Dear Doctor: Is it advisable to try to ‘walk off’ sciatica pain?

From oregonlive.com

DEAR DR. ROACH: I’m in considerable pain from sciatica. I wanted to know whether it’s a good idea to make myself walk around and try to walk off the pain, which is at a level 8 out of 10. It slightly lessens when I do. I don’t have any choice since I live alone. -- P.L. 

Most cases of sciatica, such as those caused by a herniated disc, start to get better in a week or so but may take several weeks to get completely better. (Getty Images)Getty Images/Science Photo Libra

ANSWER: The best answer I have is that if your activities help reduce the pain, you should do them. I don’t recommend forcing yourself to stay in bed if you don’t need to, but I also don’t recommend pushing yourself into doing activities that are painful.

Most cases of sciatica, such as those caused by a herniated disc, start to get better in a week or so but may take several weeks to get completely better (or nearly so). Physical therapy is an effective treatment to reduce disability and improve pain.

People who aren’t getting better from sciatica need to get re-evaluated and will likely need imaging, such as an MRI, to find out what is causing the pain. People with progressive weakness need immediate evaluation.

https://www.oregonlive.com/advice/2025/12/dear-doctor-is-it-advisable-to-try-to-walk-off-sciatica-pain.html

What should you do when sciatica flares?

From health.harvard.edu

By Heidi Godman

These options can help calm the searing pain of an irritated sciatic nerve

People with diagnosed sciatica have no trouble recognizing a flare-up. It strikes as numbness, tingling, or pain in the buttock and down the leg, caused by irritation to the sciatic nerve, which begins in the spine and travels downward into the leg.

While it's easy to identify a flare-up, it's trickier to tamp it down. It may take a combination of approaches to ease discomfort.

What is sciatica?

Sciatica is the term for discomfort caused by irritation of the sciatic nerve. This nerve starts at each side of the low back and extends down through the buttocks, back of the thigh, and lower leg.

Irritation usually occurs in the spine, with one of the nerve roots that eventually form the sciatic nerve. Anything pressing against a nerve root — such as a bony growth from arthritis in the spine or a bulging disc in between the spinal bones — can inflame the nerve root and send pain, numbness, or tingling all the way down one of the sciatic nerves.

"If you've never had it before, it's common to worry that you may have damaged your sciatic nerve. It's usually more of an irritation, however, as opposed to an outright injury," says Dr. Max Epstein, a physiatrist at Spaulding Rehabilitation Hospital. "But if you also experience muscle weakness or significant changes to your bowel or bladder habits, that could be a sign of nerve damage. In either case, you should speak to a health care provider as soon as possible."

Pill-free approaches

Coping with sciatica discomfort starts with pill-free strategies that you can try immediately.

Stay active. One of the most important things you can do when sciatica flares is to avoid bed rest. "Part of low back pain is muscle-related, possibly because muscles surrounding the irritated nerve roots tighten and try to protect the area. Movement keeps the muscles loose and working correctly. If you don't move, they can get tight and increase pain," says Dr. Max Epstein, a physiatrist at Harvard-affiliated Spaulding Rehabilitation Hospital.

Modify activities. If activity is painful, do only what you can tolerate. "Think of a green, yellow, or red zone of pain. The green zone is a mild amount of pain while doing an activity. That's okay. But if you get into the yellow zone, it's time to pull back and modify an activity," Dr. Epstein says. "For example, if it hurts to carry a full laundry basket, take out a few things. Or if it's painful to stand at the sink and do dishes, open the cabinet below the sink and rest your foot on the bottom of the cabinet. That will take tension off the nerve."

Stretch. Keep the muscles loose and limber with gentle stretching, but only within the green zone of pain. For example, you might stand and try to touch your toes to stretch your back and leg muscles. Or try some yoga poses. Dr. Epstein recommends the cat-cow: Get down on all fours, with your hands directly beneath your shoulders and your knees beneath your hips. Inhale and lift your head and tailbone toward the ceiling, while curving your lower spine toward the floor. As you exhale, round your back, bringing your chin toward your chest and tucking your tailbone under. Repeat the exercise 10 times.

