Sciatica: Causes, Treatments, and Exercise Recommendations

Sciatica

Hello, Doctor: I have a question to ask you.
Three years ago, one morning, while I was running up the stairs, I suddenly felt a sharp pain in my lower back.
Initially, I thought I had just strained my back, so I went to the hospital and received several injections, but they only provided temporary relief.
Once the medication wore off, the pain returned.
After graduating from university, I had to undergo a military service health assessment at Cheng Kung University Hospital, where I was diagnosed with sciatica.
The hospital's diagnosis report stated that the patient experiences pain in the lower back and left leg.
An MRI showed a herniated disc at L5-S1, which is compressing the first sacral nerve root.
An electromyography (EMG) test also indicated changes consistent with nerve root damage.
Later, when I consulted a neurologist at Cheng Kung University, I asked if my condition was serious.
He told me that it was a mild herniated disc and that surgery was not necessary; rehabilitation would suffice.
However, after nearly six months of acupuncture treatment, I still feel that my condition fluctuates.
Sometimes, if I lift heavy objects, I experience severe back pain.
Now, I can hardly bend down because it causes significant pain.
Additionally, sitting or standing for extended periods leads to considerable discomfort in my lower back, and even sneezing causes pain, which is very distressing for me.
Therefore, I would like to know if my condition requires surgical intervention for better outcomes.
Also, I still play basketball and run when I am not in too much pain, but sometimes after exercising, my lower back feels very uncomfortable.
Should I avoid these activities due to my condition? If so, what types of exercise would be more beneficial for my body? That is my question.
Thank you for your response!

Xiao Guo, 20~29 year old female. Ask Date: 2004/08/23

Dr. Shi Qiming reply Orthopedics

Dear Sir/Madam,
In younger patients, spinal disorders often present as herniated discs, which constitute a significant proportion of cases.
Generally, conservative treatment is the primary approach, with surgery being considered in no more than 15% of patients.
Before considering surgical options, it is important to determine the following:
1.
Has the duration of the condition exceeded six months, and has there been a trial of medication?
2.
Has there been continuous rehabilitation for more than eight weeks without symptom improvement?
3.
Is there no improvement in pain at all?
4.
Have two spinal imaging studies confirmed the presence of a herniated disc, or even a rupture, that cannot be reduced?
If symptoms improve, engaging in physical activity (swimming being the most beneficial) can have a positive therapeutic effect on the spine, and it is worth trying.
If you have any further questions, you are welcome to come to our orthopedic department for a detailed examination.
Sincerely,
Dr.
Wang Zikang
Chief of Orthopedics, Hsinchu Hospital

Reply Date: 2004/08/23

More Info

Sciatica, or sciatic nerve pain, is a common condition that arises from irritation or compression of the sciatic nerve, which runs from the lower back down through the legs. Understanding the causes, treatments, and appropriate exercises for sciatica is crucial for managing this condition effectively.

Causes of Sciatica
The most common cause of sciatica is a herniated disc in the lumbar spine, particularly at the L5-S1 level, which can compress the nerve roots that form the sciatic nerve. Other potential causes include:
1. Spinal Stenosis: Narrowing of the spinal canal can put pressure on the nerves.

2. Degenerative Disc Disease: Age-related changes in the spine can lead to disc degeneration and nerve compression.

3. Spondylolisthesis: A condition where one vertebra slips over another, potentially pinching the nerve.

4. Injuries: Trauma to the back or pelvis can lead to sciatica.

5. Muscle Spasms: Tight muscles in the buttocks can irritate the sciatic nerve.

Treatments for Sciatica
Treatment for sciatica often begins conservatively. Here are some common approaches:
1. Physical Therapy: A tailored rehabilitation program can help strengthen the muscles supporting the spine, improve flexibility, and reduce pain.

2. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and inflammation. In some cases, corticosteroid injections may be recommended to reduce swelling around the nerve.

