9 Treatment Options for Sciatica
Justin Field, MDJustin Field, MD

9 Treatment Options for Sciatica

By Justin Field, MD

Dr. Field is a board-certified, fellowship-trained orthopedic spine surgeon. He has specialized training in minimally invasive spine surgery and motion sparing technologies, such as cervical and lumbar artificial disc replacement, as well as non-fusion stabilization.

April 28, 2022

Sciatica pain can feel like an all-consuming problem. The pain cuts right through the middle of you, making it hard to ignore. Despite the pain it causes, sciatica is a symptom of a deeper issue in your spine. Since sciatica occurs when something pinches or compresses the sciatic nerve, sciatica treatment often focuses on what causes that problem. In many instances, another spinal condition is the root cause of sciatica.

Treatment options are diverse and vary from sciatica treatments at home to non-invasive injections or surgical interventions. Here are nine treatment options for sciatica, including non-surgical and surgical methods.

Non-surgical Treatments for Sciatica

Non-Surgical Treatments for Sciatica

With some exceptions, doctors initially pursue non-surgical treatments for most sciatica cases. Whenever possible, avoiding surgery minimizes risks and shortens recovery times. The specific therapies doctors recommend depend on your pain level and condition. Here are a few possible treatments your doctor may recommend to help with your sciatica pain.

1. Physical Therapy

Doctors often prescribe physical therapy to sciatica patients as an initial measure. If significant pain is present, they will address that before prescribing physical therapy. Physical therapy for sciatica can strengthen your muscles and reduce inflammation. In doing so, it helps relieve pain and helps your body recover from sciatica over time.

Physical therapy consists of strength and aerobic conditioning and stretching exercises. Physical therapists tailor the exercise and conditioning programs to each patient’s fitness level and medical condition. Your routine should avoid aggravating your sciatica pain while working specific muscles to help you overcome it.

For sciatica, physical therapy routines generally focus on:

  • Strengthening the spine and abdominal, buttocks, hip and lower back muscles.
  • Increasing core strength.
  • Stretching tight, inflexible muscles, such as your hamstrings or the piriformis muscles in your buttocks.
  • Promoting circulation and the exchange of fluids and nutrients through light aerobic exercise

Physical therapy may involve walking, swimming, pool therapy, resistance training and range-of-motion exercise.

2. Hot and Cold Therapy

Alternating hot and cold therapy can promote healing and relieve pain. As you alternate with heat and ice, the ice decreases inflammation, and the heat increases circulation. The reduced inflammation relieves pain, while the increased circulation encourages healing.

Cold therapy

Besides reducing inflammation, cold therapy can also relieve pain by:

  • Cooling muscle fibers to decrease muscle spasm frequency
  • Constricting blood vessels and reducing blood flow to produce numbing sensations
  • Decreasing nerve conduction on the skin

You can apply cold therapy with ice packs for 15 to 20 minutes at a time. Avoid using ice any longer, as you could experience nerve damage through frostbite.

Heat therapy

Heat therapy has an inverse effect on sciatica pain. Heat therapy benefits apply more to healing than pain relief. So you should use heat therapy after cold therapy relieves your pain. Heat therapy promotes healing by:

  • Decreasing muscle tension and spasms
  • Expanding joint mobility
  • Improving nerve tissue function
  • Increasing tissue metabolism

You can apply heat therapy through hot water bottles, hot packs, hot towels, or electric heating pads. You should also avoid using hot pads on your skin for too long to prevent skin damage.

3. Physical Activity and Exercise

Staying physically active can ease inflammation and promote healthy circulation. The amount of physical activity and exercise you can perform depends on your condition and pain level. Still, you should strive to stay as active as your body and sciatic pain allow. Even if your routine consists of light stretching or simple yoga practices, your body can still benefit. Whether you practice daily five-mile runs and resistance training or settle for short walks and light stretching, do as much as your body allows. 

Physiotherapists recommend individuals with sciatica perform exercises that focus on:

  • Core strength
  • Correct posture
  • Hamstring and lumbar spine flexibility
  • Proper lifting techniques

While some resistance and mild discomfort is normal, stop exercising or stretching if your sciatica pain worsens.

4. Medications

To treat sciatic pain, your doctor may prescribe pain relief medication as a first-order treatment. After the pain subsides, they can explore restorative options with you. They may also prescribe pain relief medication for lingering soreness after physical therapy sessions or other sciatic nerve treatments. Pain relief medications are short-term solutions for immediate pain. As such, they are not viable as an ongoing pain management solution.

