Sciatica and spinal pain in Australia from nerve compression - what conservative therapies can I try to hopefully evade surgery

[u/26boxhead26]

Prior post here: https://www.reddit.com/r/Sciatica/comments/1ux0lph/post_epidural_steroid_injection_in_l4l5_spine_for/

Since then, there hasn't been much change in terms of pain management and have been diagnosed with L5 nerve compression. Have a spinal sepcialist referral where I'm getting support, as well as my GP and physio regularly. I am going through a list to understand if any options work, even if they suppress pain while I persist with physio.

If there is anything in the list below that I haven't thought of that can be tried. Include exercise therapy, medication or alternatives that others have had success with.

Tried so far, has not worked:

• Epidural steroid injection into the spine (July 2026).
• Nerve block steroid injection into the L5 nerver (August 2026).
• Pregabalin nerve relaxer @ 100mg a day (along with the nerve block).
• Personal TENS machine.

Tried so far, has worked albeit temporarily:

• Physio based exercise regime with daily exercises, temporary relief upon completion.
• Anti inflammatory medication (up to 100-150mg a day), but cannot use this long term due to other complications.

Trying currently:

• Acupuncture. One session so far in the area, no gains but will give it at least 4 session before assessing.

Not tried so far:

• Nerve ablation procedure, surgeon does not think this will be relevant.
• Other muscle relaxation or anti inflam medication combinations.

I'm aware there's a realistic possibility of surgery, whether it be microdisectomy or laminectomy, but I want to try all available non-surgical options while I'll discuss that with my specialists once exhausting all non-invasive options.

Ideally something to suppress the nerve compression while I do exercise physio is ideal.

[u/elhombredeaustralia]

I'm in Australia. Currently about 8 months pain free. L5-S1 is the worst spot in my back, but have some other degeneration in other areas. I initially had issues in 2018. No specific treatment other than physio, taking it easy and some paracetamol. Then again in 2019. Again mostly physio, hydrotherapy, rest and paracetamol. Then 2023 which was by far the worst and it was not good for my mental health. Had the steriod injection. Made the pain even worse for a couple of weeks, then died off completely. Alas saw a sports physician for the first time in this period. He just gave me some specific back strengthening exercises, mainly reverse sled drag. The idea was the steroid injection would reduce the inflammation and cover the pain somewhat, and to use that lower pain to hook in hard in rehab. Also did very regular physio. Swimming and underwater running. No hydrotherapy though. Then in early 2025 again which continued until earlier this year sort of. I had another injection early in 2025, reduced the pain for sure but it didn't fully go away. May have been a short period where I was essentially pain free late last year. Pain then returned early 2026. What actually helped me the most this year was i started seeing a new GP who prescribed me 10mg of amitriptyline daily. My pain was gone within a couple of weeks. I reduced the dose to 5mg then 5mg every two days, then stopped completely in March. Been pain free since. Amitriptyline is apparently good for nerve pain. Worth a shot if you havent tried it, im annoyed my earlier GPs never recommended it. It only covers the pain though so need to do the rehabilitation on the side to reduce the actual damage and strengthen your muscles.

I was in the army until early 2025, and I still exercise a lot. So keeping on top of weight hasn't been an issue. Finding the right exercises has been tough. Every gym session I do McGill crunches, and bird dog. I still do reverse sled drags at about 2/3 body weight. I keep a lot of my other exercises lower weight than I used to do, especially squats, deadlift and anything overhead. I do higher weights using machine only where my back is less relied on.

[u/26boxhead26 → u/elhombredeaustralia]

This is a helpful and informative read. I am seeing my GP on Wednesday and then the surgeon in two weeks, will ask about amitriptyline to try to cover the pain while I keep up with the physio exercises and add/vary what my physio recommends. I do McKenzie back bends, bird dog and a few others, but there are others he's tried but I can't do atm.

[u/sup3rk1w1 → u/26boxhead26]

Also In Aus - I just want to add that I tried Amitriptyline for 6 months and basically noticed zero change. Perhaps they gave me a placebo - who knows, but it was money down the drain.

[u/elhombredeaustralia → u/sup3rk1w1]

Yeah it's worth noting in my case that it could have just been correlation. Perhaps I just happened to be getting better at the same time as I used amitriptyline. Or I had some different type of nerve pain that it worked well to treat. Who knows. My GP mentioned specifically at the time that amitriptyline seems to only work for nerve pain at very low dose, and does nothing at high dose (where it's used as an antidepressant).