Use hot or cold therapy. Hot or cold therapy for sciatica can take many forms. For example, you might soak in a warm bath or apply a hot pack or a cold pack to your leg or back. "What works for one person might not work for another, so you may have to experiment to see what's best for you," Dr. Epstein says. How does it help sciatica? "Heat may loosen muscles, and cold may tamp down inflammation, but we don't know for sure," Dr. Epstein explains.

Relaxation. Staying relaxed is an important part of controlling both acute pain (the kind that's sudden and temporary) or chronic (ongoing) pain.

"All pain is processed in the mind. If you're able to calm the processing centres, the perception of pain may decrease," Dr. Epstein says. He recommends trying breathing exercises, meditation, yoga, or tai chi. Practicing mindfulness — focusing attention on the present moment — might also help ease discomfort by helping you to accept it.

Drugstore remedies

Several over-the-counter remedies can also play a part in relieving sciatica.

Oral painkillers. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) help reduce inflammation, which reduces pain. But they may cause stomach ulcers and bleeding, liver or kidney damage, or an increased risk of heart attacks. So get your doctor's okay before using them, and find out the dose and frequency that's safe for you.

Acetaminophen (Tylenol) is often less effective at relieving sciatica pain than NSAIDs, but it's also less risky — unless you take it in very high doses, which can cause liver damage. The usual limit is no more than 3,000 milligrams (mg) per day, but your doctor might set a lower limit depending on your health.

Topical painkillers. Applying painkillers to your skin as creams, gels, or patches can also bring sciatica relief. Topical NSAIDs such as diclofenac gel (Voltaren) may have fewer risks than NSAID pills, since topicals stay close to the site of application and aren't well absorbed by the rest of the body. But it's still wise to check with your doctor before using them. Other types of topicals with fewer risks than NSAIDs include creams, sprays, and patches that contain anaesthetics such as lidocaine; pain signal interrupters such as menthol or capsaicin; or arnica gel, an herbal remedy thought to have anti-inflammatory properties. 

Turmeric supplements. Turmeric (a golden-yellow spice) contains curcumin, which appears to have anti-inflammatory and antioxidant properties. "Although there have not yet been studies that prove its benefit, it's the one supplement that I would support for pain relief. There's no clear recommendation for dosage, but 1,000 mg per day might help. You can take it all at once or break it up into morning and evening doses," Dr. Epstein says.

Call your doctor

A typical flare-up lasts for a few days to a week or two. If it's not improving or responding to home remedies, it's time to make an appointment with your doctor.

Your doctor might order imaging tests and prescribe a prescription anti-inflammatory drug, such as oral or injected prednisone. "That will buy you a window of time to strengthen muscles without pain, and keep them flexible," Dr. Epstein says. "That will help keep your body strong and protected, so you'll be in a better place than where you started."

What if you don't reach out for help? "At times the nerve stays irritated for years," Dr. Epstein says. "So try not to delay treatment. Usually our interventions are able to put out the fire or at least calm the severity of the symptoms in a meaningful way."

If you'd like more information, check out the Harvard Special Health Report Finding Relief for Sciatica (/frfsc).

https://www.health.harvard.edu/pain/what-should-you-do-when-sciatica-flares 

To ease sciatica, keep moving

From sanjuandailystar.com

Ryan Smith was 23 when he felt a pop in his back while performing a heavy dead lift at the gym. That pop led to an immediate, radiating pain from his spine all the way down the back of his leg and into his foot. A physical therapy student at the time, he quickly recognized it as a possible sign of sciatica.

“The pain was debilitating,” said Smith, now a physical therapist in Maryland. “I couldn’t sit, I couldn’t drive long distances, and I had to stop exercising. All my PT common sense went out the window, and I began throwing everything at it, because I needed relief.”

