Tips for Travelling with Sciatica

Many of my patients assume lower back pain and sciatica are the same thing – they’re not. Your lower spine is made up of a combination of bones (vertebrae), squashy discs between the vertebrae that act as shock absorbers; tough ligaments to provide support; muscles that help the spine bend; and nerves that travel between your spine and your brain, sending messages back and forth. At various points down the spine, these nerves emerge to supply power and sensation mechanisms to parts of your body.

What is Sciatica?

Sciatica is a form of nerve pain, that happens because of inflammation or irritation of your sciatic nerve. It’s often because one of the discs between your vertebrae has prolapsed, meaning the soft centre of the disc has broken through its capsule and has pressed on the sciatic nerve.

The sciatic nerve is the longest and thickest nerve in your body it’s a bundle of nerves that come from five nerve roots which emerge from the lower spine. You have two sciatic nerves, one on each side of the body. They travel from your lower spine to just below the back of your knees. Then they split up to control sensation and movement in your calves, feet and toes.

Any nerve pain affects all the parts of the body supplied by that nerve. Your sciatic nerve has fibres that control both movement and sensation – so a problem with your sciatic nerve can lead to both pain and weakness -this is called sciatica. What’s more, even though the problem may be a pinching of the nerve at the bottom of your spine, you may feel the pain anywhere down your lower back, hips, buttocks or legs, right down to your feet or even your toes.

Sciatica can also lead to numbness, weakness or tingling (pins and needles) over any part of the sciatic nerve, from your lower back down to your feet. The pain of sciatica is often worse over the back of your legs and feet than in your spine.

What’s the Difference Between Sciatica and Other Back Pain?

About 4 out of 5 people get at least one episode of lower back pain over a lifetime. Most of these are due to ‘nonspecific back pain’. That means there’s no obvious cause on X-ray or scan to account for the pain. It’s often due to an over-stretching of one of the ligaments or muscles, or a minor issue with one of the small ‘facet’ joints that help connect vertebrae together.

In nonspecific back pain, there’s no obvious evidence of pressure on the sciatic nerve, which is what causes sciatica. That doesn’t mean the pain isn’t real – and regardless of the cause of your pain, the same lifestyle changes may help.

What Makes Sciatica Worse?

Sciatica is due to irritation or inflammation of the sciatic nerve. That means anything that increases pressure on your sciatic nerve is going to make sciatica worse. In the past, doctors used to recommend complete rest - lying flat on your back and not getting up for anything except to go to the bathroom or eat your meals – as the best option for sciatica.

We now know that lying completely still can do more harm than good – your ligaments and muscles seize up and it can delay recovery. The good news is that sciatica usually settles within 4-6 weeks, although it can flare up in the future.

What are the Triggers for Sciatic Pain?

Different people find they have different triggers for sciatica. However, one of the most common is spending any length of time sitting or standing in the same position. If you’re travelling, it’s common to be confined to a small seat for long periods. That means travel can be a common trigger for sciatica unless you take steps to avoid it.

Other Triggers for Sciatica Include:

• Lifting heavy objects (I know you have to take luggage on holiday, but you really need to be aware of the risk of ruining your whole trip!).
• Stress or tension might lead to the tightening of muscles (holidays are meant to be a stress reliever, but it’s important to be conscious of stress if you’re frustrated about plane delays or waiting for luggage or transfers).
• Cold weather.

How Can You Reduce the Pain of Sciatica?

Sciatica can be a recurrent problem, which flares up when your sciatic nerve is touched or irritated. Many of the same physical stresses can irritate the muscles, ligaments and joints which form part of your spine. This means the same changes can reduce your chance of a flare-up of both sciatica and nonspecific back pain.

How to Reduce Your Chance of Sciatica on Holiday

Pack With Precision

Chances are that even if you’re just travelling for a few days, you’ll have a fair amount of luggage. If you can, use two small-medium suitcases rather than a single heavier bag.

Four-wheeled suitcases are often easier to steer than two-wheeled alternatives and allow you to stand upright, reducing any twisting or bending strain on your back.

Make sure that you include painkillers you may need en route in your packing. Topical rubs or anti-inflammatory medicines can be helpful – ensure you pack versions which are 100ml or less so you can get them safely through security in your hand luggage.

You may find that a lumbar back support – or even a rolled-up towel in the small of your back – will help keep you comfortable. Make sure you make room for it in your hand luggage.

