Why is my sciatica not going away is the question that most people suffering from it are asking. Most people with sciatica get better on their own after a few weeks, but if your pain is getting worse or you aren’t getting relief from simple self-care treatments (ice, heat, stretching and over-the-counter medicine), it’s time to talk to your doctor.
Your doctor can confirm the cause of your pain, suggest other treatment options and/or refer you to a spine health specialist if needed. The doctor can also confirm why the sciatica is not going away and can look into further treatments.
The most common cause of sciatica
The most common cause of sciatica is a herniated disk in your lower back. This happens when the gel-like center of the disk bulges through a weakness in its outer wall. Other causes include spinal stenosis and osteoarthritis.
A herniated disc that’s causing pressure on your sciatic nerve can be treated with physical therapy and other non-surgical treatment options. Your healthcare provider may recommend imaging tests such as X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans.
X-rays can show bone spurs, infections, tumors and other underlying problems that may be putting pressure on your sciatic nerve. MRIs are often ordered for more detailed diagnostic images of the spine, but these aren’t usually needed unless your pain is severe or if you haven’t improved with at-home treatment.
In rare cases, a cancerous mass might put pressure on your sciatic nerve. Surgical removal of the tumor is the best way to treat this condition, but it’s typically not done until other conservative treatment methods have failed or you have lost bladder and bowel control or have other serious symptoms.
Why is My Sciatica Worse When I Walk?
In most cases, sciatic pain is caused by a herniated disc in the spine. It can cause a range of symptoms, including back pain that radiates down the hip or leg.
One of the best ways to treat a herniated disc is through physical therapy. You may need to use a cane or walker during your rehabilitation, but this can help you feel better sooner.
When walking, it’s important to have a proper posture, so stand tall and place your chin level with the ground. This helps keep your back straight and engages your core muscles.
Try not to tuck your pelvis under too much while standing or walking, as this can compress the lumbar disks and irritate your sciatic nerve. A spine doctor or a physical therapist can provide exercises to improve your alignment and reduce pain, as well as prevent future sciatic pain.
Short strides are more supportive for your spine and sciatic nerve than long ones. As you gain fitness and your pain decreases, you can take longer strides as needed.
Avoid walking on rough surfaces, as these can strain your thigh and leg muscles and increase pressure on your spine. Instead, walk on smooth and flat surfaces, which can be easier on your back and spine.
Alternating therapies that use heat and ice can be effective in treating sciatica, as these both reduce inflammation and increase blood flow to the impacted area to speed healing. However, don’t apply heat too often or for too long, or you could worsen your symptoms.
Activities to avoid with sciatica pain
The pain of sciatica is usually caused by something pinching your nerve, such as a herniated disc in the spine. Another common cause is an overgrowth of bone spurs. Regardless of the cause, smart activity modification can help you get relief faster.
Avoiding activities that aggravate sciatica pain is important for your recovery. The following exercises are known to irritate the nerve and can worsen your symptoms:
Lifting heavy objects: Weightlifting can place undue stress on your lower back, especially when it’s done incorrectly. This can exacerbate sciatica symptoms and even lead to herniated discs.
Burpees: Performing burpees, particularly those that involve repeatedly bending forward and jumping, can aggravate the pain of sciatica, says Corina Martinez, a physical therapist at Duke Sports Medicine Center in Durham, N.C.
Pilates reformer exercises: Many Pilates reformer moves demand you to flex your knees and bend your upper body inward, which can aggravate your sciatica symptoms. To work your core without causing discomfort, Marko recommends the pelvic tilt exercise.
Seated hamstring stretch: Doing the seated hamstring stretch, which requires you to bend forward while holding one leg in place, can pull the sciatic nerve and make your sciatica symptoms worse.
Deadlifts: Straight leg deadlifts and Romanian deadlifts place excessive pressure on the hamstrings and lower back, which can aggravate sciatica pain.
Abdominal stretches: Some abdominal stretches, including the cat-cow and cobra poses in yoga, can stress your lower back and aggravate your sciatica symptoms.
Last stages of sciatica
If you have had a recent spinal injury, you might get sciatica symptoms that are worse when you sit or stand up. You may also feel weakness or numbness in your leg.
The pain might go away after rest and some self-care. But if it doesn’t go away within 6 weeks, or becomes severe, your doctor will recommend other treatments.
Your doctor will do a thorough medical history and exam to find out what is causing your sciatica. This may include taking a spinal fluid test, x-rays of your spine, and blood tests.
They will also want to know what activities cause your symptoms to start. Your doctor will ask you to bend backwards or forwards, lift a leg off the table, and move your legs in different directions to see if your pain gets better when you do those things.
In addition, they will perform a physical exam to check your muscle strength and reflexes. If you have weakness, your doctor might do a test called electromyography to measure the electric pulses that your muscles give off.
Treatment for sciatica varies from person to person, depending on the underlying cause of the pain. But in general, it involves a combination of home remedies, medications, physical therapy and/or surgery.
You will usually see some relief from your sciatica after 4 to 8 weeks. It takes another 1 to 4 months for you to fully heal and be able to do all the activities that you normally do. But overall health, age, and other factors can all affect the time it takes to get through these phases of healing.
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