5 Ways To Manage Sciatica Pain, From An Occupational Therapist

If you've ever experienced sciatica, that burning, aching feeling that radiates down one leg, you know how much it can impact your day.

Hip and leg pain from sciatica can affect everything from a good night's sleep to getting where you need to go.

As an occupational therapist and yoga therapist, I've personally experienced sciatica on and off for years, especially during periods of strenuous exercise and seated work. To feel better again often requires a thoughtful approach to lifestyle changes and medical support. 

What is sciatica?

The sciatic nerve is the thickest nerve in your body, at its largest, about 2 cm. It originates in the lower back as a spinal nerve and routes through the hip and down the legs, calves, and feet. It connects the central nervous system to the lower body and has sensory and motor functions, meaning it helps control the legs, feet, and toes.

The sciatic nerve has branches on both sides of the body, but with sciatica, typically, just one side is affected.

Sciatica occurs when the nerve is impinged, crushed, or compressed in some way. 

There are a few common symptoms:

Sciatica is most likely to occur in people in their 40s, with estimates of a person developing it between 12.2% and 27%1. Some research indicates a genetic predisposition1, though those whose work keeps them in strained or unnatural positions, like truck drivers, may be at higher risk.

What causes it?

Contrary to popular belief, there's not enough evidence linking sciatica to BMI 1and weight in people under 50.1 There is good evidence linking sciatica to pregnancy, herniated discs, and spinal stenosis.

For decades, the dominant clinical opinion regarding the cause of sciatica was that it was nerve pain caused by compression of the spinal nerves from herniated intervertebral discs. These discs are like pillows that act as gel cushions between each level of the spine, and when they herniate (or "slip"), they can press upon nerves leaving the spine, like the sciatic nerve.

More recently, piriformis syndrome2 has been thought to be an alternate explanation of sciatica symptoms. The piriformis is a muscle that lies superficial to the sciatic nerve in the hip and assists in hip extension and leg rotation.

Inflammation, muscle spasms, and muscle scarring can press on the sciatic nerve, which runs under it. Piriformis syndrome symptoms might feel the same as sciatica but are more localized to a specific area like the hip.

Lifestyle strategies for sciatica

Although living with chronic sciatica presents challenges, especially with everyday tasks like sitting at the computer and vigorous exercise, implementing a few strategies can make long-term or chronic sciatica more bearable:

Use proper lifting techniques, especially at the gym or if work requires lifting heavy objects. Optimizing ergonomics in your workspace can help better support the spine and hips.

Massage could also be a helpful modality to add to your tool kit. A study on the efficacy of cross-friction massage compared to stretching exercises for patients with piriformis syndrome, which often mimics or contributes to sciatica pain, demonstrated that massage therapy significantly reduces pain and improves functional abilities.

Another major complaint is sciatica interfering with sleep. Sleeping or lying on a flat back can put additional pressure on the sciatic nerve that is already inflamed or compressed, making the pain worse. Experts recommend sleeping on your non-affected side, with a pillow between your legs to relieve pressure on your knees. Another option is to sleep flat on your back with a pillow under the knees.

Yoga therapy for sciatica

Yoga can offer a therapeutic approach for managing sciatica, though it requires careful application. A 2012 study involving 80 participants revealed that yoga, including specific postures and breathing exercises, significantly reduced pain, anxiety, and depression5 while improving spinal mobility. This was compared to a control group that participated in physical therapy exercises, counseling, and educational sessions, with the yoga group showing more substantial improvements.

However, yoga's therapeutic potential comes with a cautionary note. A case report of a 67-year-old woman developing bilateral sciatica6 after performing an advanced yoga pose illustrates the importance of being mindful of one's body's limits.

In contrast, a 2015 randomized control trial involving 61 adults with nonspecific low-back pain or sciatica and disc extrusions or bulges found that a three-month yoga course significantly reduced pain and disability7 without any reported adverse effects, further supporting yoga's safety and efficacy for this demographic.

How a health care provider can help

With sciatica symptoms, it's essential to see a health care provider to diagnose the underlying cause—which could be as simple as a tight piriformis or a sign of a more significant issue like a herniated disc. 

It's important to remember that sciatica is a syndrome8, not a disease, and a herniated disc causes most cases.

See a provider immediately if there is a danger of falling because of pain or numbness, problems controlling your bowel or bladder, sudden pain or weakness, trauma, or trouble picking up your foot from the floor—as these are all signs of a severe medical issue.

A health care provider might use ultrasound, a CT scan, an MRI, or EMG to image the tissue and surrounding areas. A physical therapist, occupational therapist, or massage therapist can also be a health care team member who prescribes exercises and activities to reduce pain and improve function. In some cases, providers might recommend surgery.

Your primary care provider might recommend exercise, massage, or medications such as Nonsteroidal anti-inflammatory drugs, steroids, or Botox injections.

The takeaway

Sciatica can cause pain and activity limitations but can be managed with medical treatment, preventive strategies, and alternative and complementary modalities, such as acupuncture and massage. In most cases, the underlying cause of sciatica is a herniated disk, and how the pain is treated depends on the root issue. It's essential to seek the knowledge of an experienced clinician who has experience in promoting health and function, especially for people with chronic sciatica.