Travel Trauma

One of the most likely causes of a flare-up of your sciatica is long periods spent sitting completely still on your plane. However, do remember that rushing or carrying heavy luggage awkwardly can also act as a trigger.

• Take your time. Plan to arrive at the airport in plenty of time, so you can get yourself to the gate at your leisure.
• Lift mindfully. Make sure you use your legs, not your back when lifting heavy objects. Keep the object you’re lifting straight in front of you and keep the case or other object close to your body. If possible, get someone else to lift heavy cases off a luggage carousel, where their movement makes it hard to avoid twisting.

Pick Your Seat

Sitting still for long periods will often make sciatica worse. A few stretches, on the other hand, can ease muscle tension and may reduce pressure on your sciatic nerve.

If possible, always pick an aisle seat which will allow you to get out of your seat without disturbing other passengers.

Explain your situation to your cabin crew – they’ll have seen it all before and will often help find you somewhere you can do some deep knee bends

Keep It Moving

Keeping as active as you reasonably can is key to reducing the chance of sciatica ruining your holiday. If you’ve had a bout of sciatica, chances are that you’ve been referred to a physiotherapist.

Physios are the ultimate experts in recovering from muscles and joint problems – and the right kind of exercise is at the heart of what they do. They will usually advise you on regular exercises to do between sessions, and it’s essential to keep these up while you’re away. If you’re not sure what to do, try this video of regular exercises for low back pain.

Painkillers Preparedness

There’s increasing evidence that simple painkillers like paracetamol don’t help with low back pain, especially sciatica. Anti-inflammatory medicines like ibuprofen may help – but they carry the risk of side effects, especially if you take high doses over long periods.

For more severe pain, your doctor may recommend stronger painkillers including codeine. These can be effective in the short term – but they have lots of side effects including drowsiness and constipation. They also carry a real risk of addiction in the medium-long term.

In the past, benzodiazepines (like Valium) or medicines to damp down messages from the nervous system (such as gabapentin and pregabalin) used to be prescribed for sciatica. Studies have now shown they don’t help significantly and carry risks of side effects.

Heat packs can help relieve pain, but do be aware that you could end up with skin damage if your sciatica has resulted in numbness over the area of the skin you’re using them on.

READ MORE: Travelling with Medication

Pace Yourself

Just because you’re on holiday doesn’t mean you have to take part in every activity. Build rest days into your schedule – that doesn’t mean don't do anything, which can make your back seize up. However, it is important not to overdo it for fear of letting others down.

Listen To Your Body

Do be aware of the warning signs that mean you should seek immediate medical help while you’re away. These include:

• Pain that isn’t getting better when you lie down to rest.
• Numbness around your bottom or your ‘saddle’ area.
• Sudden weakness in one or both legs.
• Loss of control of your bladder or bowel or loss of sensation of your bladder.

Pick Your Insurance Provider with Care

In the UK, we’re used to assuming that if we need medical care it will be available on the NHS and we won’t have to pay for it if we need it in an emergency. The same doesn’t apply if you’re travelling abroad.

A GHIC card entitles you to the same treatment arrangement as local people in certain countries. You can use a UK GHIC if you’re visiting any country in the European Economic Area  – that’s any country in the EU as well as Iceland, Liechtenstein and Norway. You can also use a UK GHIC card in Switzerland if you’re a UK or EU national, or if you have a family member who is.

However, it’s essential to realise that that GHIC doesn’t mean all treatment is free:

• Many countries require their citizens to pay for part of their treatment – so you may still get a bill.
• GHIC (and its predecessor, the EHIC card) don’t cover all aspects of treatment. For instance, a GHIC doesn’t cover medical repatriation if you need to be brought back to the UK for treatment. So it’s essential to have travel insurance even if you’re travelling to a GHIC country.

READ MORE: EHIC, GHIC and Travel Insurance

• Make sure you choose a specialist travel insurer which will cover you for any pre-existing conditions, including sciatica. If you don’t, your insurance could be completely invalid – and regardless of how bad your back pain is, that could pale into insignificance compared to the bills you could be faced with!

READ MORE: Do I Need Travel Insurance?

Managing sciatica while travelling requires a proactive and thoughtful approach to prevent flare-ups and ensure a comfortable journey. By planning ahead, like selecting your seat wisely, and keeping active, you can mitigate the risks associated with long trips.

Being mindful of pain management, listening to your body, and pacing yourself during activities can further reduce discomfort and allow you to enjoy your holiday with minimal disruption.

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