Q&A: What can I do to help sciatic pain during pregnancy?

The sciatic nerve runs out through the lower spine to the buttock and down the back of the leg to the bottom of the foot. Sciatica may present as pain, numbness, tingling, or weakness. Sometimes the sensation is just in the buttock, and sometimes it radiates down.

I don't know why so many moms-to-be have pain from sciatic irritation. It may have to do with pregnancy posture or the baby's head position. Regardless, pain can be severe and impede walking and other daily activities. Oddly, symptoms often go away after several weeks with or without treatment. But some moms require treatment.

Prevention

• Watch your posture: the swayback position of late pregnancy puts strain on the low back. Wear flat shoes and watch how you sit and stand. Sometimes a "belly belt" can help support the abdomen and improve posture in pregnancy.
• Daily exercises for your back also may help prevent sciatica. Pelvic rocking on your hands and knees can be helpful, but don't arch your back (cat pose in yoga)—you want to keep neutral, and go into cow pose only, with your tummy dropped and your head up. Another way to approach this is to stand with your back against a wall and your feet a bit away from the wall, knees slightly bent. Tilt your pelvis so the small of your back presses against the wall. Hold for the count of five then release. Do this in sets of 10 several times a day.
• Starting pregnancy with strong abdominal muscles may help prevent back pain. Obviously this advice is too late for now, but a good thought if you are going to have more children.

Treatment

• Ice or heat, or both, may help. Frozen peas make a good ice pack and can be used over and over (but don't eat them once defrosted and refrozen). Heat packs can be the instant disposable type, electric, or a reheatable pad that goes in the microwave. Be sure to follow manufacturer's instructions. Some people find it helpful to alternate heat and cold.
• Tylenol® (acetaminophen) may help. Motrin®, ibuprofen, Aleve®, aspirin, etc., typically are not advised during pregnancy. Never take more Tylenol® than the bottle says. Stronger prescribed pain medications are occasionally necessary.
• Massage—professional or from a friend
• Physical therapy
• Chiropractic manipulation from a chiropractor trained in treatment during pregnancy
• Acupuncture from a trained acupuncturist
• A brief course of the steroid Prednisone can be very helpful. Prednisone doesn't cross the placenta very much, and has been used extensively during pregnancy in short courses without problems. A typical prescription would be a quick taper—70 mg the first day, 60 the next day, etc., and off by one week./li>
• Time—often sciatica just gets better in a month or two without treatment

Talk to your doctor or midwife about your symptoms. Rarely, sciatica is a sign of a more serious problem requiring imaging for diagnosis. MRI is considered safe in pregnancy.