When friends report being crippled by pain from sciatica, I pull out my "notes for friends with sciatica." This is not medical advice; I am not a doctor. I do not have medical training. But these links may provide some relief until you get to a doctor. They're culled from years of hearing what worked from friends who've been there!
The piriformis muscle is a small muscle located deep in the buttock (behind the gluteus maximus). It starts at the lower spine and connects to the upper surface of each femur (thighbone). It helps to rotate the hip and turn the leg and foot outward. It sits under deep layers of fat and muscle in your buttock, so if you sit a lot and don't move around, those muscles get compressed. Get up from that chair and move around more!
The sciatic nerve is a large, tender nerve that runs from the lower back down the back of each leg. Something that hurts or puts pressure on the sciatic nerve can cause pain in the lower back that spreads to the hip, buttocks, and leg (on either side). It is often experienced as pain radiating down the leg, but may manifest as lower back pain.
Diagnosis and treatment of sciatica (BMJ medical journal, 2007)
www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/Anatomy of the sciatic nerve (short video, Veritas Health)
• A friend says this pillow provides great relief, as she sits working at a desk, and you can see why: Bael Wellness Seat Cushion for Sciatica, Coccyx, Orthopedic, Tailbone and Backpain
You might also try a lumbar support pillow for your lower back.
• Injections? Think twice before getting an injection for low back pain or sciatica. Dr. John M. does a quick journalistic review of the literature on what evidence shows works or does not work.
http://www.drjohnm.org/2013/06/think-twice-before-getting-an-injection-for-low-back-pain-or-sciatica/
• It may be better to go to a sports medicine specialist or a physical rehab doctor (not a neurologist). It's typically a problem about muscles (especially the deep piriformis) impinging on the sciatic nerve.
• Sciatic Nerve Pain: 8 Prescription Medications That May Help (Ross Phan, GoodRx, 4-26-22)
• Sandy Yang, whose stretching classes I greatly miss, says this book helped her when she had to deal with sciatica pain: Treat Your Own Back by Robin A McKenzie
• Acupuncture for Sciatica: Will This Trial Finally Silence the Skeptics? (John Gever, MedPage Today,10-14-24) Real Chinese acupuncture was more effective than a sham version for treating sciatica stemming from herniated spinal disks in a randomized trial conducted in China. In a brief editorial, two U.S.-based scholars applauded the work as "a methodologically rigorous study," with multiple practitioners performing the acupuncture and "a well thought-out sham control....Medicare and the VA healthcare system both cover acupuncture for various conditions. Liu and colleagues agreed that the procedure "adds an effective, evidence-based, nonpharmacological treatment to address a common chronic condition."
Exercises to relieve sciatica pain
• 6 Stretches for Sciatica Pain Relief (Healthline) Reclining pigeon pose, sitting pigeon pose, forward pigeon pose, knee to opposite shoulder, sitting spinal stretch, standing hamstring stretch. For example: "Lift your left leg and place your right ankle on top of the left knee. Hold the position for a moment. This helps stretch the tiny piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve, causing pain. Do the same exercise with the other leg."
• One Minute Sciatica Exercises for Quick Pain Relief & Cure of Sciatic Pain Physical Therapists Bob Schrupp and Brad Heineck (Bob & Brad) present several one-minute sciatica exercises designed to provide you with quick pain relief. Watch them at least once, because they help understand things like "flossing the nerve." See also their 10 Exercises to Avoid With Sciatica (especially if it's related to bulging or herniated disc problem) and More exercises for if sciatica doesn't improve.
• Dr. George Best explains and shows exercises for treating disc-related sciatica and sciatica-type problems, including piriformis syndrome. See Part 1: The evil that discs do (basic sciatica exercises_ and Part 2: Piriformis syndrome. These look doable, and he explains why (or when) you might want NOT to do Downward Dog.
• Prevention exercises:
http://www.prevention.com/health/health-concerns/best-treatments-sciatic-nerve-pain
• Sciatica and Back on Facebook (good illustrations of helpful exercise positions)
https://www.facebook.com/SciaticaandBack
• 5 tips for relieving (walking is good for it!)
http://shine.yahoo.com/sciatica-5-tips-relieving-sciatic-nerve-pain-195000073.html
• Here's an illustration, which is for another condition, but the same body parts apply:
http://www.spine-health.com/conditions/sciatica/what-piriformis-syndrome
• More exercises here:
http://www.spine-health.com/wellness/exercise/stretches-and-exercise-sciatic-pain-piriformis-syndrome
Massage therapy
Medicare coverage. If it is prescribed by your doctor, you can get Medicare to pay for 10 sessions of physical therapy (PT), which might involve some deep tissue massage.
• The piriformis is deep within your glutes and the compression can sometimes be addressed by therapeutic massage (with a trained massage therapist).
• One massage therapist who helped me says that to avoid the problem you need to maintain the strength in your leg muscles and your ability to twist your torso. Another main culprit may be your hip rotator. It (or a contracted muscle in that area) exerts pressure on the underlying sciatic nerve.
• Inversion tables. Many people get relief from lying on an inversion table, which helps decompress your lumbar vertebrae. If you have a heart condition or blood pressure problems you can't be in too upside down a position; you want the table slanted down about 30% from horizontal. Start holding the position for a minute or two, until you get used to the blood rushing to your head. Then work up to holding it 5 to 10 minutes and up to 20 minutes daily; build up to the longer time. Apparently that stretches the muscles that are compressed and relieves pressure on the sciatic nerve. Here's Video showing how an inversion table works and alongside are links to other videos (including pros and cons video--conditions which might rule out using such a table). With certain pre-existing conditions you should not use such a table. (See The Cons & Pros to Inversion Therapy for the Spine / Neck Pain, Back Pain, Pinched Nerve . You can order on Amazon, which also sells less expensive inversion tables.
• Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica (Cochran evidence-based summaries)
"Moderate quality evidence shows that patients with acute LBP may experience small improvements in pain relief and ability to perform everyday activities if they receive advice to stay active compared to advice to rest in bed. However, patients with sciatica experience little or no difference between the two approaches. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate."
"Low quality evidence suggests those patients with or without sciatica experienced little or no difference in pain relief or function, regardless of whether they received advice to stay active, exercises or physiotherapy. Further research is very likely to have an important impact on the estimate of effect and is likely to change our confidence in it."
• What is the role of muscle relaxants in the management of low back pain (LBP) and sciatica? (Jasvinder Chawla et al., Medscape, 8-22-18) The aim of our study was to evaluate the treatment of back pain with tizanidine (Sirdalud) and NSAIDs.See also Effects of back pain treatment with tizanidine (Joanna Górska, PubMed.gov, 6-30-05)
Sciatica, General
• Sciatica: What It Is, Symptoms, Causes, Treatment, and Pain Management. (Cleveland Clinic)
• Sciatica: Symptoms and Causes
• Sciatica: Simple Symptoms, Complex Causes (HSS, Hospital for Special Surgery)
• Sciatica: Symptoms, Causes, Treatments, Exercise (WebMD)