Some days your sciatic nerve pain may be just a dull ache. Other days sciatic pain is constant, sharp and has you looking everywhere for relief.

No matter the cause of your sciatica, it’s important to know how to manage your sciatic pain at home and when to get help from a doctor or specialist.

Read on to learn more about sciatica at-home treatments you can try, such as heat and cold therapy, as well as targeted therapies like physical therapy and injections.

Sciatica treatment at home

Most people can find relief from sciatica without surgery, using a combination of treatments.

In general, you’ll want to focus your efforts on your lower spine, buttocks and hamstring muscles, since tightness or pressure in these areas may be causing your sciatica or making it worse.

Below, we cover when and how to relieve sciatica pain at home – and other treatment options that may work for your symptoms.

1. Cold and heat therapy for sciatica

These types of therapies are what they sound like – applying cold or heat to your body to help reduce pain. But they’re used at different times for different reasons.

When to use cold therapy for sciatica pain relief

Cold therapy is best for new pain – this can be pain related to a new injury or discomfort after exercise or stretching.

Cold therapy for sciatica involves applying something icy cold – an ice pack, frozen gel pack or even a bag of frozen veggies – to your lower back for about 15-20 minutes.

At the first signs of sciatica, use cold therapy three times a day for 2-3 days. If you have soreness after exercising, one 15-20 minute session should be enough.

There are different reasons why cold therapy helps to reduce the pain and inflammation of sciatica:

Lessens painful sensations – When nerves first start to hurt, they let the body know by sending out sensations that are sharp, tingling and painful. Cold therapy decreases the sensations that nerves send out.
Numbs the area – Blood vessels shrink when they get colder, making it more difficult for blood to get through. This causes numbness so you’re less likely to feel pain or have muscle spasms.
Reduces inflammation – When you get hurt, your blood vessels react and cause swelling in the surrounding tissues to keep the injury from spreading. Because cold therapy shrinks blood vessels, there’s less inflammation and swelling.

When to use heat therapy for sciatica pain relief

Heat is for healing, but it usually doesn’t feel good when you first apply it to a new painful area. So, hold off on heat therapy until the sharp pain of sciatica starts to go away – usually within a couple of days.

Both dry heat and moist heat are options for sciatic pain relief. Dry heat includes things like heating pads, heat wraps, heat patches and saunas. Moist heat is when water is involved – warm baths, hot showers, steam towels or moist heat packs.

In most cases, 15-20 minutes of heat is enough to provide some relief. But if your pain is severe, you can apply low-level heat for 30 minutes to 2 hours.

Here’s what heat therapy does:

Increases circulation – Heat opens up blood vessels, increasing the blood flow, oxygen and nutrients to the to the area of pain. This helps speed up healing. But if you use heat therapy on a new injury, all that extra blood flow can actually worsen inflammation and make your injury hurt more.
Relaxes muscles – Applying heat to your muscles relaxes them, improving the flexibility of your muscles and joints. When your muscles are relaxed, you’re also less likely to have painful muscle spasms.
Makes it easier to exercise – Using heat therapy before you exercise or stretch can loosen up muscles and joints. And since things aren’t as tight, you’re able to work out more effectively, allowing you to build strength and flexibility.

2. Sciatica exercises and stretches

Moving your body is often one of the best ways to improve pain. But it can be hard to know which stretches and exercises are best for your body – and how to do them correctly. That’s where a spine physical therapist can help.

A spine physical therapist can teach you specific exercises and stretches, and help create a personalized plan so you can get the most out of your in-person sessions and continue your physical therapy at home. Depending on several factors, including how long you’ve been experiencing sciatica, a more intensive physical therapy program like TRIA Neck and Back Strengthening Program may be recommended. A spine strengthening program is specifically designed for people with chronic back pain.

Types of stretches for sciatic pain

Muscle tightness in your hips and your upper legs can put pressure on your lower back, making sciatica worse. Stretching can loosen your muscles so you have more flexibility throughout the day.

