If all your nerves were a network of roads, the sciatic nerve would be a busy interstate highway. All of the nerve impulses transmitted to and from the lower half of your body must pass through the sciatic nerve, the largest and longest in the body. From its roots in the spinal cord, the thick conduit branches through the buttocks and down the back of each leg to the foot. Pain that follows this route is called sciatica. Pressure on the nerve in the spinal area is normally the cause of sciatica. The sensation can vary from mild tingling in your foot to searing pains that shoot down your leg.
Sciatica often begins after you’ve done some customary movement that never caused pain previously. Smokers, people who do a lot of heavy lifting, and people with osteoporosis or arthritis are at highest risk for developing sciatica.
To discover what’s causing your pain, you’d have to look closely at an x-ray of your spinal column, particularly the circular sections of cartilage called disks that are assigned the job of cushioning the bones and sheltering the nerve that runs alongside your spine. If you’re under age 40 and you get sciatica, it’s likely that one of those disks has slipped and is bulging between the vertebrae in your spine. Since the nerve runs alongside the spine, the off-kilter disk puts pressure on it.
If you’re hit with sciatica when you’re over 40, the cause is also disk-related, but in a somewhat different way. At that age, your disks are starting to become dehydrated. The shrinking disks can cause the spine to compress, increasing pressure on the nerve.
Do you get the pain most when you cough or sneeze? That’s just one sign that your sciatic nerve is probably pinched. You really can’t diagnose yourself from that clue alone, however, so you should see a doctor to be sure of the origin of the pain, says Barbara Silbert, D.C., N.D., a chiropractor and naturopathic doctor in Newburyport, Massachusetts. Low back pain and intermittent claudication—pain in the legs caused by poor arterial blood flow—are often mistaken for sciatic pain, notes Dr. Silbert.
Because sciatica almost always involves a mechanical problem with your back, you may need massage or chiropractic adjustment. In severe cases, surgery may be necessary to free the nerve. More often, your doctor will simply prescribe some bed rest. You might also want to try some natural supplements that can help relieve inflammation and relax spastic muscles, says Dr. Silbert.
Helping Your Body Douse Inflammation
The key to drug-free relief is to turn on your body’s natural inflammation-fighting powers, says David Perlmutter, M.D., a neurologist in Naples, Florida, and author of Lifeguide. While drugs like aspirin and ibuprofen work by reducing inflammation and thus reducing the sensation of pain, nutritional supplements can reprogram the chemical process that produces pain signals. Moreover, nutrients influence the complicated inflammation process.
"Obviously, the body must have its own ways of reducing inflammation," says Dr. Perlmutter. "The entire process of turning inflammation on and off is controlled by a group of hormone-like molecules called prostaglandins."
According to Dr. Perlmutter, there are basically two groups of prostaglandins. One group is the starter kit that initiates inflammation. The other is a "tone group" that reduces the flare-up.
Dr. Silbert explains that there are four key supplements in nature’s arsenal of inflammation fighters that may help sciatica—bromelain, the bioflavonoid quercetin, essential fatty acids, and the herb turmeric. They inhibit the production of bad prostaglandins that start inflammation, and they promote the production of good prostaglandins that fight it. In other words, they stop the bad guys and help the good guys.
Fight the Flames
Bromelain, an enzyme found in pineapple, is the jack-of-all-trades when it comes to fighting inflammation.
In a study of 146 boxers, researchers showed that bromelain significantly speeded up the healing process when the boxers were injured. Bromelain was given to 74 of the boxers four times a day, while the remaining 72 took an inactive substance (placebo). In 58 of the boxers taking bromelain, all signs of bruising disappeared in four days. In the group taking the placebos, only 10 healed completely in four days.
Quercetin, just one of more than 800 bioflavonoids that have been identified, works best with bromelain to block the inflammation process. Naturopathic doctors believe that bromelain helps your body absorb the quercetin, so they often prescribe the two together, says Dr. Silbert. Quercetin is rich in powerful antioxidants that stop the damaging effects of free radicals, the unstable molecules that damage cells.
When the pain of sciatica strikes, take up to 1,000 milligrams of bromelain and 500 milligrams of quercetin four times a day between meals, says Dr. Silbert. The strength of a particular batch of bromelain is measured in milk clotting units (mcu) or gelatin-dissolving units (gdu). The higher the mcu number, the greater its strength. Look for a supplement with a strength between 1,800 and 2,400 mcu or 1,080 and 1,440 gdu.
Beware of bromelain supplements that merely list weight in milligrams; if the measurement isn’t listed on the label, you can assume that you are getting a cheap, ineffective preparation, cautions Jacob Schor, N.D., a naturopathic doctor in Denver and president of the Colorado Association of Naturopathic Doctors.
Any type of inflammation responds well to the essential fatty acids found in fish oil, flaxseed oil, and evening primrose oil.
To reprogram your pain process, take one tablespoon of flaxseed oil and 500 milligrams of black currant oil (or three capsules of evening primrose oil) every day, says Dr. Perlmutter. These two supplements are rich in omega-3 and omega-6 essential fatty acids that your body needs but cannot make. By adding them to your diet, you can stimulate your body to produce increased levels of good prostaglandins and reduce inflammation.
If you want to use fish oil instead of flaxseed oil, take 1,000 milligrams two to four times a day, says Priscilla Evans, N.D., a naturopathic doctor at the Community Wholistic Health Center in Chapel Hill, North Carolina.
Turmeric Time?
During intense flare-ups, add some turmeric. This yellow spice contains one of nature’s most powerful anti-inflammatory drugs, a chemical called curcumin. The herb has been used for thousands of years in India’s traditional Ayurvedic medicine to treat pain and inflammation.
Several clinical studies show that curcumin has an anti-inflammatory action. Don’t reach into your spice cupboard for relief, however. Instead, opt for capsules of standardized extract that contain 97 percent pure curcumin.
When pain is acute, Dr. Evans advises people to take 250 to 500 milligrams three times a day. But you shouldn’t take turmeric as a remedy if you are pregnant or have severe stomach acid, ulcers, gallstones, or a bile duct obstruction.
If you’re taking natural supplements, you should start to see some improvement in about two weeks. Stick with the dosages to get the desired effect, says Dr. Evans.
"We lose sight of the fact that many nutritional and herbal supplements are more like foods than drugs. Dosages are important because taking just one capsule a day is not going to do much for your symptoms," she says. "In many cases, you have to take a pretty large dose of fish oil or curcumin to get an effect. Our culture, though, has conditioned us to taking just a pill or two for relief."
A Recipe for Relaxation
Sometimes, pain and tingling can be due to muscle spasms in the piriformis muscle, a pear-shaped muscle in the buttocks that surrounds the sciatic nerve. Relaxing this muscle can help relieve pain, says Dr. Evans.
Naturopaths often use a mixture of soothing herbs such as valerian, passionflower, and kava kava to promote muscle relaxation. Although valerian has become a staple on drugstore shelves, where it is sold as a sleep aid, its powers of reprieve go beyond sleep.
"Valerian is also great for easing tension and for general pain relief," says Dr. Evans. It contains substances known as volatile oils that work together to make you sleepy and relax your muscles.
Sometimes, your sciatic nerve is in the grip of a spastic muscle, and that no-win tug-of-war is at the root of the pain. Your doctor will need to confirm if a spastic muscle is the source of your pain. If it is, taking 150 milligrams of valerian three times a day may help, says Dr. Evans.
