Why do back exercises make sciatica worse? Our expert doctor explains

A reader asks: I’m 64, for the past few years I’ve had intermittent bouts of sciatica with pain in my lower back that then spreads down my right buttock and into the back and side of my right leg. I’ve had an X-ray, which my GP says has shown I have mild wear and tear and have been advised to do regular exercises. However, when my back is bad I think the exercises make the pain worse, so would it be better to rest it?

Dr Rosemary Leonard replies: Sciatica is pain caused by pressure on one or both of the sciatic nerves, which leave the spinal cord in the lower back on each side and then extends across the buttock and down the outer side of the leg to the outside of the foot.
The pressure can come from a bulging disc, but in your case it is more likely to be due to the small abnormal bony growths that can occur in osteoarthritis, or ‘wear and tear’ in the spine. Often the pain suddenly flares when the muscles in the back stiffen, which pulls the individual vertebrae close together, increasing pressure on the nerve.
Unfortunately, if you don’t move the muscles will tend to get tighter, increasing the pain. Therefore, while it is tempting to lie in bed and rest, it is far better to try and get your back moving, even if it hurts. Gently stretching your back muscles will help reduce the tension in your back and help reduce your pain, and will also increase your flexibility and range of movement.
That doesn’t mean you should push yourself through extreme pain, but rather doing some gentle stretches, bending forwards and sideways at regular intervals during that day and avoiding sitting or lying down for long periods of time.
When the pain first flares, applying an ice pack to the affected side of the lower back can help, then after four days alternate these with heat pads (available from pharmacies). Make sure the pads are wrapped in a tea towel so they do not touch or burn your skin.  
Paracetamol can help to ease the pain, as can ibuprofen, which also helps to reduce inflammation, but this can cause stomach irritation so if you take it on a regular basis you may need additional tablets to reduce your stomach acid level. Your GP can give you further advice and a prescription for these if she considers them advisable.

If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. She regrets she cannot enter into personal correspondence or reply to everyone