Medication For Sciatica

Hi Mark,

It sounds like you may have some disc issues as well as piriformis problems, so I’d suggest doing both the McKenzie exercises and the piriformis stretch as frequently as possible and also try some cold packs on the lower back to help with any inflammatory swelling that may be present. For best results, make sure to follow the instructions in the free ebook. If you don’t already have it, you can download it from the link on the right sidebar of this page:

http://www.sciaticaselfcare.com/basic-sciatica-exercises/

Walking is usually helpful, but keep the time within your tolerance – it’s not good to force yourself through a lot of pain. It is better to walk for short periods that don’t significantly increase your symptoms on a frequent basis than to try to force yourself to walk longer with pain.

If you have further questions, let me know.

Good luck!

Dr. Best

Hello Sonny,

While it’s not really a specific treatment for sciatica, swimming may reduce symptoms somewhat by means of improving circulation. In many cases, inflammatory swelling plays a role in symptoms and low-impact activity like swimming increases circulation to “pump” away swelling thereby reducing pressure and irritation on the nerves. Swimming is also good as a general conditioning exercise to keep the trunk muscles toned which can help provide stabilization of the spine to help prevent recurrences of back pain and sciatica.

Dr. Best

Hello Alan,

Some people get very good symptom relief with TENS units, while others don’t get much effect, at least not with the factory settings. In some cases, you can experiment with the settings and improve effectiveness. When they work, TENS units can be quite useful and eliminate or reduce pain without having a risk of significant side-effects. Just bear in mind that they only reduce symptoms temporarily and don’t really fix anything, so it’s still important to do the exercises, apply cold packs, etc. to promote actual healing.

Dr. Best

It would be unusual, but a bone spur at the back of knee could potentially cause sciatica, but the symptoms would probably be from the knee down rather than from the hip and buttock down. I have never personally seen a case where there was sciatica due to a bone spur in the knee, but I have seen a few cases in which what’s known as a Baker’s cyst (also called a popliteal cyst) in the knee has produced sciatica (again, only from the knee down rather than the more usual from the hip and buttock down the leg).

Dr. Best

Hello Elita,

The medication you were prescribed is an non-steroidal anti-inflammatory drug (NSAID) and it may or may not help reduce your symptoms to some extent. Like all NSAIDs, there is a risk of side-effects including kidney damage and gastrointestinal bleeding, but the risk is relatively low when taken short-term. As a point of clarification, a CT scan doesn’t say that you have sciatica. Sciatica is a symptom (specifically, pain into the buttock which may extend down the back of the leg), not a disease nor structural issue you can see. A CT scan would show things like a disc protrusion or a bone spur which in turn could cause sciatica. In many cases, inflammation contributes to the symptoms produced by such structural issues, but it is not usually the primary problem. So, using an anti-inflammatory medication will usually help reduce symptoms related to the inflammation, but it does nothing to help the underlying cause. Even when such drugs provide complete relief, because the underlying problem remains, the symptoms usually will return at some point. For this reason, I strongly recommend using methods such as those in my ebook (if you haven’t already downloaded it, you may do so from the link on the right sidebar of this page: to address the actual cause, rather than just suppressing the symptoms with drugs.

Dr. Best

I assume you mean acupuncture, and it can be helpful for many conditions, including sciatica. No treatment is 100% effective, but acupuncture is definitely worth a try.

Dr. Best

Hello Carole,

Age is not really a major factor in itself. On the one hand, older individuals tend to have more degenerative issues in the spine that can contribute to sciatica, but older individuals are less likely to sustain an acute disc protrusion (since the inner gel of the disc tends to become less fluid as we age).

Dr. Best

“Cure” is a relative term. While it is certainly possible to get rid of symptoms for an extended period of time with whatever treatment is effective for a given case, in most cases it is better to think in terms of managing the condition long-term rather than thinking of a once and for all cure. Medication is just for symptom relief, but exercises (such as the ones in my ebook) can be a good long-term management method to keep the underlying causes of the symptoms in check and most people can minimize the frequency and severity of symptom recurrences with preventive exercises, either as a stand-alone treatment regimen or in combination with other forms of conservative treatment such as chiropractic and physical therapy.

Going back to the idea of a complete, permanent cure, in most cases that is simply not a realistic expectation, even with surgery. So again, long-term management and prevention is really the way to look at it, not going in with the expectation of a one-time permanent cure.

Laser is usually helpful for reducing inflammation and muscle spasm; however it is not likely to help much when there is a major disc protrusion or some other space-occupying lesion (such as bone spurs, degeneative ligament thickening, spinal cysts, etc.) in the spine that is directly compressing the nerve. Symptoms in the buttock and foot could be due to nerve compression in the spine, piriformis syndrome, or both. While not completely definitive, the two simple tests discussed on the homepage of this website will give some indication as to whether the problem is more due to spinal issues or the piriformis.

Dr. Best

The first question I have is what recent imaging was done that the surgeon is basing his opinion on? In long-standing cases like yours, there’s sometimes a tendency to look at old imaging studies and maybe just update with regular X-rays. X-rays are not sufficient for diagnosis in a case like yours in my opinion. An MRI (preferable unless you have some kind of metal implantation in your body which contraindicates it) or CT scan is needed to be able to evaluate the soft tissue structures as well as the bony structures. If you haven’t had an MRI or CT in the past year or two, that would be my first step.

