Sciatica Treatments: Comparing Yoga Therapy with Corticosteroid Shots

Sciatica can be excruciatingly painful and can make normal life seem out of reach. The treatments available are expensive and have side effects, but your yoga practice can prevent and alleviate sciatic pain.

Steroid shots have side effects and have been shown to do little to improve the pain of sciatica, while a carefully composed and mindful course of yoga asanas may alleviate symptoms in a much more healthful way. Researchers at the University of Sydney Medical School recently reviewed the randomized and controlled studies of the use of corticosteroid shots for sciatica and concluded that sciatica patients received little benefit from the shots and should consult with their physician and consider alternate forms of treatment.

The sciatic nerves are the longest nerves in the human body, according to yoga expert Doug Keller. The sciatic nerves start in the pelvis, exit the lower spine, and travel the entire length of each leg, branching into smaller nerves. The nerve then passes between layers of the deep buttock muscles through the deep muscles of the back of the thigh, and down through the outer edge of your leg to your foot.

Sciatica, or pain from the sciatic nerve, can arise suddenly or gradually over time, and the symptoms can range from mild numbness to excruciating pain. The pain can affect the whole length of the nerve from the lower back through the buttocks muscles to thigh, calve, and foot nerves and muscles. The two most likely causes are a herniated disk in the lower back—where swelling and inflammation press on the nerve—or stiffness and compression in the piriformis muscle in the lower back. According to a 2005 study from the Journal of Neurosurgery, nearly 70 percent of sciatica cases are caused by this muscle.

Treatments include general home care, pain or antidepressant medications, and physical therapy and corticosteroid shots. Corticosteroids work by mimicking the effects of the hormones your body produces naturally. Corticosteroids suppress inflammation, which is an immune response. Corticosteroids also suppress your immune system, and can only be used a few times a year because of this side effect.

After analyzing results from nearly 24 clinical trials involving thousands of sciatica patients, Australian researchers found that spinal injections of corticosteroids had little effect. The researchers analyzed all of the randomized, placebo-controlled studies they found available in English, and found little difference in the relief offered by placebos and spinal injections.

Despite this, in recent years, the use of epidural steroid injections to treat back pain has soared from 741,000 in 2000 to approximately 1,438,000 in 2004. In the United States, corticosteroid shots are expensive, often costing hundreds of dollars per shot. Recently, a tainted supply of a steroid included in the trials was tied to a nationwide outbreak of fungal meningitis that infected 400 people and led to 31 deaths.

In contrast, yoga offers a careful and healthful treatment that is tailored specifically to the cause of the sciatica. Dr. Loren Fishman offers asanas suited to the causes of the pain, which he differentiates as radiculopathy or piriformis syndrome. Radiculopathy is the official name for compression/and or inflammation of the sciatic nerve in the base of the spine, caused by a herniated disk or spinal stenosis, which is the narrowing of the spinal opening.

Piriformis is the name of a muscle located deep in the hip. Because the sciatic nerve is sandwiched between the piriformis and the tendons that lie against the bone of the sacrum, stiffness or tightness in this muscle can exert pressure and cause sciatic pain.

Yoga practices should be gentle, progressive, and use specific asanas to treat these causes of sciatic pain. For a herniated disc, consulting with a doctor is always recommended, as herniated discs may have serious effects that require surgery, says Keller. Yoga asanas work for sufferers of herniated disc by aligning, lengthening, and strengthening the lower back. Yoga can help manage and reduce the pain and can sometimes even reduce the herniation.

If the source of your sciatica is pressure on the nerve due to a short, tight piriformis, then the focus will be on stretching this muscle. The approach will be gentle and progressive, since overworking the piriformis may lead to spasms and deep buttock pain.

In their 3-part yoga download, Dr. Fishman and Ellen Saltonstall explore the anatomy, causes, and strategies for sciatica treatment, emphasizing the importance of diagnosing the source of the pain and recommending specific yoga asanas for both prevention and treatment according to the cause.