Sciatica

Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve.

The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.

Signs and symptoms

When the sciatic nerve is compressed or irritated, it can cause pain, numbness and a tingling sensation that radiates from your lower back and travels down one of your legs to your foot and toes.

The pain can range from being mild to very painful, and may be made worse by sneezing, coughing, or sitting for a long period of time.

Some people with sciatica may also experience muscle weakness in the affected leg.

While people with sciatica can also have general back pain,  the pain associated with sciatica usually affects the buttocks and legs much more than the back.

When to see your GP

Most people find their sciatic pain goes away naturally within a few weeks, although some cases can last for a year or more. You should see your GP if your symptoms are severe or persistent, or are getting worse over time.

Your GP will usually be able to confirm a diagnosis of sciatica based on your symptoms and recommend suitable treatments. If necessary, they can refer you to a specialist for further investigation.

You should immediately call 999 for an ambulance if you experience loss of sensation between your legs and around your buttocks and/or loss of bladder or bowel control. Although it is rare, these symptoms can be a sign of a serious condition called cauda equina syndrome.

What causes sciatica?

In the vast majority of cases, sciatica is caused by a herniated or slipped disc. This is when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves.

Less common causes include spinal stenosis (narrowing of the nerve passages in the spine), a spinal injury or infection, or a growth within the spine (such as a tumour).

You can minimise your risk of developing a slipped disc or back injury that could lead to sciatica by adopting a better posture and lifting techniques at work, as well as stretching before and after exercise, and exercising regularly

How sciatica is treated

Many cases of sciatica will pass in around six weeks without the need for treatment. 

However, a combination of things you can do at home – such as taking over-the-counter painkillers, exercising and using hot or cold packs – may help reduce the symptoms until the condition improves.

In more persistent cases, you may be advised to follow a structured exercise programme under the supervision of a physiotherapist, have injections of anti-inflammatory and painkilling medication into your spine, and/or take stronger painkiller tablets.

In rare cases, surgery may be needed to correct the problem in your spine.

The Sciatic Nerve and Sciatica

Sciatica symptoms occur when the large sciatic nerve is irritated.

The sciatic nerve is the largest single nerve in the body and is composed of individual nerve roots that start by branching out from the spine in the lower back and combine to form the "sciatic nerve."

• The sciatic nerve starts in the lower back at lumbar segment 3 (L3).
• At each level of the lower spine a nerve root exits from the inside of the spine and then comes together to make up the large sciatic nerve.
• The sciatic nerve runs from the lower back, down the back of each leg
• Portions of the sciatic nerve then branch out in each leg to innervate certain parts of the leg - e.g. the buttock, thigh, calf, foot, toes.

The sciatica symptoms (e.g., leg pain, numbness, tingling, weakness, possibly symptoms that radiate into the foot) are different depending on where the nerve is pinched. For example, a lumbar segment 5 (L5) nerve impingement can cause weakness in extension of the big toe and potentially in the ankle.

Pisiformis Syndrome Feels Like Sciatica, But It Isn’t the Same

Piriformis syndrome is a condition that is often confused with sciatica. When the piriformis muscle becomes tight, it can irritate the sciatic nerve. This causes sciatica-like pain, tingling and numbness that often run from the low back to the rear, down the leg and into the foot.

Although the discomfort from piriformis syndrome feels similar to sciatica, the two have different causes. With piriformis problems, the pain is not caused by a compressed nerve root where it exits the spine as occurs with true sciatica.

Correctly identifying the cause of the pain is important because the treatments for each type of pain tend to be very different

.

Truth: Pain From Arthritis or Joint Problems Is Not True Sciatica

The pain from arthritis or other joint problems is actually more common than sciatica, and they are often confused. In reality, sciatica and arthritis are classified as different types of pain. Radicular pain like sciatica is caused by a pinched nerve.

In contrast, referred leg pain from arthritis is dull, achy and often moves around and varies in intensity. Although the leg pain from arthritis may feel similar, it is not truly sciatica. Distinguishing the correct problem is important because the treatments for each type of pain often differ.

Exercise Can Help

• Hamstring stretching. Regardless of the diagnosis, most types of sciatica will benefit from a regular routine of hamstring stretching. The hamstrings are muscles located in the back of the thigh. Overly tight hamstrings increase the stress on the low back and often aggravate or even cause some of the conditions that result in sciatica.
• Exercise correctly. As an adjunct to the above point, doing the right exercises but doing them without proper form can make the exercises relatively ineffective, and possibly may lead to continued or increased pain. It is generally advisable to learn the exercises under the guidance of an appropriately trained health practitioner, such as a physical therapist, chiropractor or physiatrist.
• Aerobic exercises. In addition to specific sciatica exercises, aerobic conditioning may also be encouraged for general body fitness. Walking is an excellent form of exercise for the low back because it is relatively low impact but can provide all the benefits of an aerobic workout. If possible, it is best to gradually progress to doing up to three miles of exercise walking at a brisk pace each day.

Caring for sciatica should be considered part of one's daily living, not just something to add to the routine at the end of the day. In addition to an exercise routine, patients with sciatica should minimize everyday stress on the lower back, including using appropriate ergonomics while lifting, maintaining good posture, making sure the lower back is supported while sitting, and avoiding sitting or standing for long periods of time.

Before beginning any exercise program, patients should see a health professional to get a correct diagnosis for their pain and to rule out any more serious problems. The proper exercises differ based on the condition that is causing the sciatic pain, so patients should not try to self-treat their sciatica before consulting a health professional.

Tips On Managing Sciatica

Treat the pain from sciatica at home. The Mayo Clinic recommends steps like taking over-the-counter painkillers, using hot and cold packs, and stretching as well as exercising. Medline Plus recommends icing the affected area for two or three days after the development of pain and then using heat. Changing the position you sleep in may also help: Medline Plus recommends sleeping in the fetal position with a pillow placed between the knees, or on the back with a pillow under the knees.

Perform physical therapy exercises as recommended by your doctor or physical therapist; this is often recommended in the case of a herniated disk. Physical therapy can help strengthen back muscles and increase flexibility so that the condition is less likely to recur, according to the Mayo Clinic.

Take prescription medications as recommended by your doctor in order to clear up pain from sciatica. According to the Mayo Clinic, these include anti-inflammatory drugs, muscle relaxers, prescription painkillers, and tricyclic antidepressants as well as anticonvulsant medications. Corticosteroid injections may also be recommended.

Keep the position of your back in mind while reaching and lifting. When you lift, lift with your legs, keeping your back straight, feet spread and stomach muscles tight. Don't twist as you lift. Hold objects close to your body and don't lift them higher than your waist. Reaching up for an object can strain the back. Raise yourself up as close to the object as you can, via a stepladder or chair.

Sleep on a comfortable mattress. For some, this means a firm mattress, but for others this means a soft mattress. What's important is that you are comfortable, you don't wake up sore and stiff and are able to maintain good sleeping posture.

Sit for short periods in an ergonomic chair that has lumbar support since sitting for long periods of time can be hard on the back. Don't cross your legs. Keep your feet flat on the floor. When driving, use a lumbar support and move the seat close to the steering wheel so that you don't slouch or put pressure on your back.