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Pain
Taming the pain of sciatica: For most people, time heals and less is more
- By Steven J. Atlas, MD, MPH, Contributor
Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the leg, often below the knee. The most common cause is a bulging ("herniated") disc in the lower back. Discs are tire-like structures that sit between the bones of the spine. If the outer rim of the disc tears, usually due to routine pressure on the lower back, the jelly-like inner material can come out and pinch or inflame the nearby nerve. Sciatica is most common in people 30 to 50.
How do you know if it is sciatica?
The key to diagnosing sciatica is a thorough history and a focused exam. Sciatica symptoms are often worse with sitting or coughing and may be accompanied by numbness or tingling in the leg. A physical exam can confirm that the sciatic nerve is involved. If there is muscle weakness or diminished reflexes in the involved leg, an imaging test such as a back MRI can be useful and help guide a decision for early surgery.
Treating sciatica pain… and managing expectations
Many people think (understandably) that the worse the pain, the more likely something bad is going on. However, this isn’t true for sciatica. The body can reabsorb the disc material that is causing symptoms, even for those with severe pain. So, treatment focuses on controlling pain and keeping people as active as possible.
If the pain is excruciating, lying down for short periods can help, but prolonged bed rest does not. So, once the pain becomes manageable, it’s important to get up and start walking short distances. Since sitting increases pressure on the discs in the lower back, avoid prolonged sitting or driving. Many people try treatments like physical therapy, massage, acupuncture, and chiropractic manipulation, but evidence suggests that while these approaches may help typical low back pain, they are less helpful for sciatica. Over-the-counter pain medicines like ibuprofen and naproxen can help. When they don’t, short-term use of stronger, prescription pain medicines may be needed.
The good news is that for most (roughly three out of four) people, symptoms improve over a few weeks. For those not improving after six weeks, surgery is an option. We know surgery can speed up recovery, but by six to 12 months people who have surgery are usually doing about as well as those who decide to just give the body more time to heal on its own. Surgery involves removing the disc material that is affecting the nerve. It is generally a very safe procedure, and while complications are rare, they can happen. What’s more, 5% to 10% of people who have surgery will not be helped by it or may have worse pain afterwards.
Patients often ask about spinal injections — where steroid medicine is injected into the affected area. It is worth considering for those with uncontrolled pain or for those with persistent, bothersome symptoms who want to avoid surgery. Injections can provide short-term sciatica relief. Like any procedure, it has uncommon risks including more pain, and it doesn’t seem to decrease the need for future surgery.
Sources
Herniated lumbar intervertebral disk. New England Journal of Medicine, May 2016.
Evaluating and managing acute low back pain in the primary care setting. Journal of General Internal Medicine, February 2001.
Epidural corticosteroid injections for radiculopathy and spinal stenosis. Annals of Internal Medicine, September 2015.
Adapted from a Harvard Health Blog post by Steven J. Atlas, MD, MPH
About the Author

Steven J. Atlas, MD, MPH, Contributor
Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Comments
Dr.Atlas, I had a few questions regarding this article and sciatica. Why is the pain associated with sciatica worsened when coughing? Is it because coughing increases pressure on the discs in the lower back like sitting? Also, I know that this article includes ways of reducing pain and managing symptoms but is it possible for the symptoms of sciatica to completely disappear without external help such as surgery or injections? Lastly, is it possible to have sciatica with chronic back pain as well? Thank you!
Sarvika,
You’re correct – things that increase pressure in the disc space can worsen sciatica. This includes things like bending over, sitting and coughing. Regarding your question about symptoms disappearing without external help, this is a key point of my piece. Yes, for most (over 75%) symptoms improve with time. We believe this is related to inflammatory cells in the body recognizing the disc material that has migrated out of the disc itself as being out of place and working to reabsorb the material. This can take weeks, which is why sciatica typically lasts longer than usual low back pain due to muscle or soft tissue strains. Also, it isn’t clear whether injections help the body resolve the problem. Studies are conflicting on whether injections decrease the need for subsequent surgery. But it is possible that the anti-inflammatory agents used may prevent the body from healing itself as noted. Finally, it is possible to have chronic back pain with sciatica. This includes patients with chronic low back pain who then develop sciatica due to a new disc herniation or those who actually have sciatica for a long period of time. The challenging issue is that surgery appears less effective in those with chronic sciatica. Depending on the study, this refers to symptoms that have lasted more than 6 – 12 months.
I am surprised you didn’t mention stretching and/or yoga, both of which are effective in managing sciatic pain and symptoms; yoga has a specific stretch, lying on one’s back, that addresses sciatica;
Thanks for your comment. In a short piece like this, it is hard to cover everything. I do refer to physical therapy that would include stretching. These treatments can help keep one active as the body deals with the disc herniation, but there isn’t much evidence that these treatments, including yoga, decrease pain or affect the overall outcome. Most studies showing the benefit of yoga have been in those with chronic back pain without sciatica.
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