Struggling with sciatica and don't know where to start? Sciatic nerve pain is characterised by lower back pain, buttock or hip pain, and pain down the back of the leg that can be utterly debilitating. Fortunately, with the right advice, the majority of people with sciatica recover within six weeks.
GP Dr Roger Henderson looks at the symptoms, treatments and pain relief options for this painful condition:
What is sciatica?
Sciatica is defined as pain or discomfort associated with the sciatic nerve, which runs from the lower back down the back of the legs to the feet. It most commonly occurs in adults in the 20 to 60 year age group and in older people.
Sciatica most commonly occurs as the result of conditions caused by spinal degeneration, such as spinal stenosis. This is when the pathways through which the sciatic nerve travels are narrowed. Again, this causes compression and/or irritation of the sciatic nerve.
What is the sciatic nerve?
The sciatic nerve is the largest and longest nerve in the body. It originates in the lower spine, branches into the pelvis, then travels down through the buttocks and the back of the legs and branches into the lower legs and feet. Sciatic pain occurs when there is pressure on, or damage to, the sciatic nerve.
What causes sciatica?
The most common cause of sciatica is a disc prolapse – also known as disc herniation or slipped disc. This occurs when one of the soft, gel-filled discs between the vertebrae of the spine bulges or ruptures, compressing and/or irritating the sciatic nerve.
Another common cause of sciatica is muscle spasm that compresses the sciatic nerve as it travels through the muscles. Other less common causes of sciatica include infection and tumours.
Sciatica risk factors
Factors that increase the likelihood of developing sciatica include pregnancy, being overweight – a very common cause – and smoking. But basically any injury or process that causes compression of the sciatic nerve can cause sciatic pain. In many cases however, no specific cause for the sciatic pain can be identified.
What are the symptoms of sciatica?
The pain caused by sciatica can range from being mild to being very severe and can occur suddenly or come on gradually.
Sciatic pain is commonly described as a cramp-like pain that can be burning or sharp in nature and is typically felt in the lower back and hip, and going down the back of one leg. It may be associated with sensations such as:
- Pins and needles
- Numbness and weakness
The characteristic that distinguishes sciatic pain from other types of back pain is that the pain travels below the knee, and pain may be aggravated by specific actions, such as sneezing, coughing, lifting or sitting.
How long does sciatica last?
Sciatica symptoms are usually most severe in the early stages of the condition, when compression and inflammation of the sciatic nerve are at their greatest.
It's common for the pain to gradually reduce after this time until it resolves completely – usually within four to eight weeks.
In rare cases, compression of the sciatic nerve can be so severe that there is progressive weakness in the legs and/or loss of bowel and bladder function – this is known as cauda equine syndrome. If these symptoms are experienced, medical attention should be sought immediately as they can signal severe nerve damage.
How is sciatica diagnosed?
In order to make an accurate diagnosis your doctor will take a detailed medical history, including the nature and duration of the symptoms, and what action or event lead to the onset of the pain.
✔️ They will assess your neurological function by checking the strength, sensation and reflexes in your legs.
✔️If loss of bowel or bladder control has been experienced, your doctor may perform a rectal examination to check for loss of sensation and muscle tone.
✔️ If sciatic pain persists for a number of weeks, X-rays may be taken to assess any changes to the bones of the spine and pelvis and to rule out other causes for the pain such as tumours and infection.
✔️ A CT scan (computerised tomography) or MRI scan (magnetic resonance imaging) may be recommended in some cases in order to assess the nerves, discs and spine in more detail.
How is sciatica treated?
The main aim of initial treatment is the relief of pain. Bed rest was traditionally recommended but this is no longer the case and may in fact hinder recovery.
• Moderate activity
It is now recommended that heavy physical activity should be avoided, but moderate activity should be maintained. It is thought that maintaining activity assists with overall recovery by helping to reduce inflammation.
Pain relieving medications, such as paracetamol and non-steroidal anti-inflammatory medications (NSAIDs), are commonly used to treat sciatic pain. Other medications that may be used are low-dose antidepressants (these reduce nerve stimulation) and epidural cortisone injections.
• Muscle relaxant
In cases where muscle spasms are thought to be the cause, muscle relaxant medications may be recommended. When pain is severe the use of opioids, eg pethidine and morphine may be necessary.
This may also be helpful in the treatment of the condition and some people may relieve of their symptoms using osteopathy, chiropractic treatment, massage or acupuncture.
While most cases of sciatica resolve within four to eight weeks, surgery may need to be considered in severe, prolonged cases where non-surgical treatment has been unsuccessful.
Surgery aims to relieve the pressure on the sciatic nerve. This may involve removal of part of one of the intervertebral discs (discectomy) or removing the cause of pressure on the nerve (decompression). Only about five percent of people with sciatica need surgery. All other forms of treatment should be exhausted before surgery is considered.
Can sciatica be prevented?
While back pain due to sciatica, and other causes, is common, there are a number of measures that can help to prevent it occurring or reduce the likelihood that it will recur:
- Maintain correct posture when standing, walking and sitting.
- Don't smoke.
- Maintain a healthy body weight.
- Practice safe lifting techniques. When lifting, bend the knees and keep your back straight. By doing this, the strain is taken by the hips and legs, not the back. Hold the object close to the body. The further away from the body the object is, the more stress is put onto the lower back.
- Undertake exercise that maintains aerobic fitness and strength and flexibility in the abdominal and spinal muscles.
- Ensure that your back is well supported when seated.
- Use chairs that provide good back support and are designed to provide a good seating posture.
- A lumber roll or contoured cushion can help to provide lower back support.