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Sciatica

Does it have other names? Nerve root pain, Lumbar radiculopathy, Lumbar referred

pain, Sciatic neuralgia,

About:

Many nerves branch off from the spinal cord in the lower back and bundle together to form

the sciatic nerve in the leg. Sciatica is a general term referring to irritation of any of the

nerves forming this bundle.

Sciatica can involve pain and

‘nerve symptoms’ in the lower

back and down the legs. This

most commonly affects the back

of the leg sometimes as far down

as the foot. Nerve symptoms can

include changes in sensation, pins

and needles or weakness in the

legs.

Sciatica is usually caused by

irritation of the nerves as they exit

the spine. This irritation can be caused by nerve compression (sometimes called a ‘trapped

nerve’) or inflammation around the nerve. This inflammation is part of the body’s natural

protective system. As the body clears this inflammation the sciatica symptoms usually begin

to settle.

- In younger individuals the most common cause of sciatic is injury to the intervertebral

discs which can then irritate the nerves as they leave the spine.

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- In older individuals the tissues around the spine gradually thicken and stiffen. This is

part of normal ageing. However, in some people these changes can irritate the nerves

as they leave the spine.

Research shows multiple factors can contribute to experiencing sciatica. These include:

Being unfit

Being overweight

Smoking

Depression and emotional distress can trigger or increase sciatic pain for some

people. This is because emotions, beliefs and worries can affect how we feel pain.

In the early stages of a sciatica ‘flare up’ many people will experience moderate-severe pain

in their leg and/or back. For most people, sciatica will settle on its own over time without any

need for specific treatment. This will most often occur within a period of 6-16 weeks.

However, because nerves can be very some people may have some symptoms for a

number of months.

Management:

Sciatica is a common condition. It is rarely dangerous or serious (unless combined with

symptoms outlined under CES). Your spine will remain resilient and strong even if it may not

feel that way when you are in pain.

back pain myths link

10 facts back pain link.

Medication and therapies can help but there is not usually a ‘quick fix’, especially in the

short term. During the early stages evidence shows that:

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maintaining movement

staying active

managing effective pain control

reducing negative emotions/concerns regarding the outlook and causes of the

problem

can help achieve better outcomes and recovery.

Very few people with sciatic require scans such as X-rays or MRIs (magnetic resonance

imaging) to manage their pain and symptoms. Accurate diagnosis can be made via a

thorough clinical exam. MRI is only well utilised to:

Investigate a strong clinical suspicion of more serious spinal conditions

Determine the potential benefits of spinal injections or surgery

Very few people who do have an MRI scan go on to have any further injection or surgery.

This is because:

the symptoms often get better in the meantime

no target for injection or surgery was identified

further invasive treatment is agreed to be inappropriate for that individual.

Furthermore, up to 80% of people over the age of 60 will have visible signs of age-related

changes on an X-ray and MRI. Most of these individuals do not have any symptoms.

What can I do to help myself?

Pain Relief Medication – Over the counter painkillers may be helpful, such as

Paracetamol, or Ibuprofen that you can buy at the chemist. However, Paracetamol alone

is not recommended to manage sciatica. Nonsteroidal anti-inflammatory drugs

(NSAIDs), such as Ibuprofen, should be considered as the first-line response (at the

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lowest effective dose for the shortest time possible). Your pharmacist/GP will be able to

give you expert advice if you have any concerns regarding medication. It should be

considered that pain ‘killers’ are unlikely to take away your pain completely but allow it to

feel more settled.

Heat or Cold Packs – Apply either a hot or cold pack (whichever you prefer) to the

painful area for 10-15 minutes. Ensure you wrap any pack in a damp tea towel to avoid

direct contact burning the skin. This process can be repeated multiple times a day as

long as the skin returns to normal temperature between applications. You should not

use hot or cold packs in the presence of any altered sensation.

