I used to have severe pain when sitting. It got so bad these last few years that I couldn't sit for more than 20 minutes without excruciating pain. I went to everyone - PT, chiro, massage therapist, acupuncture, you name it. FYI I am a licensed massage therapist so not a total noob when it comes to good posture, good body-mechanics, etc.
Here's what worked for me. Maybe this will help someone else.
1) Regular core and flexibility work.
For me this was yoga - a 60 minute class does all that and more. Pilates may be a good alternative - I've heard great things from clients with similar issues. The core I am speaking of here is not just the abs or superficial muscles of the front body, but most importantly, the inner stability muscles of the torso. These are severely underdeveloped in most adults who sit often. So, crunches do NOT accomplish the core stability needed to keep the spine and hips healthy.
If you are currently experiencing extreme pain, take it slow. Do not jump right into a Power Yoga class, this will just hurt more. Ask around, find a Yin Yoga, Hatha Yoga, or Restore Yoga class with a teacher who can help you find positions that will not hurt. Listen to your body.
2) Learn to tell the difference between pain that is bad and pain that is not so bad.
Pain is used across the board to describe unpleasant sensations so let's be more specific. There is severe, sudden onset unpleasant sensation (aka pain) that is your body saying "stop doing that, that will make things worse". And there is the mild to intense unpleasant sensation that often comes from stretching. This is what I mean by pain that is not so bad. Also, NEVER stretch beyond a 6-7 on the 1-10 pain scale, this causes micro, or sometimes macro, damage (this is for everyone, not just those with chronic pain!!).
When working with a chronic issue like most low back pain / sciatica seems to be, it seems clear that a good bit of it was mental for me. I was scared of causing more pain so my movements became very limited, things got more stiff, thus more pain. I started with small gentle movements that I knew where safe (a PT or chiro can help with this), stayed within that tolerable range, and slowly expanded. Listen to your body.
3) Yoga ball chair at my desk.
I bought just a ball with a cover and love it. I sometimes work at an office that has the Gaiam Yoga Ball Chair and it works great. Transitioning to a yoga ball chair can take some time depending on your core stability. Most will come with recommendations to start with short sessions (10-20 mins) a couple times a day and build from there. Listen to your body! If you are feeling fatigued and slouching, the ball is not helping anything. The ball should force your core to work (protecting your spine) but if those muscles get fatigued, and they will if this is new to you, then take a break.
4) Regular bodywork during flare ups (and semi-regular during pain free times).
This could be massage, chiro, PT, acupuncture, whatever works for you. There are affordable options most places if you don't have insurance. Find a massage place with a package discount or monthly subscription discount. Go to community acupuncture. If you're on the western slope of Colorado, message me and maybe I can help you find something.
Don't wait until things get terrible to get help. I put this last on the list, though, because once I got to a pain free place, this dropped to a minimal frequency for me. Don't get me wrong, I love receiving bodywork of any kind, and thus do it regularly, but point is, I don't need a lot of treatment for my back anymore because the above items have kept me pain free.
Hope this helps. Take care my friends.
