In this post, I’d like to offer a step-by-step guide to addressing your sciatica, no matter if it has been going on for 3 days or 3 years. My goal is to at least give you a proactive head start and empower you with at least a little knowledge on what you should be actively doing now, even if you are scheduled to work with a physical therapist or another health practitioner in the very near future.
The following tips and instructions should help with at least some of your symptoms, if not all.
I will not go into details as the possible cause and symptoms of why you might be experiencing. For this I will redirect you to a previous post I wrote in 2017, 3 Common Causes & Symptoms of Back Pain & Sciatica.
You can also check more on the definition of sciatica and things to consider in this free E-book on Sciatica:
Sciatica affects the largest nerve in your body, the sciatic nerve ( except for “sciatica” that creates symptoms in the front of your thigh, actually affecting your femoral nerve…and very inappropriately named), it is of the utmost importance to not ignore your symptoms, start working on decreasing them as soon as possible, and seeking prompt medical help.
Your nervous system is what guide, direct and command any function and system in your body. Unfortunately, nervous tissue and nerves do not heal fast. And the longer they are injured or irritated, the higher the chance they will be forever changed. In the case of your sciatic nerve, if you experienced a bout of sharp Sciatica 3 months prior but you’re still experiencing tingling and numbness in your foot, with or without current back pain, this means your sciatic nerve is still irritated or lacks mobility with various daily movement and tasks. And the longer you wait, the higher the chance of never getting rid of that foot numbness.
Before I move on to the actual tips, I want to give a disclaimer:
You are a unique human being. Your body is also unique. There are not two bodies alike. Your type of sciatica might require a healthcare professional to guide you and make alterations to the following exercises. And so I will always recommend for anyone suffering with sciatica to consult with a healthcare professionals. And of course, I recommend a conservative practitioner. Getting the appropriate medications should be helpful.But if it is your first time diagnosed with Sciatica, I would highly recommend you start following the following tips without being influenced by the results of an MRI or being led to believe that a back surgery only will fix your problem.
I have seen too many people deciding or being rushed into surgery for sciatica. The results of the MRI/ imaging must always be correlated to your actual symptoms. In any case, even if you have surgery, physical therapy will likely be prescribed afterwards.
And what about if the physical therapy itself would have been enough to address the problem?
Undergoing surgery is a trauma to the body and back surgeries can often “open a can of worms…”
My main disclaimer and warning: If your sciatica involves changes in your bowel and bladder control, or severe numbness and lack of feeling in your groin ( the area that would touch a saddle if you were riding a horse), you need to act NOW. This is a medical emergency and you could require an emergency surgery. No joke.
And now, on to the tips you are here for:
1. Start Moving….Start Walking
Standing tends to introduce more extension in your lower back, which helps with relief of pressure on a herniated disc. Of course, it sometimes takes more than a minute of walking to start experiencing a relief.
Shortening steps prevents placing the nerve on excessive stretch. So walk with shorter step than usual on your affected side.
Keep in mind if your sciatica is due to arthritic changes, walking might actually exacerbate your sciatica.
2. Start Mobilizing Your Sciatic Nerve…Vs Stretching Your Leg.
Stretching a tight painful leg might sounds like a good idea when you suffer from sciatica, feels tightness and sharp jabs of pain down from your hip to your toes. You might feel you need to stretch/ pull out the pain from the backend side of your leg.
In the case of sciatica, you will likely exacerbate your condition if you stretch your leg in the same fashion as you would stretch your hamstring / back of your leg. Static/ sustained leg stretch are rarely tolerated by sciatica sufferers.
Instead, I would like to show you how you can mobilize (vs “stretch”) your nerve. (First part of the video)
You can also mobilize your sciatic nerve in sitting, which would be ideal for someone that experiences symptoms their symptoms in sitting, when at the office.
3. Should You Use Ice or Heat With Sciatica?
Sciatica is an inflammation of the sciatic nerve. When something is inflamed, you want to calm it down, “cool it off”. Ice is a natural inflammatory and can help you in managing some symptoms of sciatica.
Apply for 10-15 minutes at a time. Repeat every hours as needed. Using ice at the end of a hard day can really help take your pain a few notches down.
4.Keep A Pain Journal:
Writing down your symptoms behavior when your pain is at its worse, or when it is relieved, keeping a log of your activities for the day and reflecting on them at the end of the day, will help you identify what triggers and relieve your symptoms. Finding out which position (sitting, brushing your teeth, etc…) or activity( lifting, bending over/putting your socks on) will not only help you relieve your pain but having a better understanding but will also be invaluable information for the healthcare practitioner that will help you possibly later down the road.
5.Not All Shoes Are Created Equal: Wear The Right Ones.
Our spine are loaded with every steps we take. Once again, it's physics...
