][3] |
| Acupuncture | Needles placed at specific points [4] | Trials report benefit, but study quality limits certainty [4] |
Sciatica often improves when you keep moving
Sciatica happens when the sciatic nerve, which runs from your lower back to your feet, is irritated or squeezed [1]. It usually heals on its own given enough time. About 80 to 90% of people get better without surgery, typically within several weeks when a herniated disk is the cause [2]. A herniated disk is a soft cushion of tissue between the spine bones pushing out [1].
- Carry on with normal activities as much as you can [1].
- Start gentle exercise as soon as you can, because anything that gets you moving can help [1].
- Do not sit or lie down for long periods. Even if moving hurts, it is not harmful and can help you recover faster [1].
- Do not stay in bed. Too much rest may cause discomfort in other parts of your body, and motion helps reduce inflammation [2].
- Try gentle heat or cold on painful muscles [2].
When home care is not enough
See a doctor if your pain has not improved after a few weeks of home treatment, or if it stops you doing your normal activities [1].
When to get care
A serious back problem can cause genital numbness and bladder or bowel changes
Some leg and back symptoms could point to a serious back problem that needs hospital treatment as soon as possible [1]. These signs need emergency care [1]:
- Weakness or numbness in both legs that is severe or getting worse [1].
- Numbness around or under your genitals, or around your bottom [1].
- Trouble starting to pee, or being unable to pee or control it, when this is not normal for you [1].
- Not noticing when you need to poo, or being unable to control it, when this is not normal for you [1].
Do not drive yourself to the emergency room. Ask someone to drive you [1].
If you think you may have a medical emergency in the United States, call 911 or go to the nearest emergency room.
Pain medicines and physical therapy may ease sciatica
Ibuprofen, aspirin, naproxen or muscle relaxants may offer relief [2]. It is not clear how much anti-inflammatory painkillers such as ibuprofen help with sciatica [1]. A pharmacist can advise you on painkillers [1].
Physical therapy can include exercise advice and hands-on techniques such as massage [1]. Your doctor may suggest short walks and stretching exercises so you can return to your usual activities [2]. Some people find that general activity advice is not enough. Plans that cover flare-ups, medicines, changes to daily tasks and tailored exercise may serve them better [5].
Sleep problems and emotional strain were prominent in the accounts of people living with this kind of nerve pain, and the researchers say clinicians should assess them [5].
Epidural steroid injections and surgery treat pain that does not settle
If your pain is severe and other treatments have not helped, you may be referred to a specialist for an epidural or another painkilling injection [1]. An epidural is an injection near the spinal nerves. Epidural steroid injections are widely used for lasting symptoms and give short-term pain relief, but evidence of lasting benefit is limited [3]. They are not approved by the US Food and Drug Administration, and in rare cases they carry risks of infection and nerve injury [3].
Surgery may be considered if you still have disabling leg pain after three or more months of nonsurgical treatment [2]. The surgeon may remove the herniated disk or bone spurs that press on the nerve [2]. It is usually very successful at relieving pain, especially when most of the pain is in the leg [2]. Surgery can still bring complications, and later problems can include recurring pain or another herniation [3].
Less common options
A procedure that seals off some back nerves so they stop sending pain signals is another option for severe pain after other treatments have failed [1]. If bone spurs and spinal stenosis (narrowing where nerves pass through the spine) cause the problem, nonsurgical treatment works less often, but there is still a good chance of improvement [2].
Acupuncture shows promise for chronic sciatica but the evidence has limits
A review of randomized trials in adults with sciatica from a herniated disk found that acupuncture reduced leg pain and improved function compared with comparison treatments [4]. Most of the trials were from China [4].
The authors also say that weaknesses in the existing studies call for cautious interpretation and better trials [4]. Earlier evidence on acupuncture has been described as controversial because of study quality, differences in treatments and follow-up length [4].
Sciatica can come back so lifting technique and not smoking matter
If you have had sciatica, it may return [1]. A few habits may lower the chance [1].
- Use a safe technique when lifting heavy objects [1].
- Keep good posture when sitting and standing [1].
- Do not smoke, because smoking can increase your risk of sciatica [1].
Even after successful treatment, a disk can rupture again [2]. Your doctor may give you exercises to strengthen your back, and it is important to walk and move while limiting too much bending or twisting [2].
Sources
- Sciatica nhs.uk
- Sciatica orthoinfo.org
- Treatment Gaps and Emerging Therapies in Lumbar Disc Herniation Pain physician
- Effectiveness of acupuncture in the treatment of chronic sciatica from herniated disks: a systematic review and meta-analysis Frontiers in medicine
- Supporting sciatica: a qualitative evidence synthesis of the needs and preferences of people with lumbar radicular pain when self-managing their condition Disability and rehabilitation
Not medical advice. This page is general education written from the sources above. It cannot diagnose a condition or replace a licensed clinician who knows your history. If you may be having an emergency, call your local emergency number or go to the nearest emergency department.