Feb 10, 2009

Sciatica and Epidural Injections

Here's another good question from this week's mailbag:

Hi Dean

After four weeks of severe sciatic pain and not being able to walk more than a few yards, I finally got in to see an osteopath last week. He said I might want to consider cortisone injections as part of the physical therapy. I read about epidural steroid injections in the forum but I'm wondering what you think of them.

Any advice would be appreciated.



My response…

Hi Allen,

I'm glad you asked this question because I've been meaning to address this subject for some time now. Initially, I was skeptical of the use of steroids or other pharmaceuticals for treating back pain because of my long history of being a natural health nut.

There was a time when I viewed anything coming from conventional medicine -- and especially the big pharmaceutical companies -- as some sort of toxic poison.

I'm still not crazy about "artificial ingredients" so to speak, but I'd like to think I've gotten a little smarter when it comes to science, medicine and health over the past few years.

Which Brings Us to Epidural Steroid Injections

My first experience with the therapeutic use of steroids came about in an unlikely and rather unpleasant fashion.

A couple years ago one of the family cats came home dragging her hind legs. She was obviously injured so we rushed her to the Vet. Long story short, he gave her a steroid injection and sent her home with oral steroids to be given daily for the next week. Within a few days she was back up and around like nothing had ever happened.

We still have no idea how she injured herself, but we were sure she was going to be crippled and would probably have to be put to sleep. Instead, she fully recovered.

That was a real eye opener.

Then Came the Knockout Punch

howard cosell

Not long after that Ken (a.k.a. krd) started posting in the forum his experience with the epidural injections and how they knocked down his sciatica symptoms like Muhammad Ali taking on Howard Cosell.

I couldn't ignore the evidence after that.

So now I've come around 180 degrees on the subject of steroids for the treatment of sciatica. If your doctor is recommending them for you, I believe they are definitely worth a try.

Keep in mind that they don't work for everyone. This is probably due to the fact that sciatica has many possible causes and simply eliminating the inflammation may not do the trick.

Also, keep in mind that the epidural will not heal anything. It only eliminates the inflammation and swelling, which should give you relief from the pain. This relief is your window of opportunity to proceed with physical therapy to correct the cause of your sciatica.

Next: Part Two: Are You a Candidate?


Table of Contents for this series:

  1. Epidural Steroid Injections
  2. Are You a Candidate?
  3. The Difference Between Corticosteroids and Anabolic Steroids
  4. Risks and Side Effects
  5. The Procedure

Supplemental Article: Sciatica and the Saline Story

About the Author

Dean Moyer is the author of the books, Rebuild Your Back, Rebuild Your Neck and The Pain Relief Manual. Copies of his books are available exclusively through this website. Read more...

Rebuild Your Back
Rebuild Your Back
Second Edition
Rebuild Your Neck
Rebuild Your Neck
The Pain Relief Manual
The Pain Relief Manual


1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002;5: 133-48.

2. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336: 1634-40.

3. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995;63: 279-88.

4. Watts RW, Silagy CA. Meta-analysis and the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesthesia Intens Care 1995;223: 564-9.

Last updated: Feb 10, 2009