Sciatica
Sciatica is a broad term used to describe symptoms caused by compression or irritation of the sciatic nerve or its contributing nerve branches. The sciatic nerve is the largest nerve present at the back of the leg - it passes the lower back, down the hamstrings, and the outside of the lower leg to the foot. It controls the muscles at the back of the thigh, all muscles below the knee, and it provides sensation to the skin of most of the leg.
Sciatica is characterized by a sensation of pain, tingling, or burning passing along the course of the nerve, extending from the lower back down into the leg. The specific location of the pain or altered sensation is dependent upon the nerves that are irritated or compressed. Sciatica is often associated with low back pain.
The most common cause of sciatica is from a prolapsed intervertebral disk. Here a part of the fluid-filled center of the intervertebral disks (the disks which separate each of the spinal column bones) is allowed to leak out through a tear in the outer disk layer. This prolapse, or disk bulge, causes direct compression or irritation of a nerve which causes the symptoms of sciatica.
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Symptoms of sciatica
The hallmark symptom of sciatica is pain that typically starts in the lower back or buttock and radiates down the leg. This pain can vary from a mild ache to sharp, shooting sensations. Other symptoms may include numbness, tingling, or muscle weakness in the affected leg. Understanding these manifestations is crucial for accurate diagnosis and tailored treatment.
Diagnosis and differential diagnosis
Diagnosing sciatica involves a comprehensive assessment by a healthcare professional. Imaging studies like MRI or CT scans may be used to identify the underlying cause. To guide appropriate treatment strategies, it's important to distinguish sciatica from other conditions that can cause similar symptoms such as different stages of disc herniation.
When will my sciatica improve?
Most cases of sciatica are self-limiting and get better on their own. Over 9 out of 10 people with sciatica symptoms will get better within 3 months. There are several simple steps that you can take if you are suffering from sciatica to help improve your symptoms and reduce the risk of future episodes.
Treatments
Medical interventions for sciatica aim to alleviate sciatica pain, reduce inflammation, and address the underlying cause. Common treatments include over-the-counter or prescription medications like nonsteroidal anti-inflammatory drugs (NSAIDs), nerve painkillers, or corticosteroids. In some cases, epidural steroid injections may be recommended to target inflammation.
Physical therapy and exercise
Physical therapy plays a vital role in managing sciatica. Therapeutic exercises improve flexibility, strengthen core muscles, and promote proper posture. Tailored exercise programs may include stretches for the hamstrings, piriformis, and lower back to alleviate pressure on the sciatic nerve.
Healthwords pharmacists' top tips
It is most important to remain active despite your pain; sitting or lying for long periods can actually make your pain worse or prolong symptoms. Gentle exercise can relieve your symptoms and help speed up your recovery. Stretching out the hamstrings at the back of the thigh is the best exercise.
Simple painkillers such as anti-inflammatories can be effective at relieving your pain.
A safe lifting technique is essential if this is part of your working or home life, and can help reduce the risk of future episodes. If you are overweight, weight loss will reduce the stress on your spine and can help prevent recurrent episodes of back pain or sciatica. Smoking also increases your risk of back problems such as low back pain and sciatica: your doctor can support you to stop smoking if you are ready.
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When should I see my doctor?
If your symptoms are severe or have failed to improve over six weeks, you should seek attention from your doctor. Your doctor may advise you on specific exercises or stretches, offer additional painkillers that are effective for nerve-related pain, or refer you to a physiotherapist.
If your symptoms fail to improve, you may be referred to a specialist, where treatment options will depend upon further investigation. Only a very small proportion of people with sciatica will need to see a specialist.
It is important to be mindful of certain symptoms that would require you to seek urgent medical attention. These include: sciatica in both legs, a feeling of numbness around your bottom, loss of control of your bowel or bladder, or if your symptoms are associated with you feeling generally unwell and feverish.
Am I fit for work?
You are fit for work if you have sciatica, although you may require a short period off from work if your symptoms are severe. You should discuss temporary lighter duties if your job involves manual labor, to allow your back to recover.
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