If you have had a recent MRI or CT, it is entirely possible that it has been mis-read by either the orthopedist, the radiologist, or both (rare, but I’ve seen it happen). The other possibility that comes to mind is that you may be in Canada, or possibly Ireland. I don’t know what the deal is in those countries, but they REALLY resist doing surgery on anyone under the NHS. I’ve seen cases with full-on disc ruptures in which the doctors outright lied (my assumption since the radiology report clearly indicated a major problem) and told the patients there was nothing wrong and just stick with the pain meds. If that’s the case with you, it is not easy to get the necessary treatment, but there are ways I can go into if need be.

Finally, it is possible that you have had a recent MRI or CT and it did not show anything significant. In about 25% of cases, standard MRI (done lying down) failed to show significant disc lesions that did show up on upright or loaded MRI. If your symptoms are significantly better when lying down versus standing or sitting, there may be a problem that would go undetected by a lying down MRI. If that is a possibility, I would inquire about getting an upright MRI (or a loaded MRI, which is done lying down with a harness system to mimic weight bearing).

If you’re in the U.S., you’re likely on Medicare and if the diagnostics don’t show anything significant to do surgery on, the surgery won’t be covered. You have to have a good reason for them to cover such an expense, and if the surgeon can’t justify it, he probably doesn’t want to try to get authorization from Medicare (it makes him look bad and if he does it too often, it can trigger audits and all sorts of unpleasantness for him).

From what you’ve said, surgery is probably indicated in your case, but the diagnostics may very well be the issue. If you’ve had recent imaging, you can get a second opinion, either from a local radiologist, another surgeon, or you can send the report and/or images to me to take a look. Just an FYI to temper expectations, surgery might or might not get you symptom-free, but it sounds to me like it probably would make a significant improvement in your case.

Hopefully this clears some things up for you and at least gives you a point to move forward from.

In any event, I wish you good luck!

Dr. Best

Hello,

First, I think it’s important to look at this as a condition to be managed from now on, rather than something to be cured once and for all and never have to do anything about it again. This goes into more detail on that concept: Sciatica Management Versus Cure.

Unfortunately, prolonged sitting is going to continually place stress on the damaged discs. I recommend either getting a standing desk or some type of computer platform that allows you to change from a sitting to standing position periodically throughout your work day. There are several of these types of platforms on the market ranging in price from fairly expensive (Varidesk is one brand on the high end of the price scale) to more inexpensive basic stands that are a set height that you can just place on top of the desk when you want to work standing up (Furinno is one brand of these). Even just a sturdy box will work if need-be. If your work will not allow you to work in a standing position, then the best you can do is try to take brief breaks from sitting as often as possible. Even just 30 seconds to a minute of standing up, stretching and/or walking around a few times per hour will help.

Besides figuring out what will work to reduce your sitting hours, the basic McKenzie exercise from my free ebook (done in whichever position best centralizes and decreases symptoms – as discussed in detail in the instructions) is a good preventive exercise. When symptoms are present, I recommend doing it as frequently as possible, up to 5 or 6 times per hour for a minute or so at a time, but for prevention, a minute or so a couple of times per day will usually go a long way toward preventing symptom flare-ups. There are additional prevention exercises in the members area of my site or in my expanded book, but frankly, the McKenzie exercise is the most important, although stretching the hamstrings and working on keeping the abdominal core muscles toned is usually helpful as well.

It is not unusual for residual symptoms to last for a few weeks following a major flare-up, as it takes some time for the inflammatory response and muscle reactions to subside. Using cold packs as directed in my free ebook helps with the inflammation. Massage, either self-massage or done by a professional, will usually help considerably with the soreness in the back and buttock muscles (just go easy on them at first to avoid causing increased irritation).

Just in case you have not already downloaded my free ebook, you may do so from the link on this page.

If you have further questions, let me know.

Good luck!

Dr. Best

Hi Cindy,

The glide and the McKenzie stretches are intended to be done based on the principle of centralization. Centralization means that the exercise causes the pain furthest from the spine to reduce. For example, if you have pain that extends from your low back or buttock area to the foot, you are looking for the exercise to cause the pain in the foot to decrease first (the pain higher up in the leg or in the low back/buttock area may stay the same or even increase, but as long as the symptoms furthest from the spine decrease, you’re on the right track). The McKenzie exercise in straight extension is the one that most commonly produces centralization in the case of disc herniations, so therapists and doctors will often just have people do that one without testing to see if if produces centralization or if another position produces better centralization. It’s important to test all 6 of the McKenzie positions (straight extension, straigh flexion, and extension and flexion combined with left and right side bending). The same goes for the glide – usually it’s done with the painful side furthest from the wall, but it’s important to test for centralization. Anything (even if it’s part of the normal treatmnent protocol) that causes greater symptoms furthest from the spine (de-centralization) should be avoided!

In my opinion, when significant pain is present, resistance exercises should be avoided. So, I would not recommend doing the superman with weights on your feet and hands while you’re hurting. Even without the weights, the superman exercise may irritate the muscle reactions that are present. That exercise is good for strengthening and rehabilitation after the major symptoms are gone, but it may only be irritating things right now. The other stretches you mentioned are probably fine, but it’s always advisable to stop doing any exercise that seems to be causing increased symptoms after you’ve used it a few times (as I said in my last reply, increased symptoms are common in the first few therapy sessions, but if therapy is still causing increased symptoms after 5 weeks, the program needs to be re-evaluated).

Dr. Best