Ice it! That is often the advice people give for pain, usually pain caused by an injury or over extension of some body part that sets off pain. But does ice work for sciatica?

The answer is often yes! To see why, let’s look at what causes sciatica and how cold or cryotherapy can affect the pain. The large sciatic nerve runs from the base of the spine through the buttocks and down both legs.

Anything that puts pressure on or causes friction with the sciatic nerve can cause pain up and down the length of the nerve. The most common places where this can occur is within the spinal column, where nerves exit the vertebra, and along the piriformis muscle located deep in the buttocks that runs adjacent to the sciatic nerve in the pelvis.

Irritation of the sciatic nerve in the spinal column is often due to a narrowing or stenosis of the spinal canal, or by a swollen or herniated disc, disc degeneration or a malalignment causing the vertebra to slip forward to impinge on the nerve.

Another pain source is irritation from the piriformis muscle that connects the spine, runs through the pelvis and connects to the top of the thighbone. It is the muscle that moves the hip and allows it to swivel. If injured the piriformis can swell and rub against the sciatic nerve irritating it.

The irritation sets off an inflammatory response, the body’s 911 call that rushes immune cells, blood cells, and other molecules such as platelets to stop bleeding, to the site of the irritation or injury.

The function of inflammation is to eliminate the initial cause of cell injury, clear out dead cells and tissues damaged from the original insult and the inflammatory process itself, and to initiate tissue repair. A byproduct of that repair operation is swelling, which in the case of the sciatic nerve, can cause pain that extends along the nerve into the leg and even feet, sometimes called radiculopathy.

So what’s ice got to do with it? Actually cold therapy acts to blunt the inflammatory response and reduce the swelling around the sciatic nerve and numb or reduce nerve activity. It can break the cycle of irritation, inflammation, swelling and more irritation, which in turn reduces the pain.

If the sciatica is caused by swelling of the piriformis muscle or muscle strain, cold therapy can be very effective for pain relief and along with rest and avoidance of the positions or activity that caused the piriformis inflammation in the first place can be enough to allow the muscle to return to a normal state and produce long-term relief.

If the pain is due to swelling around the sciatic nerve at the base of the spine, long-term relief will depend on what is causing the swelling. If it is injury to muscle or tendons near the sciatic nerve cold therapy can be effective. If the swelling is due to degenerative disc disease or stenosis, cold therapy is likely to provide only temporary relief, which will be an indicator that more aggressive therapy may be needed.

With Dr. Michael Gomez, the emphasis is on providing a personalized approach to each patient’s needs. Our goal is work with you to find the optimal outcome for your condition. We are happy to review your MRI and discuss your treatment options and answer your questions to ensure you get the best treatment for your sciatica. Contact us today!