Sciatica - what is that awful pain in my buttock and leg??
Something we see on a daily basis is “sciatica”. That awful, painful trapped or irritated nerve that gives you pain down your leg, sometime all the way into the foot. But as a patient, do you truly understand what it is, what causes it to happen and what to do if you have got it. In this blog I’m going to lightly cover these three topics.
What is sciatica?
Sciatica is the broad term for “pinching” or “irritation” of the sciatic nerve which is the biggest nerve exiting your lower back and traveling down the leg to the foot. The sciatic nerve supplies the power to your leg muscles and the sense of feeling to the back and side of the thigh and the whole of the lower part of your leg. Often with “sciatic” pains you will experience more pain in your leg than in your back. If you have sciatica you may get any of the following symptoms in your buttock, back and sides of your thighs and into your lower leg, feet and toes:
painful, searing, throbbing, aching.....
tingling, burning, hypersensitivity.....
numbness, reduced sensation
muscles weakness, foot-drop....
Common causes of sciatica include interverbral discs injuries or inflammation, osteoarthgritis and spinal stenosis and things external to the spine such as piriformis syndrome.
Herniated, bulging or inflamed discs:
This is often refer to this as a slipped disc but I cannot stress enough that disks do not “physically slip”. A bulging disk changes shape when the intervertebral disc comes under repetitive strain or sudden excessive load. This causes the fibres of the disc to bulge backwards and to one side and can put pressure on the nerve root as it exits the spinal column. With a disc bulge it is common to experience more pain in the leg than in the back.
When you suffer an injury like this it is not an injury for life, disc bulges will often be reabsorbed over time and symptoms will start to subside.
Prognosis is really good for these issues 85% of people with acute disc bulges will recover with conservative treatment in 8-12 weeks (Massa et al 2017) and conservative treatments (non-operative) saw good to excellent results in 90% of cases (Saal, 1996). So it’s not all bad news.
Risk factors for developing these issues are manual jobs that spend too much time in a flexed position, inactivity, weight and smoking (yes, smoking is yet again shown as a strong risk factor to your health and well-being) .
Spinal stenosis is narrowing of the spinal canal in the centre of the spine (spinal canal) (Amundsen et al 1995) . This results in irritation/impingement around the spinal cord itself. Often patients will suffer pain down both legs (Amundsen et al 1995) and in the lower back which is made worse with activity and can often be almost completely eased when you bent over, effectively opening the spinal canal diameter. Most sufferers are older, is associated with osteoarthritis and age related change within the spinal canal. State of degenerative change does not directly measure to the severity of the symptoms.
Piriformis syndrome is where the sciatic nerve gets irritated as it passes underneath (sometimes through) the piriformis muscle when it goes into spasm. This will result in deep buttock pain and general pain down the back of the leg, can cause occasional tingling/pins and needles. Recovery is pretty good once diagnosed and is helped with stretches and manual therapy. This can be a confusing diagnosis and there is lots of disagreement as to the cause of these symptoms.
What do I do if I have sciatica
Keep Active! Sitting down for to long will exacerbate your symptoms and put more pressure on your lower back.
See a medical professional. Consult an osteopath, GP or other professional to get an accurate diagnosis on what may be the potential cause and can best tailor your recovery.
Medication. NSAIDs (Ibuprofen) are proven to help with low back pain and sciatica, especially in the early stages. Paracetamol and codeine are effective for reducing your pain levels in some patients. Severe sciatica is difficult to manage at times, even with high levels of oral pain relief.
General low back stretches and exercises to try and free up the lower back.
Want to stop it coming back?
Here is the NHS guidelines for reducing your chances of recurring sciatica.
Stay active - regular exercise
Use a safe technique when lifting
Good posture when sitting or standing
Sit correctly if you work at a computer
Lose weight if your overweight
What about x-rays and scans
Xrays will show you the outline of bones, joints and may demonstrate the presence of anatomical anomalies but otherwise they are really of no help. Some practices will convince you that you need x-rays but there is no rationale for this, the NICE guidelines strongly discourage this and may be more about making money than helping you.
MRI scans show discs, nerve, bones and joints much more clearly. However there is very little relationship between what you see on an MRI and what's causing your symptoms. A good explanation of this is that 37% people aged 20 who have never had back pain will have disc bulges if you scan them.
There are times when it is appropriate to x-ray or scan patients with sciatica and this is usually:
Patients who are not improving over 6-8 weeks
Patients with other health problems or complicated past medical histories that may cause concern
Symptoms that are worrying such as significant loss of muscle power, change of bladder or bowel function....
Saal, J.A., 1996. Natural history and nonoperative treatment of lumbar disc herniation. Spine, 21(24 Suppl), pp.2S-9S.
Massa, R.J., Mesfin, F.B., 2017. Herniation, Disk.
Amundsen, T., Weber, H., Lilleas, F., Nordal, H.J., Abdelnoor, M. and Magnaes, B., 1995. Lumbar Spinal Stenosis: Clinical and Rad