Some common medications that doctors prescribe for sciatica pain include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen (Advil), acetylsalicylic acid (Aspirin) and naproxen (Aleve).
  • Opioid analgesics like oxycodone or tramadol
  • Oral steroids, including prednisone or methylprednisolone

5. Epidural Steroid Injections

Epidural steroid injections (ESIs) involve an injection of local anesthetics and corticosteroids into the epidural space of your spine. The epidural space separates your spinal cord’s protective dura mater layer from your vertebrae. Within the epidural space are blood vessels, connective tissue, fat and spinal nerve roots. The purpose of ESIs is to relieve inflamed and irritated spinal nerve roots. ESIs help sciatica through the following mechanisms:

Reducing inflammation

Corticosteroids interrupt the subsequential production of inflammatory enzymes, known as the inflammatory cascade. To put it plainly, they limit inflammation in an irritated sciatic nerve.

Relieving pain

Pain relief with ESIs minimizes your need for NSAIDs or opioid pain relief medications. Opioid medications can become addictive if you rely upon them too much.

Continuing exercise

As ESIs provide long-lasting pain relief, they let you continue physical therapy without relying too much on pain relievers. Exercise and physical therapy strengthen the muscles around your sciatic nerve and increase blood flow to the area to help it heal.

6. Nerve Root Blocks

Like ESIs, Nerve root blocks are injections that contain a steroid and local anesthetic. They work differently from ESIs because nerve root blocks target a specific nerve root, rather than the epidural space. 

With a nerve root block injection for sciatica pain treatment, your doctor injects the steroid-anesthetic combination localized around the specific nerve root which connects to the sciatic nerve. 

An ESI can numb sciatic pain and reduce inflammation. Local anesthesia interrupts the nerve signals between your brain and the irritated nerve. In comparison, corticosteroids help to block or slow the inflammation process that can increase the pain patients perceive.  The combination of local anesthetic and corticosteroid has the following therapeutic effect:

Surgical Treatments for Sciatica

Doctors usually explore non-invasive options before surgery. Still, some sciatica cases need surgery first. Other sciatica cases need surgery after conservative interventions fail to solve the problem.

Your doctor may pursue surgery as an initial treatment if any of the following conditions or injuries cause your sciatica pain:

Sciatica-related conditions treatable by surgery
Bilateral sciatica

If you experience sciatica pain in both legs, it is known as bilateral sciatica. Common causes of bilateral sciatica include disc hernias or spinal stenosis. Doctors may prefer surgery for bilateral sciatica because it often indicates advanced degenerative structural issues in the spine.

Cauda equina syndrome

Though it’s rare, If cauda equina syndrome develops, it is a surgical emergency. Cauda equina syndrome occurs when an injury or condition compresses the bundle of nerve roots in your lower lumbar spine known as the cauda equina, which includes your sciatic nerve. When sciatica occurs with cauda equina syndrome, it is usually bilateral sciatica. Without prompt treatment, cauda equina syndrome can cause paralysis of your lower extremities, impaired bladder or bowel control, and difficulty walking.

Spinal tumors

Tumors in the spine can cause sciatica-like symptoms. If you are experiencing sciatica from a spinal tumor, your doctor will want to act quickly to remove the tumor. If it is malignant, they will want to surgically remove the tumor to prevent its spread to other parts of the body. Although a benign tumor will not cause cancer, it can cause severe neurological issues. So prompt surgical removal of a benign spinal tumor remains necessary.

Severe fractures

vertebral compression fracture in your lumbar spine can cause sciatica symptoms. If the fracture is severe enough, it will need surgery for proper healing.

Below are some common surgical treatments for sciatica.

7. Microdiscectomy

Your doctor may recommend a microdiscectomy if a lumbar disc herniation (LDH) causes your sciatic pain. Since a microdiscectomy involves a small surgical incision, it is minimally invasive. A microdiscectomy takes approximately one to two hours. Before the procedure begins, an anesthesiologist or surgeon will give you either anesthesia so you feel no pain during the procedure.

A microdiscectomy occurs in the following steps:

  • Your surgeon will make a small incision near the herniated disc in your back.
  • They will use special X-ray guidance, known as fluoroscopy, to ensure they reach the correct location.
  • Using fluoroscopy, your surgeon will insert a small, sterile wire into the incision.
  • After inserting the wire, they will insert two or three tubes over the wire to gently push apart tissue so they can access the vertebrae. Each inserted tube is slightly bigger than the previous one.
  • Your surgeon will insert surgical tools through the tube, such as a tiny camera, light and various instruments.
  • Using those tools, your surgeon will remove the herniated part of the affected disc to relieve pressure on the spinal nerve.
  • After removing the tools, tubes and wire, they will stitch and bandage the surgical wound.
Micro-endoscopic discectomy
Micro-endoscopic discectomy

Since a microdiscectomy is usually an outpatient procedure, patients often go home on the day of their surgery. After having a microdiscectomy, your surgeon will give you aftercare instructions to care for the wound and recover from the surgery.