Nerve flossing exercises for sciatica pain relief
These are slow and gentle movements that target specific nerves in the body. These exercises are sometimes called nerve gliding or neural gliding and may help improve range of motion while reducing nerve pain and damage.

Nerve flossing exercises can be done while sitting, standing or lying on your back. An example of sciatic nerve flossing would be to stand with one foot on a chair and the other foot on the floor. From there, lean forward until you feel a stretch in the leg that’s on the floor. Hold for a few seconds before returning to a standing position.

Lower back and hip stretches
If you have sciatica, you likely have a condition like a herniated disc, bone spur or pregnancy that is putting extra pressure on the sciatic nerve root in your lower back. Stretching your hips and lower back can relieve some of the pressure. A good exercise for this is the table stretch.

Face a table and stand with your feet a little further apart than your hips.
Place the palms of your hands flat on the table with your arms outstretched. Your arms should be straight in front of you and your back should be flat.
Pull your hips away from the table until you feel there’s stretching in your lower back and hips, and then hold the position for about one minute.
Move your hips from side to side while you’re bent forward to increase the stretch.

Hamstring stretches
If you have sciatica, you may have pain and tightness in your upper legs. A great stretch for this is the scissor hamstring stretch.

Place one foot about 3 feet in front of the other then push your hips forward as you pull your shoulders back – but try to make sure that your hips are still even.
Put your hands on your hips. If you feel unstable, rest your hand on a chair or flat surface.
Bend forward from your waist so your upper body is over your front leg – most of your weight should be over your front leg and your back should be straight.
Hold 5-10 seconds, then repeat with the other leg.

Piriformis muscle stretches
The piriformis is a muscle that’s deep in the buttock. If it’s tight, it can irritate the sciatic nerve. While piriformis muscle problems can happen to anyone, they are especially common during pregnancy. So, one of the great stretches for pregnancy-related sciatic pain is the seated piriformis stretch. Here’s how it works:

Sit in a chair with your feet flat on the ground.
Put the ankle of your affected leg on your opposite knee.
While holding your back straight, lean forward until you feel a stretch deep in your buttock.
Hold for 30 seconds.

Types of activities and exercise for sciatic pain

Low-impact exercise can help get sciatic nerve pain under control and build up your strength. But while there are many benefits of exercise, make sure you don’t push yourself too far. If your go-to exercises are uncomfortable, consider taking the plunge and spending time in the water.

Swimming, water aerobics or even walking the length of the pool are all ways to get moving while lessening the pressure on your nerves. Other low-impact exercises to try are walking, yoga or cycling.

For best results, stretch your back and hips before heading out – maybe even use some heat therapy to relax your muscles.

3. Massage for sciatic pain

Massage is another way to ease muscle tension and pain. When doing massage for sciatica at home, focus on your lower back, the rear pelvis and thigh. But try to stay away from spots that are especially painful since it’s possible to make your sciatica worse. Applying heat before a massage can help loosen things up while cold therapy can reduce pain.

If your back is sore, an ice massage can be a great way to go, assuming you have a friend or family member willing to lend a hand. Here’s how to do it:

Start by freezing water in a paper cup.
Remove the cup from the freezer and tear off the upper part of the cup so you can see ice over the top of the cup.
Rub the ice into your back and thigh, peeling way more of the paper cup as the ice melts.

4. Medications for sciatica pain relief

Different medications can help with pain and inflammation from sciatica, including:

Oral anti-inflammatory medications

It’s best to start with over-the-counter (OTC) options before talking to your doctor about prescription options. Oral anti-inflammatory medications can provide fast-acting, short-term pain relief. Ibuprofen (Advil) and naproxen sodium (Aleve) are often recommended but ask your doctor about what makes sense for your unique situation.

Topical ointments, gels or creams

Topical creams, ointments and gels can improve pain and relax the muscles that may be causing discomfort. Even better, they start to work right after you use them.