3. Heat and Ice Therapy: Applying heat or ice to the affected area can provide temporary relief.

4. Alternative Therapies: Acupuncture, chiropractic adjustments, and massage therapy may also be beneficial for some individuals.

5. Surgery: If conservative treatments fail and the pain is debilitating, surgical options such as discectomy or laminectomy may be considered.

Exercise Recommendations
Exercise plays a vital role in managing sciatica. However, it is essential to choose the right types of activities to avoid exacerbating the pain. Here are some recommendations:
1. Low-Impact Aerobic Exercises: Activities like walking, swimming, or cycling can improve overall fitness without putting too much strain on the back.

2. Stretching Exercises: Gentle stretches for the lower back and hamstrings can help relieve tension and improve flexibility. Examples include the piriformis stretch and knee-to-chest stretch.

3. Strengthening Exercises: Focus on strengthening the core muscles, which support the spine. Exercises like pelvic tilts, bridges, and modified planks can be beneficial.

4. Avoid High-Impact Activities: Running, jumping, or heavy lifting can aggravate sciatica symptoms and should be avoided, especially during flare-ups.

Conclusion
In your case, it is essential to continue with physical therapy and follow the recommendations of your healthcare providers. While surgery may be an option in severe cases, many individuals find relief through conservative measures. It is crucial to listen to your body; if certain activities like basketball or running exacerbate your pain, it may be wise to limit those until you have built more strength and flexibility.

Always consult with a healthcare professional before starting any new exercise regimen, especially with a history of sciatica. They can provide personalized guidance based on your specific condition and needs. Remember, the goal is to manage pain effectively while improving your overall physical fitness and quality of life.

Similar Q&A

Understanding Sciatica: Causes, Prevention, and Management Tips

Hello Doctor: I apologize for bothering you, but I would like to ask about sciatica. A relative of mine recently went to the hospital, and it seems they were diagnosed with sciatica. Could you please tell me what causes sciatica? Additionally, how can patients prevent their condi...

Dr. Ye Qingnian reply Orthopedics
Sciatica is caused by the compression of nerves in the lumbar region of the spinal cord, leading to back pain and numbness or tingling that radiates down the back of the thigh and calf. The most common causes include 1. herniated discs, 2. bone spurs, and 3. tumors compressing th...

Understanding Sciatica: Causes, Treatment, and Prevention Tips

Hello, Dr. Jiang! I have been experiencing sciatica for a month. The doctor took an X-ray and said it is not serious. However, taking anti-inflammatory painkillers and undergoing rehabilitation have been ineffective. I feel pain when sitting or standing. I work while sitting ever...

Dr. Jiang Junyi reply Neurology
Dear Ms. Christine, You mentioned, "I have pain when sitting and standing. I work sitting down every day. I haven't fallen or twisted anything. It happened suddenly, and I don't know the cause..." A herniated disc can cause compression of the nerve roots, lea...

Understanding Sciatica: Causes, Symptoms, and Treatment Options

On the morning of the 19th of last month, I woke up and suddenly felt pain in the left side of my lower back near the hip while picking something up. After exercising that evening, I found it very difficult to climb stairs. A rehabilitation specialist diagnosed me with a piriform...

Dr. Shi Guozheng reply Orthopedics
If it is a herniated disc, the pain may radiate from one side of the buttock down the back of the thigh to the calf and into the sole of the foot, potentially accompanied by neurological symptoms such as numbness and decreased sensation in the foot. Additionally, an increase in a...

Effective Exercises and Precautions for Sciatica Rehabilitation

Hello Doctor: My mother is 51 years old and has spinal instability, which is causing pain in her right leg from top to bottom. What exercises can help with her rehabilitation? Also, what movements, behaviors, or dietary restrictions should be avoided?

Dr. Wang Shouji reply Orthopedics
Alex: If sciatica is caused by spinal instability with significant nerve compression, the severity needs to be assessed, and sometimes surgical treatment may be necessary. If surgery is not required, then medication and rehabilitation therapy are essential. Care should be taken w...