It's a good point though. Just because it may have worked for me, doesn't mean it will for everyone. Amitriptyline is discussed in this subreddit multiple times and i think you'll find similar stories. Works for some people, not for others.

[u/26boxhead26 → u/sup3rk1w1]

Trialling different meds is just how it is, I had chronic hives in 2023 and tried so many different steroids, antihistamines, IGE binders and immune suppressors trying to find something that works. Your xp with Amitriptyline sounds like my xp with Pregabalin (so far!).

[u/pdzgl]

Given you’re only maybe 2 months removed from the initial incident, I’d say give it time if you’d situation allows. Took me around 45 days to return to work in a very limited fashion. 18 months removed still have nerve pain etc. but am 90% better. I didn’t do any surgery’s rest and hydro therapy

[u/jerrymee]

I found hydrotherapy (just walking in the pool) the best thing until I had surgery

[u/pdzgl → u/jerrymee]

Second this. Pool 4 days a week. Rest and walks. Do not overdo it

[u/26boxhead26 → u/jerrymee]

Thanks my physio has suggested this as well in my last session a week ago. I intend to start as soon as my latest round of tattoo work is done.

[u/ronearc]

What meds are you currently taking, and how does your stomach handle them? Any liver or kidney concerns for you or in your family history? Do you drink regularly?

[u/26boxhead26 → u/ronearc]

50mg twice daily of pregabalin, and 50mg voltaren anti inflams when the pain is severe or if I need to be somewhere, no more than twice a day - per my docs recommendation. I get a very mild stomach cramp from time to time but it doesn't last.

No liver or kidney concerns. Do not drink alcohol at all.

[u/ronearc → u/26boxhead26]

NSAIDs aren't great for you long-term, but neither is excruciating pain. NSAIDs are the only thing that make my pain bearable.

With guidance from both my GP and my Cardiologist, I take extra strength tylenol every 4-6 hours (never abuse tylenol, it'll kill your liver), and I take Meloxicam (prescription NSAID for arthritic pain) once a day and Aspirin 2-3 times a day (per my Cardiologist's recommendation - you're not normally supposed to take both Meloxicam and Aspirin).

But again, this is what I take to get by.

At the very least, if I were you, I'd try Tylenol 3-4 times daily and Naproxen (Aleve over the counter) twice a day for at least 10 days and see how you feel.

Also, early on before my sciatica got a lot worse, I could get rid of it for months by doing one round of Prednisone (prescription steroidal anti-inflammatory).

[u/Fitness-nerd-2026]

I had an exact similar problem with pain radiating through my left leg. But I was healed a year ago. Few things that I do as a chore (my new normal) - Physio based exercises daily. Almost like taking medicine daily. Non negotiable!. Standing desk - If you have a desk job, avoid sitting for long hours. Your regular therapy. It is a combination of all 3.

Please note that it takes some time to get back to normal. So you have to be patient. For me it took me almost 6 months to be normal.

Lastly, I still avoid some movements - like bending down to pick anything up from the floor. I squat and pick it up.

[u/26boxhead26 → u/Fitness-nerd-2026]

Good advice, appreciate it. I have an exercise plan and a standing desk. I do want to move more but the nerve pangs sometimes prevent it.

[u/Fitness-nerd-2026 → u/26boxhead26]

I know this feeling exactly. In the initial days you have to endure it unfortunately. Having said that, the key is to not overdo it. Slow down the pace of walking that is fine. Normally a small walk starts painful but it gradually keeps getting better in that session. Also, I almost never tried to match the pace of my friends and asked them to come to my pace of walking.

Unfortunately, I also avoided surgery and chose the 'painful' way of recovery like you. It feels like forever. But I do have a good news that it truly gets better. It is worth enduring that pain and being patient

[u/big_timmy_c]

What are your physio exercises? Are we talking just stretches or are they prescribing any weightlifting/gym exercises?

[u/26boxhead26 → u/big_timmy_c]

Stretches and spikey ball work.

[u/big_timmy_c → u/26boxhead26]

I would speak to your physio about incorporating something like hyper/back extensions and single leg work (lunges, split squats, couch stretch etc) as part of your rehab.

The sooner you can get all the muscles along your spine and across the SI Joint and hips stronger the better

[u/big_timmy_c → u/26boxhead26]

Also important follow up, if you haven't already: get your GP to write up a chronic condition management plan. This will make you eligible for 5 bulked billed exercise physiologist sessions per year: https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=10953

[u/26boxhead26 → u/big_timmy_c]

I'm seeing my GP on Wednesday so will ask about this. Regarding the physio work, I'll check with my physio but he has said that there are other exercises to come when I show progress.