Q: I have recurrent sciatica, which is a serious pain in the behind. Can you suggest any natural health tips?
—Aimee T., Bend, Ore.
A: Several years ago, I herniated a lumbar disc while running on pavement. This kind of pounding “compression” is one of the most common causes of herniated (ruptured) spinal discs, which is a leading cause of sciatica. Another cause of sciatica is muscle compression, which is known as piriformis syndrome.
The sciatic nerve is the largest nerve in the human body. Multiple strands of nerve fiber form this huge nerve; the strands weave together as they emerge from the spinal cord in the lower back area and pass under the deep muscles of the buttocks, through a notch in the base of the pelvic bone “girdle,” and then splay out and down the legs. The branches of the sciatic nerve cover the front, sides, and backs of the legs, all the way down to the toes. Severe injuries to the sciatic nerve can compromise bowel and bladder function—this is a medical emergency, so go to a clinic immediately if you have back/leg pain accompanied by loss of bowel or bladder control. Loss of motor function always signals an emergency.
There are many options for reducing sciatic pain with natural approaches and home remedies. First, distinguish whether the sciatic pain is due to nerve compression (usually because of a bulging or herniated disc) or piriformis syndrome. In the latter, the piriformis muscle, located under the gluteus muscles, goes into spasm and contracts. The tightening of the piriformis muscle puts pressure on the sciatic nerve, which lies beneath the piriformis muscle, causing inappropriate firing of the sciatic nerve. The resulting pain, which can be local (in the buttocks) or go some or all of the way down the leg, can be debilitating and prohibit sitting or lying on the affected side. Getting up from a chair or bending over to pull on boots can be excruciating.
If you put a heating pad on your bottom for 20 minutes or so at bedtime and the pain is better in the morning, it is likely your pain is a muscle problem, such as piriformis syndrome. For relief, stretch the piriformis several times daily. It can be difficult to stretch this muscle because it is so deep. The piriformis covers a short distance from the outer edge of the sacrum (the base of the spine) to the top of the femur (thigh bone). To stretch the piriformis, lie on your back on the floor and bring the knee of the affected side toward the opposite shoulder (i.e., if your sciatica is in the left buttock or leg, bring your left knee toward the right shoulder). Back off if this causes pain. If you have piriformis syndrome, avoid doing the King Pigeon yoga pose, which creates outward rotation of the femur.
However comforting heat may feel, discontinue use if your pain is worse in the morning; try ice instead, especially 5 to 10 minutes before bed. Ice is beneficial for nerve inflammation. If your sciatica improves with bedtime icing, the problem is inflammation, which is most likely caused by a ruptured or bulging disc. When a disc, which acts as a shock absorber between each bony vertebra, bulges or ruptures, it puts insistent pressure on the sensitive nerves of the spine. Sometimes a ruptured disc creates so much “debris” in the area adjacent to the spinal cord that surgical removal of the squeezed-out inner disc material provides the quickest relief. However, many recent studies have shown that although patients receiving spinal surgery usually feel better sooner than their counterparts who eschew surgery, two years later there is absolutely no difference in pain levels or functioning between the surgery and the no-surgery groups. If you are willing to take a little time to heal, you will likely end up better off without surgery.
Once you have determined your sciatica is from disc pressure on the sciatic nerve, it will be extremely useful to adhere to an anti-inflammatory diet for several weeks (no animal products, except fatty fish and eggs, no sugar; and plenty of turmeric, leafy greens, and water). Acupuncture can be effective, as can St. John’s wort—1,800 milligrams daily, as a nerve-healing agent—and high-potency B vitamins.
Conventional doctors offer a steroidal “dose pack”—usually 50 milligrams of Prednisone tapering to 10 milligrams over five days. This can be helpful, but often doesn’t work more than once or twice. However, if the dose pack does help, this confirms that the problem is due to inflammation of the sciatic nerve. Sometimes steroidal anti-inflammatories are injected right into the affected area to block the natural agents of inflammation. Again, this may work once, but is not typically a permanent solution. The real solution will take a little time and perseverance. Avoid sitting for prolonged periods, and try walking gently for 20 minutes twice daily. If you need to sit, place a soft pillow under your bottom, and roll a hand towel into a small bolster to put behind your waist. This will help maintain the natural curvature of your lumbar spine (low back) and prevent slumping—the absolute worst posture for sciatic nerve compression.
The single most important aspect of preventing recurrent sciatica is improving your core strength. I teach my patients an easy routine of 14 exercises that takes about 15 minutes to perform. (For more detail on this routine, go to dremilykane.com and search for low-back exercises.) If you have sciatica, maintaining a commitment to this 14-exercise routine can firm up your core, which is key to stabilizing the lower back and preventing future compression trauma. Done faithfully, this routine can save your butt!