Frustratingly enough, the New England Journal of Medicine reports that most incidences are nonspecific with no clinical identifiers – meaning no amount of X-Ray or MRI imaging will be able to localize the problem. This makes it difficult for modern medicine to treat. Surgeons can fix your spine pathology, but what if it has no bearing on your source of pain?

The fact that most of us now have office jobs plus long two-way commutes doesn't help the problem. A study of over 700 office employees found that over 60% percent had chronic back pain which disrupted their sleep.

I have been suffering from sciatica for the last five years and would like to share my experience managing my pain and helping others understand and compare available options for treatment. The Mayo Clinic defines sciatica as pain emanating from the sciatic nerve, which is a major nerve running from the lower L4 lumbar spine down into the buttocks and legs. This is a troublesome nerve because it spans such a large, prominent area of our body that gets easily aggravated by the office work lifestyle.

What is the office work lifestyle? Basically, it's sitting for long periods of time in a car, train, subway, or office chair due to the demands of work. On certain days, I develop a deep, radiating pain inside the glutes and sharp, warm pain in my lower back. At its worst, I would go nights without rest and be grumpy, irritable, and moody throughout the day. It was a life-changing circumstance that prevented me from taking long flights (international vacations begone!) and socializing with friends. I would confine myself to the bed and watch Netflix all weekend, which didn't help my situation at all.

One year after my injury, I decided I needed to take control of the situation. I was gaining weight, feeling horrible most of the time, and most importantly, not getting better. I was too young to let chronic pain take over and effectively let myself become disabled.

The first thing I did was to enroll in physical therapy. Depending on the state you live in, you may not even need a doctor's referral for your first few visits. Check with your local physical therapy office to verify. For those who have never tried it before, physical therapy has some resemblance to personal training at a gym. The primary overlap is that they both involve heavily guided one-on-one sessions. Personal training is generally focused on aerobic and strength training, though, and making measurable progress via better lap times, more reps, and heavier weights. Your personal trainer can be an excellent fitness coach, but most of the time will not have the medical expertise necessary to teach you how to tackle physical injury and illnesses.

This is where physical therapists come into play. Think of them as a combined doctor-fitness coach. A good physical therapist will have a deep understanding of physiology and physiological ailments, and be able to work with you to develop a regimen of body weight and resistance exercises to build back strength in the muscle groups impacted by your condition. In my experience, sessions are generally 30 minutes to one hour, during which my physical therapist and I talk through my pain (and progress if any has been noted), run through exercises, check my form when performing said exercises, and finish with manual massage therapy and heat treatment. The skill of your physical therapist and your ability to communicate with him or her is important. Don't be afraid to try out multiple therapists until you are comfortable settling on your favorite. Physical therapy can be a long-term relationship so you want to make sure it is a good one.

For me, I found that physical therapy moved me in the right direction. By strengthening my back and glutes, I was able to better manage the daily motions, improve my posture at work, and make conscious, informed lifestyle decisions to make sure that my pain would not get worse. I was able to take longer trips again knowing better what my tolerances and physical thresholds were. But, at, the end of the day, the pain was still there. That is when I started searching for a dedicated option.

While I was living in the San Francisco Bay Area – Palo Alto, specifically - I found a wonderful massage studio that practices traditional Thai massage, and as I discovered, two other types that greatly alleviated my pain for weeklong stretches at a time. The first was deep tissue massage.

Many of us have experienced a massage at some point in our lives, but don't know how to differentiate between the different types. The 'standard' massage that you get at resorts and massage chains is the Swedish massage. It is relaxing and generally intended to relieve mild body tension while providing sensory relaxation. Deep tissue is a different beast in that the therapist provides specific, targeted pressure on your muscles, kneading out tightness and improving circulation. For me, deep tissue massage was a heaven-send. My therapist was able to find the source of the tough, nagging pain in my glutes and lower back with her fingers, hands, elbow, and entire body to literally dig out the pain. It has been difficult to find the exact mechanism of action, but empirical studies show that massage therapy paired with physical therapy, such as lumbar traction, relieves chronic pain more than physical therapy alone. For me, it was a game-changer.

After learning about my sciatica, my massage therapist also recommended hot stone massage therapy. She used heated stones as extensions of her hand and moved them along the paths of my muscles. The stones themselves were quite hot, but because they were always being moved, provided more of a sustained warmth rather than direct heat near my tense spots. It was extremely relaxing and, in my opinion, helped more than the heated pads and blanked at the physical therapy office. If your massage therapist offers this option, give it a try. I think hot stone massage can also be beneficial for individuals with more general muscle pain since the heat from the stones naturally loosens up muscles.

Combining weekly physical therapy with weekly massage therapy, I am happy to report now that pain from my sciatica is down from a level seven to a level three, at its worst. Immediately after my massage therapy, it is closer to a zero or one. For those of us with chronic pain, the prospect of a magic bullet is appealing, but unfortunately rare to nonexistent. In reality, we have to dedicate real work, time, and resources to get better. For me, physical therapy is the work portion, and massage therapy is the enjoyment portion. Together, they help to elevate my lifestyle back to what it was like before my injury.