With some type of shoes, such as high heels, flip flops, sandals, shoes with poor cushioning, hard-soled flat shoes, the amount of stress through the joints in our spine goes up to unacceptable level. Over time, this repeated stress and pressure adds up and lead to a painful and tight lower back, exacerbating symptoms of sciatica
Wearing shoes with proper cushioning under your heel will help absorb pressure and prevent your lower back from taking unnecessary load, which should help decrease your low back pain, and irritation of sciatic nerve.
It’s a universal truth… MOST people DO NOT drink enough water. This has significants consequences on our health. When you have an injury or inflammation like in the case of sciatica, water is needed for your body to fight inflammation, allow healing, and to stay healthy.
So staying hydrated is key and my advice is to drink much more water than you are normally used to. Carry a reusable water bottle with you throughout the day. Having it will make you not forget and prompt you to drink more water.
7.Avoid Any Painful Movements Or Positions...& How You Should Sit:
When you have back pain and sciatica, finding a comfortable position seems impossible. Changing position often is necessary during episode of acute back pain/sciatica. The most common case of sciatica are due to bulging disc pushing on a nerve root in your lower back. The position of sitting typically put your lower back in a flexed position , which tends to exacerbate the protrusion of the disc and hence the pressure on the nerve. And so it becomes very important to change position often and to not sit for more than 15-20 minutes at a time. When you start feeling pain, don’t wait to change position. In the case of sitting, you will most often feel a relief once you stand. The reason for this is there is about ten times more pressure that goes through your spine in sitting when compared to the standing position.
Using some support ( start with a small rolled towel) in your lower back to maintain the natural curve is generally a good way to alleviate some pressure on the nerve root.
Make sure you also watch what you do when sitting:
Do not sit cross legged or with your feet crossed as this placed extra stress and unnecessary stretch on your spine, your joints, and your muscles.
At home, lying on your couch vs sitting might be preferable during an acute episode.
8.With Acute Sciatica, Avoid Bending Forward From The Low Back
Bending forward by flexing your lower back tends to increase the pressure placed on nerve root and sciatic nerve, increasing the intensity of the pain down your leg.
One thing to prevent this that can be very effective when you need to pick an item on the ground, or like brushing your teeth, is to take a step in order to stand with one foot in front of the other, shoulder width apart. This position will force you to bend from the hips instead of your back, will force you to use your hip muscles instead of your lower back muscles, which will place much less stress on the spine in the lower back, avoiding compression of the sciatic nerve.
9.The Classic Mistakes To Avoid With Sciatica:
10.What Exercises Help With Sciatica?
If you’re are a walker, I would suggest you resume your walking progressively. Go on short, but frequent walk.
I would avoid biking, regular or stationary, as this tends to placed your back in a flexed posture, exacerbating your sciatica. If your sciatica symptoms are verified to be from stenosis, biking should be tolerated and actually help. But every cases are different and specific.
If your are used to workout at the gym, I would refrain from my heavy weight lifting. I would instead focus on gentle movement of your upper back, lower back and hips, as long as they are pain free.
I also published a couple videos on YouTube with some ideas of where to start:
Of course, keep in mind that these might not help. And again the one thing to remember is the importance of not experiencing pain when doing these.
11.Find A Skilled Physical Therapist...
Sciatica is common... You are not alone. There is someone out there that can help you. It might sounds cliché to say but many people try to go through their sciatica by themselves... Severely delaying their progress and returning to normal...and sometimes actually doing irreversible damage because their sciatic nerve has been inflamed for too long... Leading to decrease sensation in their leg and foot...for the rest of their life.
In this day and age, there are no other professional that is more apt to help you treat your sciatica than a physical therapist who will take a close look at your back, pelvis, hip, and leg, take the time to discuss, explain and identify the root cause of your sciatica.
More important , a physical therapist will help you get faster results and teach you how to take care of your back for the long term so you can stay away from drugs, injections or surgeries. A skilled therapist knows various hands-on techniques to help alleviate your symptoms and decrease your pain that are the perfect adjunct to some of the other things I showed you in this post. Physical therapy is the most cost effective way to address your sciatica and back pain.
In addition to applying the previous tips, a consult with a physical therapist is an easy process as it does not require a prescription from a physician (this is called Direct Access).
Your physical therapist is a movement specialist and will create a customized plan and home program for you to reach your goals, manage your pain, and help you return to a normal active life.
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Pierre-Yves Butheau, MPT, CMP has been a physiotherapist for 19 years and has a passion for helping people move better, return from and prevent injuries, as well as improve their function and quality of life. He has a strong interest in addressing the root cause of and treating neuro-musculoskeletal conditions while educating his patients with the knowledge to manage their conditions and prevent recurrence. Pierre also has a niche in treating Bell's palsy and temporomandibular joint dysfunctions.