Most people find that these products help – at least a little bit. But not all people experience sciatica in the same way, so look for one that says it will treat the symptoms you have. If you’re pregnant, it can be a good idea to look for one that says it’s safe during pregnancy.

To use, rub the ointment, gel or cream near where it hurts. It’s also important to apply the product to the rear pelvis – the area that’s closest to the sciatic nerve root. Sciatica starts at the nerve root, so if you’re able to stop the pain there, you may be able to stop it from spreading.

Prescription medications

Your doctor may prescribe different types of oral medications for sciatic pain, including:

Muscle relaxers – These medications can help with painful muscle spasms.
Norepinephrine modulators – These antidepressants can reduce the amount of physical pain you feel but may take a while to work. They work by releasing chemicals that reduce the pain signal.
Anti-seizure medications – The medications can calm your nerves, reducing the burning, stabbing and shooting pain that often comes with sciatica. They work by blocking pain signals.
Controlled substance pain relievers – Opioid medications can be an effective way to make the pain go away in the very short term. But opioids often make your pain worse when you stop taking them. Plus, they can also be addictive. So, doctors usually reserve them for severe pain, and then only prescribe them for a short period of time.

5. Diet for sciatica

Adjusting your diet may help you reduce sciatic nerve pain and flare ups. Foods high in sugar, refined carbohydrates and saturated fats can lead to low levels of inflammation in your body that don’t go away, making it easer to develop pain.
By filling your plate with healthy foods like fruits, vegetables, fatty fish and good fats, you can help reduce the inflammation in your body that could be contributing to sciatic pain.

6. How to sleep with sciatica

There’s no sleeping position that works for everyone with sciatica – and finding a comfortable position may take a little time. The following are suggestions based on sleep position.

Side sleeping

Sleeping on your side helps aligns your hips and decrease the pressure on your pelvis. If you have spinal condition, side sleeping can also help open up the narrower places in the spine. Here’s what to know:

Lay on the side that’s opposite of where it hurts.
Bend your knees and slightly curve your upper body forward over your knees.
Use pillows to make yourself comfortable. A pillow between your knees can take the pressure off of your pelvis. A pillow under your body can provide cushioning and help hold you in place while you sleep.

Back sleeping

Laying your back with elevated knees reduces pressure on the lower back and spinal discs. But it may not be the best choice for everyone, including those who have symptoms of sleep apnea. Here’s how to make it work for you:

Lay on your back with your head and neck on a small pillow. The rest of your body – including your shoulders, back, butt and heels – should be in contact with your bed.
While on your back, think about which parts of your body aren’t comfortable.
Adjust your position until it feels good. You may wish to use one or more small pillows to elevate your knees. It can also help to put a small pillow in the curve of your lower back.

Another option is to sleep in a reclining chair or adjustable bed that allows you to keep your head elevated.

Stomach sleeping

Stomach sleeping can be tough with sciatica because you need to arch your back and turn your head to the side. But if you’re able to sleep and wake up feeling refreshed after a night of stomach sleeping, there’s no need to change.

Targeted therapies for sciatica pain treatment

If at-home treatments for sciatic pain aren’t giving you enough relief or working as well as they used to, more targeted medical treatments may help.

Steroid injections for sciatica

Your doctor may recommend a steroid injection in your lower back to reduce the inflammation around the nerve root that may be causing sciatic pain.

The effects of steroid injections are temporary, but can reduce pain, improve function and set conditions for healing. With less pain, you‘ll be more comfortable when doing stretches and exercises that will help you heal.

If your pain returns, you won’t be able to get another steroid injection right away since more serious side effects are possible if you have too many, too close together.

