📌 What is Sciatica? Sciatica is pain along the sciatic nerve, running from the lower back down to the leg, caused most commonly by lumbar disc herniation, nerve compression, spinal stenosis, piriformis syndrome, etc. 1. Initial Management (Acute Stage: First 48–72 hrs) Rest Avoid prolonged bed rest (no more than 1–2 days) Avoid heavy lifting, bending, twisting Cold → Heat Therapy First 48 hrs: Ice pack 15–20 min × 3/day After 48 hrs: Shift to warm compress to relax muscles 2. Medications (According to Pain Severity) Use under physician supervision, especially long-term. Drug CategoryExamplesUseNSAIDsIbuprofen, Naproxen, Diclofenac, EtoricoxibFirst-line for pain & inflammationNeuropathic Pain ModulatorsPregabalin, GabapentinEffective for nerve pain & burning sensationsMuscle RelaxantsThiocolchicoside, TizanidineHelpful if muscle spasm presentVitamin B12 + B6 + B1Methylcobalamin, NeurobionImproves nerve healingSteroids (short course)Prednisolone, MethylprednisoloneOnly in severe radicular pain—short duration Example short medical plan (for reference only): Naproxen 500 mg 1 tab BD after meal Pregabalin 75 mg HS (once at night) Cap. Methylcobal 500 mcg OD Muscle relaxant (if spasm): Thiocolchicoside BD (Avoid if stomach ulcer, kidney issues, pregnancy unless advised by doctor.) 3. Physiotherapy (Most Important & Long-term Cure) Start once pain reduces slightly. 🔥 Core Exercises Cat-camel stretch Pelvic tilt Sciatic nerve gliding exercise Hamstring stretching McKenzie extension exercises In chronic or recurrent cases: Strengthen core + lower back Swimming, cycling, yoga, pilates recommended 💡 Regular physiotherapy is the strongest evidence-based treatment. 4. Lifestyle and Prevention Maintain proper posture when sitting/driving Avoid prolonged sitting > 45–60 minutes Use firm mattress Weight reduction if overweight Start routine walking 20–30 min daily Always lift weight with bent knees, straight back 5. Possible Adjunct Therapies TherapyUseTens / Ultrasound therapyPain relief during acute phaseEpidural steroid injectionSevere persistent radicular painChiropractic / Osteopathic manipulationOnly by certified professionals 6. When Surgery is Needed? (Rare) Only if no improvement in 6–12 weeks OR red-flag signs appear: 🚩 Red Flags (Urgent Evaluation Needed) Progressive weakness of foot/leg Loss of bowel or bladder control Saddle anesthesia (numbness in inner thighs/perineum) Severe pain worsening despite therapy