Treatment for sciatica — pain that occurs along the sciatic nerve because of compression — generally starts with home remedies such as stretching, and, if it doesn’t clear up on its own, progresses to other approaches, such as physical therapy, steroid injections, and, as a last resort, surgical interventions.

According to Shideh Chinichian, MD, a family medicine physician with Mercy Medical Group based in El Dorado Hills, California, some doctors prefer that you wait a few weeks before making an appointment to see if the pain of sciatica goes away on its own, because it will in many cases.

“The time to see an MD is after two or more weeks of severe pain,” says Loren Fishman, MD, the medical director of Manhattan Physical Medicine and Rehabilitation in New York City.

But you should seek immediate care “when weakness or intractable pain develops, or the numbness begins to ascend from the feet to the ankles toward the knees, or when there is a loss of bowel or bladder control,” says Dr. Fishman.

When you see a doctor for symptoms suggesting sciatica, you will be asked about the nature of your symptoms, when and how they started, and whether anything worsens or improves them. Your doctor will also assess your back, legs, and neurological function with some simple tests.

Arriving at a diagnosis of sciatica may require no more than that, but in some cases your doctor will also want you to have an imaging study, such as an X-ray, or test the functioning of your muscles and nerves using electromyography.

Pain Management Strategies for Sciatica

Once it’s determined you most likely have sciatica, you and your doctor will decide together how to treat it.

Initial treatment can include the following:

• Applying ice or warmth to the areas that hurt
• Stretching your hips and legs, particularly your hamstrings, the muscles on the backs of your thighs
• Avoiding sitting for long periods
• Seeing a physical therapist for assistance with stretching, heat or ice therapy, and exercises to strengthen the core muscles that support the spine
• Taking anti-inflammatory or analgesic medication, as recommended by your doctor
• Trying complementary therapies, such acupuncture or a method like the Alexander technique, which can improve overall body alignment

If these interventions do not help the pain, and imaging tests were not done earlier, Dr. Chinichian says a physician will likely consider ordering an X-ray to look for bone spurs that could be pressing on the nerve root, or an MRI to see if there is a herniated disk potentially causing the symptoms.

How to Stretch Safely With Sciatica

When stretching to help with sciatica, stretch only until you feel a gentle tension in your limb or other body part. Hold the stretch for at least 10 seconds initially, and build up to holding the stretch for at least 30 seconds. Don’t bounce as you stretch, and don’t hold your breath; breathe normally. (1)

An easy hamstring stretch for people with sciatica is to lie on your back, raise one leg in the air, wrap a towel or strap around the raised thigh or foot, and support your leg with the towel while gently straightening your knee. The leg on the floor can be bent or straight, whichever is more comfortable. You should feel a stretch along the back of your leg.

Another option is to sit on the edge of a chair with both feet firmly on the floor. Extend one leg and flex the foot, so the weight of your leg is resting on your heel. Keeping your back “straight,” gently rock forward on your sit bones so your navel moves slightly toward your leg. You should feel a stretch along the back of your leg.

When you stretch, do it with the goal of feeling better, not becoming more flexible or increasing your range of motion. Over time you may become more flexible and increase your range of motion, but these gains tend to happen slowly, with regular practice.

Pushing (or pulling) too hard in a stretch can cause tiny tears in your muscles, tendons, and ligaments, which will hurt and can cause you to become less flexible, not more.

Using Over-the-Counter (OTC) Pain Medication Safely

Over-the-counter anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), can help ease the pain of sciatica, but overusing these medicines — taking too much at once or using them for prolonged periods — can have dangerous side effects, including damage to the lining of the stomach and even stomach ulcers. (2)

The pain reliever acetaminophen (Tylenol) can cause liver damage if you take more than 3,000 milligrams per day. When calculating your total daily intake, it’s important to read the labels of all the prescription and nonprescription drugs you take to determine which, if any, contain acetaminophen. If you’re not sure if a product contains acetaminophen, ask your doctor or pharmacist. (3)

The risk of liver damage from acetaminophen is also higher in people who drink three or more alcoholic drinks per day or have pre-existing liver disease. (3)

If you find yourself relying on OTC pain medication to relieve sciatica pain for weeks on end, see your doctor for an alternative plan to controlling pain.