Exercise – It may feel daunting to exercise with nerve pain but there is lots of research

showing that gentle exercise within the limits of your pain can help you recover more

quickly. Therefore, it is important to remain active. This will not cause damage or harm to

the tissues. People who excessively avoid normal movement are more likely to

experience pain for a longer period of time. This is called persistent pain. Therefore, try

to avoid bed rest throughout the day time and try some of the recommended gentle

exercises below.

You can expect some discomfort when doing exercises but it is important that this is kept

within a tolerable level. Any increased discomfort should settle within 20-30 minutes of

completing the exercise.

Modifying Activities –

It is important to exercise but in the short-term it can be helpful to modify your activities.

This is to help prevent further aggravating your back pain.

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o Pacing activities by striking a balance between rest and activity. Do not try to

‘push through pain’ because this can make it more irritated. It can be useful to

breakdown you activities in to more manageable chunks.

o Regular gentle movement every 30-40 minutes can help keep your joints and

muscles moving and prevent increased back pain caused by staying still for too

long.

o Most people find nerve pain feels worse at night because they are staying still for

a longer time. Try changing your sleep positions regularly. There is no perfect

position for easing sciatica and it varies for each person. Find what is most

comfortable for you. If you are waking with nerve pain you may find it helpful to do

some gentle movements before trying to resettle again.

o If you are limping because of your back pain then using a walking aid can help

you feel more comfortable and balanced when walking. This could allow you to

continue with your day to day activities more easily.

o You may need to talk to your employer/occupational health department to see if

any adjustments can be made to help you continue work throughout this period.

Weight Loss – There is evidence that being overweight can affect the pain people

experience from their lower back. If weight loss has been discussed with you by a GP

or other healthcare professional useful resources to help achieve effective weight

loss can be found here

Education – It is well researched that having a better understanding of your

condition helps reduce worries about this. This can help you manage your condition

more effectively and return to function more quickly.

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Smoking- Evidence suggests that smokers are more likely to suffer more severe and

persistent pain than non-smokers. For advice on quitting smoking click here

Rehabilitation Exercises:

Knee rolls

knee hugs

cat-cow stretch

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child’s pose

Bridge

Lumbar flexion

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Side bend

Marching on spot

Arm raises

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Exercise dose:

- Little and often 1-2/day as able

- Only perform as pain allows

- Increase as you feel able

What to do if I’m in need of more help?

• Review your Medication – If your pain is still not well controlled despite the above

strategies it is recommended you consult with your GP/Pharmacist to review your current

medication. Your GP or pharmacist may discuss neuropathic pain medication with you

depending on prescribing policies.

• Review with your physiotherapist – Should you continue to be significantly limited

with your day to day activities or would like some further advice please feel free to contact

your Physiotherapist who can expertly review your rehabilitation options.

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Cauda Equina Syndrome

In extremely rare cases (1 in 100,000 people with lower back pain) individuals

can develop Cauda Equina Syndrome (CES). Cauda Equina Syndrome occurs

when the deep spinal nerves below the spinal cord become severely

compressed. These nerves are essential for controlling, bladder and bowel,

sexual and some pelvic organ function. Without early intervention CES can lead

to irreversible changes to these functions. Specific symptoms are associated with

CES and any combination of the following symptoms Immediate Medical

Attention must be sought. – either attend A&E or call NHS Direct on 111.

Loss of feeling/ pins and needles between your inner thighs or genitals.

Numbness in or around your back passage or buttocks.

Altered feeling when using toilet paper to wipe yourself.

Increasing difficulty when you try to urinate.

Increasing difficulty when you try to stop or control your flow of urine.

Loss of sensation when you pass urine.

Leaking urine or recent need to use pads.

Not knowing when your bladder is either full or empty.

Inability to stop a bowel movement or leaking.

Loss of sensation when you pass a bowel motion.

Change in ability to achieve an erection or ejaculate.

Loss of sensation in genitals during sexual intercourse.

Fortunately these symptoms are rare and when recognised early lead to

favourable out comes with urgent specific medical intervention.