Question:

I have very painful sciatica, which has reduced me from someone who walked several days a week to a complete slug. I do stretching exercises twice a day given by a therapist, but it does little good. Any advice? 

Answered by Shelly Walker, PT, OCS:

Sciatica is an aching or burning pain that begins in your buttocks and travels down the back of your leg. It can be constant or may come and go with change of position. You may experience numbness and tingling as well. It is often worse when sitting or bending forward. 

Sciatic nerve pain occurs when the nerve in the buttock area becomes irritated by being over stretched or compressed. The pain runs down the back of your thigh like your hamstring. Common causes include a bulging disk or boney changes in the spine due to arthritis or occasionally, muscle spasms in the buttocks. Pregnant women may experience sciatica if their baby's head presses on the nerve in the pelvis.

Sciatic nerve pain is not related to bursitis, shingles, plantar fasciitis or radiculopathy. Sciatica is related to radiculopathy, however, sciatica is a more general term and radiculopathy is related to a specific spinal level. Lumbar radiculopathy is caused when the nerve roots located by the spinal canal become irritated.  Symptoms include a sharp pain in the back and legs that worsens with certain activities. It can also cause weakness, numbness and tingling in the legs.

How to treat sciatica

To treat sciatica, you must identify and address the cause. In general, your nerves need space, the ability to move and glide and good blood flow and oxygen to function properly. 

Remaining active and flexible go a long way toward preventing sciatica. Sitting for long periods of time at your computer or on long car rides are not nerve friendly activities. Stop the car every couple of hours and walk around and stretch for a few minutes. If you work at a desk all day, try to get up and walk around every 30 to 60 minutes. A sit to stand desk can help relieve pressure on your bottom and get the blood flowing. 

While stretching your hamstring may seem like a good idea, nerves don't tolerate more than 9 seconds of traction before they get fired up and let you know about it. Therefore, prolonged stretching isn't good until the nerve is calmed back down. Cold packs may be helpful in decreasing the sensitivity of the nerve. 

When to seek health care advice

Depending on the cause of your sciatica, it may resolve in a couple of weeks with changes in your activity patterns or it may linger for several months. If you have been self-treating for two to three weeks and are seeing no improvement or you develop muscle weakness in your leg, it may be time to seek professional evaluation to help pinpoint the cause of your leg pain.

If you experience a new loss of bowel or bladder control in association with your sciatica, you should go to the emergency room. It could be a serious problem that requires immediate attention.