Your doctor may encourage you to wear a back brace as you recover. Most patients resume driving and light activity approximately two weeks after the surgery. Your doctor will ask you to limit bending, twisting and lifting for six weeks after the procedure. After six weeks, most patients resume regular activity.

Depending on your condition and activity level, you can expect a full recovery from a microdiscectomy anywhere from 12 weeks to one year.

8. Laminectomy

If your sciatica pain occurs from spinal stenosis or bone spurs, your doctor may suggest a laminectomy. Spinal stenosis occurs when the area around the spinal cord narrows due to various causes, including bone spurs or overgrowths. As that space narrows, it puts pressure on your spinal cord and nerves.

With a laminectomy, the surgeon removes the lamina section of vertebral bones. The lamina in each vertebra forms the roof above your spinal canal. A laminectomy provides space for your spinal nerves to move freely by removing part or all of the lamina. An anesthesiologist will give you general anesthesia before the surgeon begins the procedure. You will be asleep for the duration of a laminectomy, which is typically one to three hours long.

Surgeons generally perform laminectomies in the following steps:

  • As you lie face-down, your surgeon will make an incision into the middle of your back.
  • They will use a surgical microscope to look inside your back.
  • Using special cutting devices known as kerrison rongeurs, the surgeon removes part or all of the lamina. They also remove the spinous process, or the bony part that juts out on each vertebra.
  • Before closing the wound, they remove disc fragments, bone spurs and other tissues.
  • The surgeon sews up and bandages the surgical wound.

Because this is an open surgery, patients stay in the hospital after a lumbar laminectomy for one to three nights. Most patients can drive within two weeks and resume light work after four weeks. The estimated recovery time for a lumbar laminectomy is four months to one year. Minimally invasive options for laminectomy procedures significantly reduce patient recovery times.

9. Transforaminal Endoscopic Lumbar Decompression

Transforaminal endoscopic lumbar decompression (TFELD) is ultra minimally invasive treatment for chronic sciatica pain or spinal stenosis when conservative approaches provide limited relief. This surgery focuses on freeing the nerves inside your foramen, which is the hollow boney tunnel your spinal cord exits out to your legs. A TFELD procedure widens this space to relieve pressure on your nerves. It can also be ideal for patients who have had failed back surgery.

As an endoscopic surgery, this outpatient procedure requires local anesthesia and mild sedation.

To perform a TFELD, surgeons follow these general steps:

  • As you lie on your belly, your surgeon makes a ¼-inch incision in your lower back.
  • They insert a ¼ inch metal tube into your disc, and then insert an endoscope, with camera attached, to visualize the affected nerve.
  • They insert micro-surgical tools including a laser through the endoscope.
  • To widen the foramen space and decompress the affected nerve, they clear away bone spurs, herniated discs and other debris compressing the nerve.
  • The surgeon closes the skin with one stitch and bandages the wound.

After a TFELD procedure, most patients return to work within one to two weeks.

How Is Sciatica Diagnosed?

To diagnose sciatica, your doctor or spine specialist will ask you various questions about your pain and symptoms. Some of these questions may include:

  • When did your pain start?
  • Where do you experience your pain?
  • Is there anything that triggers your sciatica pain?
  • How would you rate your pain on a scale of 1 to 10?
  • What is your normal activity level?
  • Besides pain, what other symptoms do you have?
  • How much do your pain and symptoms affect your daily life?

Depending on your answers, they may also run some tests after a physical and neurological exam. During the physical exam, they will evaluate your:

  • Posture
  • Range of motion
  • Overall physical condition
  • Spine alignment and curvature

For the neurological exam, your doctor will assess your reflexes, muscle strength and nerve function by gently holding your legs and knees in different positions. If they think testing is necessary, some standard diagnostic tests for sciatica include:

  • X-ray
  • Computerized tomography (CT) scan
  • Medical resonance imaging (MRI)
  • Electromyography/Nerve Conduction Velocity (EMG/NCV) test

Learn More About Sciatica Treatment Options With the Desert Institute for Spine Care!

When dealing with sciatica, or any other spine-related issue, it is helpful to know all you can about the best treatments for sciatica. At DISC, our skilled spine specialists have expert knowledge and ability in diagnosing and treating sciatica. Whether you want more information about your treatment options or want to schedule an appointment for sciatica treatment with our spine specialists, we can help. Contact us today!

LEADERS IN MINIMALLY INVASIVE SPINE CARE
1635 E. Myrtle • Suite 400 • Phoenix, AZ 85020
Ph: 602-944-2900 • Fax: 602-944-0064

DISC - Desert Institute for Spine Care
Copy link
Powered by Social Snap