Sciatica is pain resulting from irritation or injury to the sciatic nerves that start in your lower back and branch down your legs. The pain is often accompanied by a burning or pins-and-needles sensation.

An estimated 13% to 40% of the population will experience sciatica in their lives, most often during their 30s, 40s or 50s. The most common cause is a herniated disc, a condition that actually becomes less frequent as you age.

Unlike with muscles or other soft tissues, there is no consistent way to prevent nerve injury. But there are steps you can take to jump-start the healing process after you experience it.

Identifying sciatica

Sciatica has some unique distinctions from other back, butt or leg pain and only affects 5% to 10% of people who suffer from lower back pain.

“People often use the term to describe almost any pain traveling down the leg,” said Amy Benton, a physical therapist in Portland, Oregon. But true sciatica starts from the bottom of the lumbar spine, just above the gluteal muscles and usually radiates past the knee.

When the pain stays above the knee, it might feel like sciatica, Smith said, but it usually isn’t.

How to find relief

There’s no easy fix for sciatic pain, and the best healer is time. What eases one person’s pain might not work for the next. Whereas muscles, tendons or ligaments respond well to rehabilitative exercises, the evidence for physical therapy’s effectiveness on sciatica is mixed.

Still, it’s important to find ways to move.

“The worst thing you can do is to keep limiting your life and activity,” said Tom Jesson, a Houston-based physical therapist and author of “Understanding Sciatica.” “If you can tolerate the pain, keep moving as much as possible.”

Most experts agree that gentle exercise, like walking and swimming, is the best place to start. “This will get blood flowing around the tissues and the nerve pathway,” said Benton, who also recommends gentle massage or manual therapy.

Avoid stretching your back in the early stages, especially bending forward. It might seem like a logical way to get relief, but it can aggravate the nerve even more. Likewise, said Benton, don’t massage the space around the nerve in your back with a tennis ball or similar object, and don’t twist through the lower back while carrying weight.

There are a few targeted exercises that can help once the pain has calmed down, usually after the first couple of weeks.

It’s important to not only identify sciatica correctly, but find exercises you can comfortably do. (Joyce Lee/The New York Times)

Pain relieving exercises

Doing a prone press-up, which is a gentle version of a cobra pose, can ease nerve pain. Lie face down on the floor with your palms on the floor parallel to your chest. Gently press up, lifting your upper body off the floor but keeping your hands and hips on the floor. Hold for a couple of seconds, then release back to the floor. Repeat this 10 times.

Nerve flossing

Another option is nerve flossing, which gently slides the nerve within its sheath and can help alleviate short-term pain.

There are several flossing techniques for sciatic pain. These are not muscle stretches, so be gentle and focus on ease of movement. One common variation: Lie on the floor with your knees bent, feet on the floor. Place both hands behind the knee on the affected leg and pull it toward your chest, with your chin tucked. Hold for about five seconds and then slowly lower the foot back to the starting position. Try once or twice a day for 10 to 20 repetitions, but stop immediately if pain increases.

Moving forward

Exercises and physical therapy can help sciatica, but repair still takes time. “When you compare healing time to something like a calf strain, you’re in for a much longer process,” said Smith.

Most people will begin to feel some pain relief after the first two to four weeks, Jesson said, and more in the first three months. For some, sciatic pain can linger a year or more. Progress often isn’t linear, and you should expect occasional flare-ups.

In Smith’s case, that initial pop was a herniated disc. The most severe pain lasted for only a few weeks, but it was three full years before he returned to his regular strength training.

While there’s no foolproof method for preventing sciatic pain, core stability exercises may help, as does keeping your cardiovascular system healthy. Benton recommends her patients work with a physical therapist or trainer to check their form on major movement patterns, like squats, dead lifts, pullups and push-ups.

https://www.sanjuandailystar.com/post/to-ease-sciatica-keep-moving