Home Program for Sciatica and a Herniated Disc

What you are treating

Sciatica is leg pain from a pinched nerve in the low back, most often from a herniated disc. The disc material that is pressing on the nerve shrinks over time as the body absorbs it, and the nerve calms down. About nine out of ten people with a disc herniation get better without surgery, most within six to twelve weeks. This plan is designed to get you through those weeks comfortably and to protect the disc while it heals.

A useful rule: leg pain that moves up toward the back is improving, even if the back hurts more. Leg pain that moves farther down the leg is worsening. Let that rule, not the amount of pain alone, guide what you do.

Week 1 to 2: calm it down

• Keep moving. Short walks, 5 to 10 minutes, several times a day, on level ground. Lying still for days makes it worse.
• Avoid the positions that load the disc: sitting for long stretches, slouching, bending forward at the waist, lifting, and twisting. When you must sit, use a small rolled towel behind the low back and get up every 20 to 30 minutes.
• Lie on your stomach for a few minutes several times a day if it does not increase leg pain. Then prop up on your elbows for a few minutes. Then, if that is comfortable, press up with your arms, keeping the hips on the floor, 10 times, holding a second or two at the top. These extension movements shift pressure off the back of the disc, where the herniation is. Do them every two to three hours.
• Medicines: acetaminophen on a schedule; an anti-inflammatory (ibuprofen or naproxen) with food for one to two weeks if your stomach and kidneys allow it; a short course of an oral steroid or a nerve-calming medicine if I prescribe one. A muscle relaxant at night if spasm is keeping you up. Opioids have little place here.
• Ice or heat, whichever feels better, 15 minutes at a time.
• Sleep on your side with a pillow between your knees, or on your back with a pillow under the knees.

Week 2 to 6: get moving

• Walk farther each day, aiming for 30 minutes.
• Keep doing the extension press-ups, and add standing back bends: hands on the hips, lean back gently, 10 times, several times a day, especially after sitting.
• Nerve glides, once leg pain is easing: sit at the edge of a chair, slump slightly, straighten the painful leg and pull the toes up while looking down, then relax while looking up. 10 slow repeats, twice a day. If it increases leg pain, stop and try again in a few days.
• Begin gentle core work, holding the spine neutral: lying on your back with knees bent, tighten the lower belly and hold 10 seconds, 10 times. Progress to bridges, bird-dogs, and side planks on the knees as the leg settles.
• Physical therapy starts here if you are not improving on your own. A good therapist teaches you which direction of movement eases your leg and builds the program from it.
• Return to work as soon as you can do it with the sitting and lifting rules.

Week 6 and beyond: build it back

• Walk daily. Add a stationary bike or swimming.
• Strengthen the hips and core three times a week: hip hinges, bridges, bird-dogs, side planks, and later squats with a neutral spine. The hips should do the bending, not the back.
• Learn to lift: load close to the body, bend the knees and hips, no twisting while loaded.
• Keep the extension press-ups as a daily habit if sitting is a big part of your day.

When an injection makes sense

If after two to three weeks the leg pain is still severe enough to stop you from sleeping or working, an epidural steroid injection can calm the nerve and let you do the program. It does not shrink the disc. It buys time for the body to do that. Most people need one, sometimes two.

When surgery makes sense

• The leg is getting weaker, or a foot is dropping.
• Leg pain is still disabling after about six to eight weeks of a real effort with this plan and, when appropriate, an injection.
• The herniation is large and matches your symptoms, and you want a faster path back.

A microdiscectomy or an endoscopic discectomy removes the fragment through a small incision, with same-day discharge for most. Surgery relieves leg pain faster than waiting, but at one to two years the results are similar for most people who can tolerate the wait. That is a choice you get to make.

Call 911 or go to an emergency room if you have

• New trouble controlling your bladder or bowels.
• Numbness in the groin, buttocks, or inner thighs.
• Weakness in both legs, or weakness that is getting worse quickly.

Learn more

OrthoInfo, Sciatica: orthoinfo.aaos.org (opens in a new tab)

My guides to lumbar radiculopathy, epidural steroid injection, and endoscopic lumbar discectomy.

This plan is general guidance for Dr. Wey's patients and does not replace the advice we discuss in clinic. Stop and call us if any exercise makes leg pain spread farther down the leg, or if you notice the warning signs at the end.