Sciatic nerve pain: what can you do?

The sciatic nerve is the longest and thickest nerve in the human body. Experts also refer to it as the ischiadic nerve. The sciatic nerve originates in the plexus of nerves in the lumbar sacral region. It runs through the buttocks behind the hips and into the legs. There it runs along the back of the thigh to the back of the knee, where it divides into two main branches: the tibial nerve and the peroneal nerve. The path followed by these main branches of the sciatic nerve ends at the feet.

The sciatic nerve performs important functions in the body: it transmits motor signals from the brain to the muscles in the legs and feet. At the same time, it reports sensations from there back to the brain. Anyone with a trapped, inflamed or damaged sciatic nerve will usually experience pain. 

Pain in the sciatic nerve has various possible causes:

Reasons for a trapped sciatic nerve:

• Herniated disc: In the case of a herniated disc, fluid leaking from the disc puts pressure on the nerve roots of the sciatic nerve. Another cause of pain is a bulging disc.
• Spine misalignment: For some patients, this puts pressure on the sciatic nerve.
• Muscle tension in the back or buttocks: These types of muscle tension occasionally lead to sciatic nerve pain. They can be caused by a lack of exercise, overexertion or cold.
• Pressure in the pelvis: Some pregnancies cause pressure in the pelvic area, especially in the third trimester. This can sometimes lead to sciatica pain. This also applies to certain types of tumours.

Reasons for an inflamed sciatic nerve:

• Infection with the herpes zoster virus or Borrelia bacteria
• Mechanical irritation, e.g. from a bone tumour

Reasons for a damaged sciatic nerve:

• Injury to the nerve or nerve root, for example due to an operation
• Chronic illnesses such as rheumatism or diabetes
  

There are many symptoms of sciatic nerve pain. They include:

• Pain in typical areas: The pain is usually felt in the lower back. In addition to back pain, sciatic nerve pain occurs in the buttocks. From there, the pain runs to the back of the thigh and into the calf. Sometimes the pain spreads to the feet and toes. Sciatic nerve pain usually occurs on one side – that is, only on the left or only on the right.
• Movement-related pain: This intensifies with certain movements. For example, when you lift something, or when you sneeze or cough.
• Impaired sensation: If the sciatic nerve is inflamed or otherwise impaired, you may experience symptoms such as tingling or a feeling of cold or warmth. Sciatic nerve complaints also sometimes lead to numbness.
• Weakness: Weakness in the legs is another possible symptom if the sciatic nerve is inflamed or otherwise irritated.
• Motor complaints: Some sufferers experience motor impairment. For example, they find it difficult to lift their front foot or big toe, or they report a loss of strength or a feeling of paralysis in places. These symptoms often affect the hip flexors, lower legs and feet. Luckily, symptoms of paralysis are rare.
  

When you are diagnosed with sciatic nerve pain, your doctor will first ask about your medical history and your complaint: how long the pain lasts, what triggers it, and what alleviates the complaint. This is followed by a physical examination; the doctor will check your agility, muscle strength and reflexes. An important test for sciatic nerve pain is the Lasègue test. You lay on your back and your doctor raises your outstretched leg. If this causes pain, it may indicate that the sciatic nerve is affected. In certain cases, an imaging technique such as magnetic resonance imaging (MRI) can be useful in determining the causes and extent of the complaint.

From household remedies and exercises to medical treatment: there are quite a few things you can do for sciatic nerve pain. 

Sciatic nerve: household remedies

For treating the sciatic nerve, there are a number of simple activating measures and household remedies that can help:

• Limited bed rest: Rest is a good way to recover from acute pain. However, avoid complete bed rest. Instead, stay on the move and perform light activities. It’s best to talk to a specialist about how much movement makes sense for you.
• Massage: Using both hands, massage the upper area of your buttocks at the level of your tailbone with circular motions for two minutes. Move upward while circling. This massages and relaxes the sciatic nerve.
• Cold/heat: You may notice an improvement if you apply cold or heat to the sciatic nerve. Whether this helps varies from case to case. Try it out – for example, by placing a cold-hot pack on the painful area. A hot water bottle or cherry stone pillow may also have a beneficial effect.
• Acupressure also has a positive effect on sciatica pain in some cases. One acupressure point for the sciatic nerve is located in the middle of the back of your knee. Stimulate it by lying on your back, raising your knees slightly and taking five breaths. 

Physiotherapy 

In some cases, physiotherapy may be useful in treating the sciatic nerve. Among other things, this helps strengthen the back muscles and relax tense muscles. In some cases, your physiotherapist may apply tapes on the area around the sciatic nerve. These are self-adhesive elastic cotton tapes that can help relieve the pain. 

Medical treatment for sciatic nerve

For sciatic nerve pain, medical treatment may be advisable – for example, with medications such as ibuprofen, paracetamol or opioid analgesics. In certain cases, specialists prescribe antibiotics – for example, when an infection or an accumulation of pus triggers sciatic nerve pain. Occasionally, epidural steroid injections also alleviate the complaint. Talk to your doctor about the best treatment for your case.  

What helps with sciatica pain if medication and physiotherapy are not effective? In rare cases, specialists recommend an operation. This could be, for example, if a herniated disc is causing severe pain or additional severe complaints. These can include symptoms of paralysis and bowel dysfunction. 

Sciatic nerve: exercises for pain

In addition to home remedies, physiotherapy and medical treatment, special exercises can also help with sciatica pain. Which exercises work in which cases is highly individual. Ask a professional for advice and let them guide you through the exercises.

Did you know that if you have pain in the sciatic nerve, exercise may have a calming effect? That can include hiking, swimming or yoga. Talk to a specialist about the exercise that’s best for you. Avoid exercising with heavy weights. This may exacerbate the pain in the sciatic nerve. 

Sciatic nerve pain: what else helps?

• Medicinal plants: Natural painkillers such as ointments with arnica, willow bark and devil’s claw can sometimes have a soothing effect on sciatic nerve pain, particularly if the pain is caused by a rheumatic illness.
• Essential oils: Some sufferers find that a bath with essential oils alleviates symptoms. Choose oils with spruce needle, rosemary or comfrey.
• Put your legs up: To relieve the sciatic nerve, lie on your back. Place your lower legs on several cushions or a chair so that your hips and knees are at a right angle. This step position relaxes the spine.
• Sleeping position: If you have pain from your sciatic nerve, it is important to find the right sleeping position. Look for a position that is comfortable for you. If possible, change your sleeping position regularly. This stimulates blood circulation in the muscles and prevents tension.
• Long-term behavioural change: Prevent sciatic nerve pain in the long term with plenty of varied exercise. This will help to prevent tension. 

Sciatica pain is unpleasant. Fortunately, there are many ways to alleviate it. Ask a specialist to show you sciatic nerve exercises and find out what does you good. Consult your doctor; they will be able to support you with individually tailored treatment.