Steroid Injections

For severe sciatica pain, a physician may recommend an epidural steroid injection, in which a corticosteroid medicine is injected near the spinal nerve roots. The relief from an epidural steroid injection can last for a few months or longer.

Surgery for Sciatica

Surgery can be highly effective for severe cases of sciatica. The type of surgery depends on what is causing the pain.

If it appears a herniated disk is pressing on the sciatic nerve, all or part of the disk can be surgically removed.

Another option to relieve pressure on the spinal cord or nerves is a laminectomy. This type of surgery removes the back section of a vertebra to enlarge the spinal canal.

“Referral for surgery can become an option when conservative methods have failed to improve symptoms affecting quality of life,” Chinichian says.

Complementary Approaches to Sciatica

Many Americans look to complementary approaches to relieve the symptoms of sciatica. Among the more popular modalities tried for musculoskeletal pain, including sciatica, are:

• Supplements
• A mind-body approach, such as hypnosis or yoga
• Practitioner-based approaches, such as the Alexander technique or chiropractic
• Whole medical system approaches, such as acupuncture (5)

Some of these approaches have been studied for the treatment of sciatica. A 2015 systematic review and meta-analysis of studies of acupuncture for treating sciatica concluded that acupuncture may be more effective at decreasing leg and lower back pain than NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen. Acupuncture combined with pain medication also appeared more effective than medication used alone. And acupuncture also appears to be associated with fewer side effects than NSAIDs. Still, the number of studies in the analysis was small. (6)

Even approaches that have not been studied in any systematic way for sciatica may be worth a try, as long as there’s no reason to believe they might worsen your sciatica.

That being said, any complementary therapy must be approached with caution, with the costs of the treatment and potential risks clearly understood.

Supplements, in particular, can be risky if they interact with any prescription or nonprescription drugs you take.

Even normally safe activities, such as yoga — for which there is evidence of a positive effect on low back pain (7) — or Pilates, can worsen sciatica if pursued too vigorously or if poses that exacerbate the underlying cause of the sciatica are done. Speaking to a class instructor or physical therapist can help you to identify moves that shouldn’t hurt and may help. And as always, listening to your body is paramount during exercise. If something causes acute pain, stop doing it.

If you’re uncertain about the risks of a therapy, speak to your primary care doctor before giving it a try.

The Alexander Technique

The Alexander technique teaches people how to release unnecessary muscle tension so they can sit, stand, and move more comfortably.

Judith C. Stern, a retired physical therapist and certified teacher of the Alexander technique, says that physical therapy helped her clients with sciatica, but it wasn’t a long-term solution.

She says the Alexander technique addresses an individual’s body-use patterns, which include posture and tension habits. It teaches the pain sufferer strategies for using their mind-body connection in a positive way, Stern says.

The Alexander technique involves hands-on instruction, with the teacher gently moving or guiding various body parts while you are sitting, standing, walking, or lying on a table.

A study published in BMJ looked at the effectiveness of the Alexander technique for long-term relief of chronic or recurrent back pain, and found that a series of 24 lessons in the Alexander technique taught by registered teachers continued to provide pain-reduction benefits a year later. A comparison group that had six Alexander lessons followed by an exercise prescription did almost as well as the group that had 24 lessons. The underlying cause of participants’ back pain is not specified, so it’s unknown how many had sciatica. (8)

Regardless, unlearning old habits of movement and learning new ones takes time and repetition. A typical rule of thumb is that it takes 10 to 30 Alexander lessons to achieve lasting change, and some people continue to take lessons beyond that.

“I think it’s the best-kept secret in the treatment of sciatica,” Stern says.