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Question : I’ve had sciatica for a couple of weeks now. I’d like to exercise, but I don’t seem to get any better or worse whether I do or don’t. The pain is worse at night and first thing in the morning.
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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December 05, 2011
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A:

Sciatica is a condition in which the sciatic nerve is irritated or injured. The sciatic nerve is a large nerve that travels through the buttock and into the back of the leg. So that’s usually the location of the pain. The pain often feels like a shooting or burning pain. And it’s often worse at night or if you’re sitting on a hard surface.

Possible causes include:

  • Compression of the sciatic nerve in the lower spine from a herniated (slipped) disc
  • Spinal stenosis (narrowing of the space around the spinal cord)
  • Compression of the nerve in the buttock
  • Trauma
  • Arthritis of lower spine

In many cases, no definite cause can be found.

“Exercise” is recommended. But that usually means a stretching program and strengthening of core muscles in the lower back and abdomen. It would not include jogging, playing tennis or any other activities that might strain or put added pressure on the tissues surrounding the sciatic nerve.

That said, it’s great that you’re exercising! You did not say what type of exercise you enjoy. If it doesn’t cause your symptoms to get worse, the benefits of exercise may outweigh the risk of it making your sciatica worse.

Other helpful treatments for sciatica include:

  • Loss of excess weight
  • Ice
  • Avoiding sitting for too long, especially on a hard surface
  • Changing to a firmer, more supportive mattress
  • Massage, yoga, or chiropractic care
  • Pain relievers, such as ibuprofen, naproxen or acetaminophen
  • Medicines for nerve pain such as amitriptyline (Elavil) or gabapentin (Neurontin)
  • Corticosteroid shots near the area of the compressed nerve

Surgery is rarely necessary. In general, you should only consider it:

  • When other treatments have failed
  • If you have a problem causing the sciatica (such as a slipped disc) that can be fixed with surgery

While exercise is generally a good thing, it is possible that your exercise program is slowing your recovery. I recommend reviewing your symptoms and your exercise routine with your doctor. It may be helpful to go for more tests or meet with a physical therapist or a sports medicine specialist.

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