To promote health and improve clinical outcomes in a variety of chronic conditions, including sciatic nerve pain, health care providers increasingly recommend interventions aimed at addressing lifestyle.
Modifiable lifestyle risk factors are often nutritional or physiologic in nature, and interventions to address them commonly include general physical activity, smoking cessation, and weight loss.
There are numerous types of interventions commonly used for modifiable lifestyle risk factors.
- For physical activity, these include walking and jogging, swimming, or cycling.
- For smoking cessation, these include “cold turkey,” nicotine patch or gum, and group or cognitive behavioral approaches.
- For weight loss, these include calorie restriction, food-type restriction, and medically supervised diets.
Although health care providers have long sought to improve their patients’ health through education and advice on general lifestyle modifications, this has generally depended on the availability of evidence to support an association between a risk factor and a particular health condition.
The relationship between sciatic nerve pain and physical inactivity is likely complex because there is evidence suggesting that either too much or too little activity may be associated with sciatica pain.
However, there exist numerous potential confounders as many studies on this topic have occurred in an occupational setting.
For example, although physical activity such as repetitive lifting or twisting has been associated with sciatic nerve pain, this was likely confounded by high job dissatisfaction and low education. When examining recreational rather than occupational physical activity, many studies have reported that general physical fitness appears to lower the incidence or severity of sciatica pain.
Several hypotheses have been offered for a possible association between sciatic nerve pain and smoking, including repeated microtrauma from chronic cough leading to disc herniations, reduced blood flow to the discs and vertebral bodies leading to early degeneration, and decreased bone mineral density leading to vertebral body or end plate injury. Systematic reviews (SRs) have reported that 51% to 77% of epidemiologic studies found a positive association between smoking and sciatica pain.
Although a causal link between obesity and sciatic nerve pain appears intuitive because of additional weight on load-bearing spinal elements and altered biomechanics leading to excessive wear and early degeneration, evidence to support such hypotheses is lacking.
An SR of 65 epidemiologic studies reported that only 32% found a positive association between obesity and sciatica pain. Little is currently known about the prevalence of lifestyle modification counseling among spine providers.
A cross sectional study of 52 consecutive patients presenting to an academic spine surgery clinic reported that despite an increased prevalence of morbid obesity (body mass index greater than 30) compared with the general population, less than 20% had received counseling about lifestyle modification from their primary care physicians.
It has been reported that chiropractors commonly offer preventive care services, including smoking cessation, weight-loss programs, fitness counseling, and stress management to their patients, including those with sciatic nerve pain.
Sciatic Nerve Pain Relief in 3 Steps
Physical activity, smoking cessation, and weight-loss programs may be self-administered or under the guidance of a physician, psychologist, therapist, physical therapist, or other health care provider.
These interventions are typically administered in private practices, outpatient clinics, community health centers, or physical fitness centers, and are widely available throughout the United States.
Sciatic Nerve Pain and Physical Activity
According to the Centers for Disease Control and Prevention, regular moderate-intensity activity is sufficient to produce health benefits in those who are sedentary.
Health care providers should recommend that adults engage in 30 minutes of moderate-intensity activity 5 days per week, or 20 minutes of vigorous-intensity activity 3 days per week.
Moderate intensity activity burns 3.5 to 7 calories per minute and includes such activities as walking briskly, mowing the lawn, dancing, swimming for recreation, and bicycling.
Vigorous-intensity activity burns greater than seven calories per minute and includes such activities as high-impact aerobic dancing, swimming continuous laps, or bicycling uphill. Regardless of intensity, patients should burn the recommended 1000 calories per week.
To promote physical, patients need to be encouraged to set realistic personal goals, gradually increasing the length and intensity of activity, and varying the type of activities to remain interested and challenged.
Sciatic Nerve Pain and Smoking
According to the American Cancer Society, smoking cessation involves four steps:
- Making the decision to quit
- Setting a quit date and choosing a quit plan
- Dealing with withdrawal
- Staying “quit”
The decision to quit smoking must originate from the patients, who are more likely to succeed if they:
- Are worried about tobacco-related disease
- Believe they are able to quit
- Believe that benefits outweigh risks
- Know someone with smoking-related health problems.
The quit date should occur within the next month to prepare appropriately and not delay much further, and might be selected for a special reason (e.g., birthday, anniversary, or a special event like the “Great American Smoke out”, which occurs on the third Thursday in November) .
Family and friends should be informed of the quit date, which may require modifying activities previously associated with smoking (e.g., coffee or alcohol use). Although including gum, candy, carrot sticks, or sunflower seeds; exercise and deep breathing may also help alleviate withdrawal symptoms.
Small self-rewards for milestones achieved (e.g., one week, one month) can help stay motivated to quit. To prevent relapses, reasons for quitting should be reviewed periodically, emphasizing benefits already achieved and those still to come.
Sciatic Nerve Pain and Weight Loss
According to the Weight-control Information Network at the National Institutes of Health, there are two main categories of weight-loss programs: nonclinical and clinical.
The former may be self-administered or performed with assistance from a weight-loss clinic, counselor, support group, book, or website.
Nonclinical weight-loss programs should use educational materials written or reviewed by a physician or dietitian that address both healthy eating and exercise; programs neglecting the exercise component should be avoided .
Although many commercial programs may promote proprietary foods, supplements, or products, these may be costly and will not teach participants about appropriate food selection to maintain long-term weight loss.
Programs promoting specific formulas or foods for easy weight loss may offer short-term weight loss because of calorie restriction but should be avoided because they may not provide essential nutrients, do not teach healthy eating habits, and are not sustainable.
Clinical weight-loss programs are administered by licensed health care providers including physicians, nurses, dieticians, or psychologists in a clinic or hospital setting.
These programs may include nutrition education, physical activity, cognitive behavioral therapy (CBT), prescription weight loss drugs, or gastrointestinal surgery, depending on the desired weight-loss and health status.The most conservative interventions are generally preferred as the starting point when seeking care for sciatic nerve pain.