What can you do for severe sciatica pain?

Written by: Mr Jonathan Bull
Published: | Updated: 18/06/2021
Edited by: Cameron Gibson-Watt

Sciatica pain is caused when the sciatica nerve in your lower back becomes compressed or irritated, causing pain to radiate across your lower back and down your legs. When this pain gets severe, how can you find relief?

 

Mr Jonathan Bull, a consultant neurosurgeon and spinal surgeon, reveals the most effective way to reduce sciatic pain and what type of treatments may be offered by a specialist.

 

A woman with sciatica

 

Why is my sciatica pain getting worse?

The likely cause of your sciatica pain worsening is due to inactivity. Lack of exercise and physical activity can make sciatica worse in the long term.

 

If you are sitting down too much, the sciatic nerve, which runs from your lower back to your feet, gets irritated from the pressure of spinal discs. The nerve ends up getting squashed between the discs and bones. Behind the disc, there is also a joint which can become stiff and painful to move and the muscles overlying that also become stiff. Usually, when you move, the joint opens and offloads the nerve, but being too inactive makes that joint less mobile and compresses the sciatic nerve.

 

People with sciatica usually avoid activity because of the pain which only causes the muscles and joint to become stiffer and tighter. Consequently, the pain gets worse.

 

Disc enlargement is another cause of sciatica pain. The nerves in the spine normally have enough space to slide up and down the spine, but if a disc bulges or enlarges, it can put pressure on the nerve and increase your lower limb pain.

 

What can I do to relieve sciatica pain?

The first step is to take painkillers to control the pain and make yourself more mobile. You can combine paracetamol and ibuprofen to relieve pain and reduce inflammation.

 

You should also focus on maintaining a good level of physical activities. This can include walking, cycling, gentle stretching, yoga, pilates, swimming, etc. Anything you can do to increase your mobility safely and gently is going to be helpful.

 

How long does an acute episode last?

It can vary, but it usually lasts around 4-6 weeks and gets better with time.

 

During these acute episodes, you should find ways to manage the pain and stay active. As long as there isn’t a neurological deficit, it should get better on its own accord.

 

How should I lie down or sleep with sciatica?

You should choose whatever feels comfortable for you!

 

Many people find the pain is worse in the morning. This is because you are inactive at night, so the muscles and joints tighten. Once you get up and begin moving around, the muscles start to receive more blood supply and the pain should improve.

 

How can I prevent future flare-ups?

There are some things you can do to prevent future sciatica flare-ups:

 

  • Exercising regularly will help maintain strength in your back. Pilates and yoga are beneficial in the long term as they help to build up core muscle strength in your abdomen that will support your back. As you get older, performing a warm-up and warm-down are also very important.
  • When sitting, you should maintain a good posture. For those working from home now, this is particularly important. You should make sure you have the keyboard in the correct position and the screen at eye height. Break up the period of time between sitting and standing, and make sure you are stretching your body regularly.
  • Avoid bending over to lift heavy objects. If you have to, make sure to keep your feet apart and bend at the waist. Do not lock your knees or make sudden movements.
  • Practice good posture when standing for long periods and wear supportive shoes when walking around.
  • Maintain a healthy diet - the less you weigh, the better. Eating well and having a healthy BMI will improve your general mood and encourage you to be more active.

 

When should I see a doctor for sciatica?

If you develop any weakness or if you can’t cope with the pain you should see your doctor. They can refer you to a physiotherapist, which at this stage is one of the best ways to manage sciatica pain.

 

If you have severe pain, numbness and problems passing urine you should go to the A&E, as this combination of symptoms can indicate a serious condition known as cauda equina, which needs urgent treatment.

 

What medication can a doctor give me for sciatica pain?

If your sciatica pain becomes more severe and you can’t manage it with over-the-counter medication and physiotherapy, then there are some injections that you can receive. These are usually epidural injections and facet joint injections.

 

When is surgery an option for sciatica?

Only a very small amount of people go on to have sciatica surgery. When all other treatment options fail, your doctor may suggest surgery.

 

Common options include microdiscectomy and laminectomy. These are usually minimally invasive and only require a short stay in hospital.

 

If you are suffering from sciatica pain and would like to see a consultant spinal surgeon, go to Mr Jonathan Bull’s Top Doctors profile and check his availability.

By Mr Jonathan Bull
Neurosurgery

Mr Jonathan Bull is a consultant neurosurgeon and spinal surgeon. He treats a full range of brain and spinal disorders which cause pain and dysfunction in the spine and the limbs with both simple and complex procedures.

He studied neurophysiology and medicine at Cambridge University before qualifying in 2000.

Mr Bull completed initial surgical training at St Mary’s campus, Imperial College, followed by higher surgical training in neurosurgery under the tutelage of Henry Marsh in the south Thames Programme. Alongside this, he achieved a Doctor of Medicine (MD Res) at University College London (UCL) specialising in MRI imaging of paediatric brain tumours.

He then undertook two specialist fellowships in complex spine surgery, initially as the Sir Victor Horsley Complex Spine fellow between the Royal National Orthopaedic Hospital, Stanmore and the National Hospital for Neurology and Neurosurgery (Queen Square). He was subsequently awarded a European Association of Neurosurgical Societies (EANS) fellowship at University Hospital Klinikum rechts der Isar. He became a Fellow of the Royal College of Surgeons in 2011.

Mr Bull joined the Barts Health Trust as a Consultant in 2012; his NHS practice is based in the Trust’s Royal London Hospital.

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