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​Why You Don’t (Necessarily) Need Surgery to Treat Sciatica Pain

By Brittany Risher | March 16, 2018
​Why You Don’t (Necessarily) Need Surgery to Treat Sciatica Pain

4 options for pain relief that will make you rethink going under the knife.

Sciatica pain can hit you from multiple angles—maybe you feel it in your back, maybe it runs down your leg, maybe it’s a bit of both. No matter what, its resulting numbness or sharp pain can leave you wondering if there’s anything you can do to find relief. It turns out, there is!

But before you treat sciatica, you have to know if you’re actually suffering from it. While many people think any low back pain is sciatica pain, that’s not actually the case. Although 80 percent of adults have low back pain at some point in their lives, only an estimated 5 to 10 percent of low back pain sufferers have sciatica pain.

Living with sciatica pain can feel debilitating at times, but there are non-surgical pain relief options that may be able to help you. If you think you have sciatica, learn more about it and see what you can do to get back to doing what you love.

What is Sciatica?

Sciatica pain starts in the low back and travels down the sciatic nerve—the nerve that runs from each side of your lower back into the hips and buttocks and down each leg—into one or both legs. You might notice it from time-to-time, or you might suffer from it constantly. “The sciatic nerve is the largest nerve of the body. Almost everything from the navel down the legs that you feel [pain-wise] comes from that,” explains massage therapist Erik Dalton, Ph.D., creator of Myofascial Alignment Techniques.

Although it can sometimes be painful, hands-on and movement therapy with an experienced healthcare professional (like a chiropractor, physical therapist or massage therapist) can help get you moving normally, Dalton explains. Only 20 to 30 percent of people with sciatica pain have symptoms that last longer than a year or two.

What Causes Sciatica Pain?

Sciatica pain is caused by a pinched or compressed sciatic nerve. And this nerve irritation can be brought about in a few different ways.

It’s All in the Back (and Discs)

About 90 percent of sciatica pain cases are caused by a herniated disc in your spine. These discs, made of rubbery connective tissue, are lodged between your vertebrae and allow your back to move. However, when a disc is pushed through the outer layer of your spine, it becomes herniated and puts pressure on the nerve, causing pain and sometimes inflammation.

A similar thing can happen with a bulging disc. A bulging disc is like a herniated disc but not as dramatic. In this case, the disc pushes against the outer core of the spine enough to distort it but not break through that outer layer of your spine. This can still cause pressure directly against the nerve root and lead to pain, weakness or numbness in the affected arm or leg.

Bone Spurs and Your Back

Bony growths that form along the edges of bones, called bone spurs, can also be a problem. These growths are often at the joints and in the spine where bones meet and when they press on the nerve, they can cause sciatica pain.

One Thing Leads to Another: Spinal Stenosis

Spinal stenosis happens when the open spaces in your spine narrow, putting pressure on the spinal cord and nerves. With the spinal cord and nerve roots compressed, that familiar pain, numbness and weakness can follow. And since bone spurs and herniated discs can lead to stenosis, sometimes one problem can lead to many.

There might be other factors like age, mental stress, smoking or increased physical activity that can increase the risk of sciatica pain. Whatever the source of pressure on the sciatic nerve, it’s the compression that really causes pain radiating from the low back and buttocks and down one or both legs. This pain can be excruciating and is often accompanied by numbness, tingling and weakness.

When Should You Seek Professional Care?

Sciatica pain can be tough to diagnose on your own. So if you think you have sciatica pain, it’s probably a good idea to seek out a healthcare professional. If you prefer massage, be sure to look for a licensed therapist who specializes in orthopedic, medical or myoskeletal massage. Dalton adds that combining massage with chiropractic care can often be an effective option.

You can find a hands-on healthcare professional near you by using the Professional Finder. For a detailed search by body part or objective (or even various healthcare professional types), enter your zip code and click “Continue.” Be sure each professional you see knows what other care you're using so all of your treatments complement each other.

How Can You Treat Sciatica Pain?

There are both professional and at-home ways to relieve sciatica pain, and often a combination of treatments works best. But if your sciatica is caused by a severe disc herniation, bone spurs or stenosis, it’s best to see a healthcare professional to find out whether you need to consider surgery to address the underlying cause of your symptoms.

In the meantime, you can use the following solutions to treat your sciatica pain. Since that can be different for each person, the effects of these relief options may vary—explore a few, and see what works for you.

Seek Chiropractic Treatment

Chiropractic care can help you find relief from sciatica through a few different types of treatment. Your chiropractor will create a specialized program to treat your sciatica pain after a series of tests to assess your movement patterns—and often doing an MRI and/or x-ray to examine your spine.

One treatment is called spinal manipulation—when a chiropractor uses his or her hands or a device to apply force to a restricted joint to release it. This relieves pain and improves physical function, explains Robert Silverman, D.C., owner of New York ChiroCare.

And spinal manipulation has been proven to help with sciatica pain. In one study, 60 percent of people who had sciatica saw the same benefit from spinal manipulation as they would have from surgery.

Spinal decompression is another treatment option for sciatica pain. This gentle approach helps stretch the spine and move herniated or bulging disc material back into the affected disc, which takes pressure off the nerve, according to Silverman. During the treatment, the chiropractor first places a harness around your pelvis. Then you lie fully clothed and face up or down on a traction table or motorized device. The chiropractor then uses a computer to move the table, painlessly stretching out your spine.

No matter the treatment a chiropractor recommends, core rehab is key for sciatica pain. Many chiropractors will suggest doing core exercises either with your body weight or resistance bands to help protect your back from future injury.

