The first and most important thing to do is to find out what's causing your pain — you can't treat it until you know what it is. It's not a one-size-fits-all treatment. True sciatica is caused by a pinching of the sciatic nerve within the spine or after the nerve leaves the spinal track.
In terms of treatment, a forward bend is good if you have spinal stenosis, which is when the spinal canal narrows and presses against the sciatic nerve. But if you have a herniated disk, flexion can make it worse. Extension is great for a herniated disk, which chokes up the narrow openings where the nerve leaves the spine, but it will seriously hurt spinal stenosis. When it comes to piriformis syndrome — a pinched nerve from too much sitting on the piriformis muscle — twisting exercises are best. Try a Parivritta Trikosana (Twisted Triangle) yoga pose. [See photo left.] Depending on the type of sciatica, I prescribe short-course steroids, which reduce swelling. For pain, I recommend taking small doses of Advil or Ecotrin (make sure they are enteric coated). Visit sciatica.org to find out more about types and treatments of sciatica.
-Loren Fishman, MD, president, Manhattan Physical Medicine and Rehabilitation, New York; author of Sciatica Solutions (W.W. Norton, 2007)
In Chinese medicine, when somebody has pain we call it an energy blockage, or a qi [pronounced “chee”] stagnation. When we put in an acupuncture needle, it moves that energy to get things flowing properly again. We usually put needles in the area where it's hurting but also in other distal points — such as on the hands and feet — which are really powerful for pain relief.
Sometimes we also do cupping, during which we take a glass cup and put it on the skin to create a little vacuum. The cup will suck up the superficial layer of fascia and skin and bring the stagnation to the surface of the skin to release it. We also do a Chinese form of massage called tuina, which can help get all of the blood flowing to the area and help it heal.
For some people, weight issues can cause sciatica, and for them we work on dietary recommendations. In general, I tell people to stay away from sugar, caffeine, and alcohol, which can raise pH levels and cause more inflammation in the body — including inflammation of the sciatic nerve.
-Natalie Zajac, Lac, Acupuncture Associates, LLC,
East-West Health Center, Greenwood Village, Colorado
Stretching is important for any sciatica. You can stretch your hip flexors, quadriceps, piriformis muscle — which is located on the backside of your hip — or you can stretch the nerve itself.
Piriformis syndrome is when the piriformis muscle tightens and irritates the nerve where it exits the pelvis. Stretching and massage can release the muscle. You can find the piriformis muscle by pressing on the center of the glute on the side that hurts. Massage deeply; you should feel a twinge of pain if the piriformis is inflamed. To stretch, stand straight and bring your left leg and ankle up and across your body, toward your right shoulder. Grasp your ankle and knee and pull them toward your right shoulder. Lower and repeat with the right leg.
For younger people with herniated disks, a lot of treatment deals with nerve mobilization and avoiding bending forward. Sitting is especially bad — people who sit all day really need to have support behind their backs or get up frequently and move around.
In older people who don't have stability in their spine, stretching and core-strengthening exercises help stabilize the spine so that it doesn't shift around and inflame the nerve.
-Ron Miller, PT, Neurospine Center of Wisconsin, Appleton, Wisconsin