Sciatica is commonly associated with sedentary lifestyles. But as I’ve discovered myself, you can be an active person who exercises most days – and still develop that signature shooting pain of sciatica. One big problem: Daily activity doesn’t necessarily compensate for a sedentary desk job featuring prolonged sitting and poor posture. My main problem: I sit at a desk all day.

What is sciatica?

Dr. Michelle De Witt

Sciatica is the sensation of pain or burning that travels down the body where the sciatic nerve is present. “The sciatic nerve has contributions from multiple nerves in the lumbar spine (lower back),” said Dr. Michelle De Witt, a physician at Novant Health Brain & Spine Surgery - Kimel Park in Winston-Salem. “It’s a very big nerve that runs from the lower back to the buttocks and all the way down the back of the leg.

“This pain is variable – it can be mild pain that goes away quickly, or it can be burning, stabbing or shooting. It’s a really common issue and about 4 in 10 people in the U.S. will experience it at some point.”

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What can cause sciatica?

“Risk factors include poor posture, prolonged sitting and too much physical inactivity,” De Witt said. “You can also have this problem if you are strength training and you’re not using the right form. Additional risk factors are being overweight and having diabetes.” Sciatica is also common among pregnant women.

The true source of pain can be difficult to pinpoint. “It’s a nerve that runs through a lot of places and has a long course,” De Witt said. “There could be an issue from an injury or a muscle pressing the nerve, for example.”

Luckily, as I experienced and as De Witt confirmed, a variety of nonoperative approaches can resolve the majority of sciatica cases. “Most of the time, sciatica will get better without surgery,” she said.

Here are 5 nonsurgical steps you can take to try to relieve sciatica:

  1. Sit less. Even if you’re sitting during your day job, De Witt said, “Get up for a couple of minutes every hour and just walk around and stretch – don’t wait until you’re in pain. If you have a standing desk, regularly alternate sitting and standing. Do the same thing if you’re driving for long periods of time: Even if you’re not in pain, take a break to walk around and stretch every hour.”
  2. Use good form in the gym. Be aware that high-impact exercises like running can exacerbate sciatica, as can using incorrect form during strength training. If you’re unsure what proper form looks like, consult a personal trainer or a physical therapist.
  3. Incorporate glute-strengthening exercises into your workout regimen. Movements like clamshells and donkey kicks with resistance bands can help strengthen glutes, which in turn can provide better support for the low back.
  4. Get bodywork to release tension in your piriformis muscle. During a bodywork session, you can address specific pain points in the body, such as a tight piriformis muscle, through targeted massage. The piriformis muscle is a muscle at the base of the buttock that can press on the sciatic nerve. Sitting or running can be a trigger for this source of sciatic pain.
  5. Lose weight and improve glucose control, if necessary. “Being overweight adds more load on your body – your spine carries your whole torso, arms and head,” De Witt said. “Diabetes can contribute to sciatica as well because it affects blood supply to your nerves."

When do you consider seeing a specialist for sciatica?

There are certain cases that would require a trip to see a specialist like De Witt. “Some red flag symptoms are unremitting pain, as well as muscle weakness in the foot, where even pointing the foot is a problem,” said De Witt, who added that this is relatively uncommon.

Additionally, she said, “If you’ve been trying nonoperative approaches to relieving sciatic pain for three months without significant improvement, it’s time to get an imaging workup and to get evaluated by a surgeon. We would start with an MRI of the lumbar spine, which will show me one of three things: disc herniation, bony overgrowth or ligament overgrowth.” Any one of these issues could warrant surgery.

“As for a surgical approach, that has to be customized to the problem in looking at the MRI and to the patient as a whole, but the general strategy would be to decompress the nerve that is being pinched,” De Witt said.

Ready to start your nonoperative approach to addressing sciatica?

In addition to the above nonoperative steps, De Witt said, “Start with your primary care physician, who serves as your medical home and can understand what your global picture of health is. Your PCP can get you to the right doctor next, as needed.”