"This is critical," Silverman says. "When the core fatigues, the periphery moves in an aberrant way, which leads to injury. Once you are able to brace your core and get the local muscles to hold the spine like the mast of a sail ship, then you can move safely."

Schedule a Massage

Not just any massage will help with sciatica pain. Although a standard massage may feel relaxing, you want to see a massage therapist who specializes in orthopedic or myoskeletal massage.

The techniques used by these therapists may look similar to a massage in a spa, but those like Dalton don't follow a routine or focus on only tight areas when working on patients. “I want to figure out exactly which structures are weak and which are too tight, and create muscle balances and restore function,” Dalton says. “We use our elbows, fingers and more to work through the tissue and relieve some of the protective muscle guarding.”

They do this gradually, stretching someone until they are just a little bit uncomfortable. Dalton explains that doing so helps the brain associate that sensation with safety and security, and in turn the brain dissociates the treatment with tissue damage, meaning you can stretch further. Over many sessions, the therapist will slowly progress the movement for more of a stretch.

Try Cold and Hot Therapy

When you first notice sciatica pain, a little cold therapy can do wonders to relieve your pain. Cold therapy, or applying cold temperature to a pain point, helps reduce pain and inflammation by constricting blood vessels and reducing blood flow to the site. Traditionally, this has meant using a bag of ice, but now there are products like topical pain relievers and cold packs that can achieve the same effects.

Topical pain relievers, like Biofreeze® Pain Reliever, work to relieve your pain through cold therapy (like ice!). But topical pain relief won’t cause the numbness or skin irritation that ice can—research has even showed that patients preferred Biofreeze over ice, and they felt its effects for longer. Plus, topical pain relievers don’t require you to sit still while you get relief. Just apply it and get on with your life.

However, some people find more relief from sciatica pain by using heat therapy. It helps increase blood flow to joints and tissues, and it can help you reduce pain before activity. TheraPearl® Packs are a great option for both hot and cold therapy, as they can be frozen or heated. Plus, they maintain their temperature for the recommended 20 minutes of treatment.

Exercise Your Core

Staying active and working your core can also be helpful when fighting sciatica pain—something a physical therapist can help with. If you’re not sure where to start, the following exercises can help. Just be sure to always follow the advice of your chiropractor or physical therapist, as he or she will choose the best exercises for your specific situation.

Try these exercises to strengthen your core. These exercises are shown using a TheraBand CLX Resistance Band, but you don’t have to use one if you’re not comfortable. You can start with just your body weight, and then when you’re comfortable, consider adding a resistance band to make them more challenging.

Bird Dog

  1. Place your feet in the center loops of the CLX band, and grab the end loops of the band in each hand, holding with open or closed grip.
  2. Kneel down to all fours, stacking shoulders over wrists and hips over knees.
  3. Stretch your left leg to an extended position as you simultaneously stretch your right arm into an extended position.
  4. Slowly return to center, then do the same on the opposite leg and arm.
  5. Repeat.

Oblique Plank

  1. Place your feet through the center loops of the CLX band, carefully moving the loops to rest just above your knees.
  2. Grasp the end loops of the band in your hands (right hand should be connected to right leg and left hand to left leg).
  3. Go into a plank position, raising up on your right elbow and keeping your body in a straight line.
  4. Extend your left arm overhead.
  5. Bring your left knee up bring your right arm down so that your elbow and knee meet in the middle.
  6. Extend both your left arm and left leg out again, keeping your body straight.
  7. Return to neutral plan position, then assume the plank position on your left elbow.
  8. Repeat the movement with your right arm and right leg.

Squat

  • Place each foot into the center loops of the CLX with feet hip width apart.
  • Grasp the end loops in your hands, with right arm attached to right foot and left arm attached to left foot.
  • Raise your hands to shoulder height.
  • Keep your elbows bent and hands at shoulder level as you slowly squat until your thighs are parallel to the floor.
  • Without leaning forward slowly return to a standing position (maintaining a neutral back and neck alignment).

How Can You Prevent Sciatica Pain?

Although sciatica pain cannot always be prevented, there are a few things you can do to lower your risk of it. One of the easiest? Staying active. And “active” doesn’t have to mean a full gym workout either—you can benefit from simple things, like walking daily.

“Walking is one of the best things because it takes you through your normal range of motion in the hips and takes you through the cross-pattern gait with your arms and legs moving in opposite directions,” Dalton says.

Any movements that mimic actions you take throughout the day, such as squats, also help. “Squats are one of our natural and innate movement patterns—all babies squat,” Dalton says. He has patients perform squats with an exercise ball behind their backs against the wall because that takes the pressure off the joints and keeps the body in alignment.

How to do it:

  1. Find a wall clear of obstacles (no picture frames, etc.).
  2. Place your exercise ball behind your back against the wall, so it sits in the natural curve of your back.
  3. Start with knees slightly bent, then lower until your thighs are parallel with the ground, keeping your abs tight.
  4. Return to standing (make sure your knees don’t lock) and repeat.

Lastly, consider seeing a movement specialist, like a physical therapist or a chiropractor. “Being cognizant of your movement can help you avoid injury,” Silverman says. Specialists can help you learn the proper techniques for lifting, twisting and other everyday movements—which can help prevent pain in the long run.

Create a Plan and Follow it to Sciatica Pain Relief

Although sciatica pain can be excruciating, the good news is that simple and proper care can make a big difference. By starting your pain relief journey with a hands-on healthcare professional (or a team!), you can get the full picture of what you’re dealing with, then find relief. Seek out a chiropractor, physical therapist and/or massage therapist who can assess your condition and create a customized treatment plan. With their help, a bit of time and a solid plan for the future, you should be able to get back to doing what you love, without surgery.

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