Physical therapy exercises for sciatica

Physical therapy is a clinically proven way to reduce pain and improve muscle strength. Typically, physical therapy for sciatica usually takes 6-12 weeks, and most people come in for physical therapy sessions 2-3 days per week. Here’s what you can expect:

Evaluation – Your physical therapist will likely do special tests such as strength testing and motion testing. This helps them determine the main cause of your pain, assess your range of motion and mobility, and more.
Therapeutic exercises – Your physical therapist will use different techniques to work the affected area and improve the strength and mobility of certain muscle groups.
Education – Your physical therapist will help you understand what’s causing your pain, the importance of staying active and how to exercise safely.
Tailored exercise program – Your physical therapist will create a personalized treatment plan that includes the best stretches and exercises for you. They’ll also offer guidance to ensure that you do them correctly.

But as we mentioned earlier, the type of physical therapy program that’s best for you will depend on a few different factors, including how long you’ve been managing sciatic pain. If you have acute or shorter-lasting sciatic pain, a standard physical therapy program is where you can start.

But for those with chronic sciatic pain that lasts more than 12 weeks, a more targeted spine strengthening program like TRIA Neck and Back Strengthening Program may be recommended. A spine strengthening program like TRIA’s uses FDA registered medical strengthening equipment proven to help you improve your spinal fitness and reduce pain without surgery.

Acupuncture for sciatica

During acupuncture, a trained specialist places extremely thin needles in different places and at varying depths that are believed to provide pain relief to specific areas of the body. Acupuncture works for many people who try it.

Acupuncture may work for sciatica by:

Releasing hormones that reduce pain and improve mood.
Stimulating blood flow to relax muscles, improve inflammation and help you heal better.
Helping to block the pain signals sent out by the brain.

Biofeedback for sciatica

Electromyography (EMG) biofeedback is a type of therapy that checks for problems with nerves, muscles or how they interact with each other. During the biofeedback session, the therapist will put special sensors on your skin that are attached to a machine that measures muscle tension.

The theory is that once you have an idea of what’s causing your pain, you’ll be able to change your behaviors to lessen your pain or make it go away completely. It’s also possible that biofeedback may relax the muscles that are contributing to your pain. Some people find biofeedback very helpful but there isn’t strong data showing that it works.

When is sciatica surgery recommended as a treatment?

Surgery for sciatica is rarely recommended as a first treatment step. That’s because a combination of nonsurgical treatments can often be effective at reducing pain and healing tissue. After surgery, there’s no guarantee that nerve pain will go away – or stay away. Surgery may allow rapid anatomic changes and provide relief initially, but it does not guard against future problems.

Surgery may make sense for you if the cause of your sciatica won’t go away on its own. For example, you have a bony growth pressing down on your sciatic nerve. Doctors generally won’t consider surgery unless you’ve had sciatic pain for at least six weeks. But back surgery may be recommended immediately if you have any of the following:

Weakness, especially if it is progressing despite treatment and time
Pain that isn't improving with time and other treatments
Numbness that is progressing
Difficulty walking despite therapy and other treatments
In other rarer circumstances, your doctor will help you decide if surgery is right for you

When should I see a doctor about my sciatica?

If your sciatic pain isn’t going away with at-home treatments, it’s time to get help. Make a medical spine care appointment with a spine specialist if you have sciatic nerve pain that:

Is affecting your quality of life
Has lasted more than three months
Keeps coming back
Continues to get worse

Visit urgent care or an emergency room if you experience any of the following:

Sudden, severe pain in your low back or leg, and numbness or muscle weakness in your leg
Problems with bladder or bowel control
Pain following an injury, such as a traffic accident or a fall

Support for your sciatica

Managing your sciatic pain and keeping future flare-ups away is possible. It will likely take some work on your part – but we can help.

At TRIA, our spine care specialists develop personalized treatment plans to help people find lasting relief from even the most difficult cases of sciatica.

Physical therapy can often be covered by insurance plans, but you may need a referral from a doctor. So, it’s a good idea to contact your insurance company to learn which services are covered – you can usually find contact information on the back of your insurance card.