Epidural Steroid Injections vs. Exercise for Sciatic Pain Relief

Sciatica is a general term describing pain that radiates from the buttock downward into your leg along the course of your sciatic nerve.¹Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015 Mar 26;372(13):1240–8.

With all the sciatica treatments that are available to you, how do you decide on the best option?

Treatments can range from nonsurgical methods, such as a guided exercise program and/or oral medications to more invasive options, such as injections or surgery. To aid you in your decision-making process, here is a comparison of epidural steroid injections and exercise for treating sciatica pain:

Epidural steroid injections relieve inflammation in your lower back

A lumbar epidural steroid injection is a procedure where a doctor injects steroids in your lower back near your spinal cord and nerve roots.²Patel K, Upadhyayula S. Epidural Steroid Injections. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 2020 Jan 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470189/

Epidural injections may provide immediate pain relief

Steroids work by decreasing the production of inflammatory chemicals and reduce the sensitivity of your nerve fibers to pain. As a result, fewer pain signals are generated and you feel less pain.³Hassan KZ, Sherman A l. Epidural Steroids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 2020 Jan 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK537320/

The goal of epidural steroid injection treatment is to²Patel K, Upadhyayula S. Epidural Steroid Injections. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 2020 Jan 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470189/:

• Reduce sciatic nerve pain by decreasing inflammation
• Improve mobility and function in your lower back and legs

Steroid injections may also help you limit or eliminate the need for long-term oral medications, thus minimizing or preventing the potential side effects associated with them.³Hassan KZ, Sherman A l. Epidural Steroids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 2020 Jan 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK537320/

Epidural steroid injections may not work for all types of sciatic pain

When performed appropriately, the majority of patients experience pain relief after an epidural steroid injection. In general, lumbar epidural injections have better outcomes when sciatica is of recent onset (such as from an acute disc herniation) and the nerve root compression is minimal. ⁴Bartleson JD, Maus TP. Diagnostic and therapeutic spinal interventions. Neurol Clin Pract. 2014 Aug;4(4):347–52.

See Epidural Steroid Injection Pain Relief Success Rates

Repeat injections may be needed for long term pain relief

Patients who have a positive but incomplete response to a single injection may benefit from a repeat injection.⁵Murthy NS, Geske JR, Shelerud RA, Wald JT, Diehn FE, Thielen KR, et al. The effectiveness of repeat lumbar transforaminal epidural steroid injections. Pain Med Malden Mass. 2014 Oct;15(10):1686–94. The decision to perform a subsequent injection should be determined by the response to the previous injection.

Once the effect of the injection wears off, recurrences of sciatica are possible. Some people may not experience any pain relief while others may have long-term improvement in their sciatic pain.⁶Manchikanti L, Benyamin RM, Falco FJE, Kaye AD, Hirsch JA. Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review. Clin Orthop. 2015 Jun;473(6):1940–56. While this treatment is relatively safe, potential risks are possible.

As a general rule, doctors typically consider epidural steroid injections if your pain persists after some combination of nonsurgical treatment, such as physical therapy and exercise, oral medications, massage therapy, and/or manual manipulation are tried for several weeks.

See Epidural Steroid Injections: Risks and Side Effects

Exercise supports and stabilizes your lower back

Exercise and physical therapy are a part of nearly every sciatica treatment plan. Sciatica exercises target specific tissues in your lower back to provide the following goals:

• Decrease the pressure on your spinal nerves, alleviating pain, numbness, and weakness in your legs⁷Jeong U-C, Kim C-Y, Park Y-H, Hwang-Bo G, Nam C-W. The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. J Phys Ther Sci. 2016 Jan;28(1):46–50.
• Stimulate the functions of your nervous system, improving the health of your sciatic nerve⁷Jeong U-C, Kim C-Y, Park Y-H, Hwang-Bo G, Nam C-W. The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. J Phys Ther Sci. 2016 Jan;28(1):46–50.
• Decrease stresses through a healing herniated disc⁸Mann SJ, Singh P. McKenzie Back Exercises. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 2020 Jan 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539720/
• Promote strengthening in line with the patient’s directional preference (forward or backward bending of the spine)
• Maintain a proper posture⁸Mann SJ, Singh P. McKenzie Back Exercises. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 2020 Jan 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539720/
• Strengthen your abdominal, core, and lower back muscles⁹Ph.D DJSMD. Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. 1 edition. New York: Avery; 2014. 320 p.

Exercise also improves the flexibility in your lower back, helps reduce body weight, and provides restful and sound sleep.⁹Ph.D DJSMD. Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. 1 edition. New York: Avery; 2014. 320 p.

Read more about Sciatica Exercises for Sciatica Pain Relief

Exercise brings healing nutrients to your sore back

When you exercise, the tissues in your lower back receive more blood, healing nutrients, and oxygen. Exercise also helps to remove toxins from your muscle fibers, relieving stiffness and improving flexibility.¹⁰Valdivieso P, Franchi MV, Gerber C, Flück M. Does a Better Perfusion of Deconditioned Muscle Tissue Release Chronic Low Back Pain? Front Med [Internet]. 2018 Mar 20 [cited 2020 Jan 19];5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869187/

Exercise may prevent recurrences of sciatica

When you commit to exercising on a daily basis, your lower back regains its strength and stability, reducing future sciatic pain flares, muscle fatigue, and pain.⁹Ph.D DJSMD. Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. 1 edition. New York: Avery; 2014. 320 p.

The same exercise may not work for everyone

It is important to learn sciatica exercises from a trained therapist who can design the exercise regimen to target your underlying condition. For example, the exercises for sciatica caused by a herniated disc may vary based on the location of the herniation and the resulting of type of stenosis (narrowing of the spinal canal or bony opening for spinal nerve roots). In addition to exercise, some therapists may recommend manual therapy and/or physical therapy to treat your sciatica.

See Physical Therapy and Exercise for Sciatica

A therapist can also guide your posture and make modifications if an exercise seems too difficult or painful.

See How a Physical Therapist Can Help with Exercise

Combining both treatments

If your sciatica symptoms are preventing you from finding long-term relief by way of exercise, you may want to consider an epidural steroid injection to allow you to perform your targeted exercise program. An epidural injection may help provide enough pain relief for you to begin and/or continue an exercise program to help alleviate your sciatica symptoms.

Finding the best course of treatment for your sciatica symptoms often comes down to a process of trying out different methods, as what works for one person may have little effect on another. Discuss your possible treatment options with a doctor to see what is recommended and what may work best for you.

Learn more:

Lumbar Epidural Steroid Injections for Low Back Pain and Sciatica

Sciatica Treatment Video