Sciatic nerve pain

Dr. Mahdi Saeedi

Introduction

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.

Sciatica Symptoms

Patien

The most common symptom from sciatica is pain. Most people describe a deep, severe pain that starts low on one side of the back and then shoots down the buttock and the leg with certain movements. Sciatica can also cause hip pain.

  • The pain is usually worse with both prolonged sitting and standing. Frequently, the pain is made worse by standing from a low sitting position, such as standing up after sitting on a toilet seat.
  • In most people, the pain is made worse by sneezing, coughing, laughing, or a hard bowel movement. Bending backward can also make the pain worse.
  • You may also notice a weakness in your leg or foot, along with the pain. The weakness may become so bad you can't move your foot.

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.

Causes of sciatica

Sciatica occurs when the sciatic nerve, which runs from your back to your feet, becomes compressed or irritated.

There are many reasons why this may happen, although the vast majority of cases are caused by a herniated or "slipped" disc.

Herniated ('slipped') disc

Your spine is made up of vertebrae, discs and nerves. Vertebrae are the blocks of bone that make up the structure of your spine and protect the nerves.

The vertebrae are supported and cushioned by discs. These discs are made from a tough, fibrous case that contains a softer, gel-like substance. A herniated disc occurs when the outer part of the disc ruptures (splits), allowing the gel inside to bulge and protrude outwards between the vertebrae. When this presses against the sciatic nerve, it can cause sciatica.

It is not always clear what causes a disc to break down, although age is a common factor. As you get older, your spinal discs start to lose their water content, making them less flexible and more likely to rupture – this is sometimes called "degenerative disc disease".

Spinal stenosis

Spinal stenosis is the narrowing of the passage where the spinal cord travels down the spine.

It occurs when the ligaments become overgrown, but bulging of spinal discs and bony spurs from the vertebrae can also contribute. The sciatic nerve is only occasionally affected, meaning that the symptoms tend to be pain in a person's lower back, with heaviness of the legs, a stooped posture and difficulty walking.

Spinal stenosis is usually caused by age-related changes in the spine, but can also be down to degenerative disease of the spinal joints, which causes the vertebrae to lose their correct alignment.

Spondylolisthesis

Spondylolisthesis occurs when a vertebra slips out of position. If the slipped vertebra compresses the sciatic nerve, it can cause sciatica.

Spondylolisthesis is most commonly caused by age-related or degenerative wear of the spinal joints. However, in younger people, it can be caused by spinal fractures and repeated excessive bending of the spine.

Other causes

Less commonly, sciatica may be caused by:

  • an infection in the spine
  • an injury to the spine, or the surrounding muscles and ligaments
  • a growth within the spine, such as a tumour
  • cauda equina syndrome

Diagnosing sciatica 

Your GP will usually be able to confirm a diagnosis of sciatica based on your symptoms.

They will ask you what symptoms you experience, and which parts of your body are affected. Sciatica typically causes pain, numbness and a tingling sensation that radiates from the lower back and down one leg. Any pain in your lower back will generally be less severe than the pain in the affected leg.

A simple test known as the "passive straight leg raise test" can also help your GP identify whether you have sciatica.

This test involves lying flat on your back with your legs straight, and lifting one leg at a time. If lifting one of your legs causes pain or makes your symptoms worse, it is usually an indication that you have sciatica.

Warning signs

During your appointment, your GP will also ask you questions about anything in your medical history and individual circumstances that could indicate a potentially more serious cause of your symptoms, such as cauda equina syndrome, an infection of the spine, a spinal fracture, or cancer.

GPs refer to these warning signs as "red flags".

Red flags that suggest cauda equina syndrome include:

  • tingling or numbness between your legs and around your buttocks
  • recent loss of bladder and/or bowel control
  • weakness in your leg and foot

Red flags that suggest cancer or infection include:

  • being over 50 or under 20 years of age
  • a history of cancer
  • symptoms of fever, chills or unexplained weight loss
  • having had a recent bacterial infection, such as a urinary tract infection (UTI)
  • having a history of injecting illegal drugs, such as heroin or cocaine
  • having a condition that weakens your immune system, such as HIV
  • a structural deformity of the spine

Treating sciatica

Treatment for sciatica is not always necessary, as the condition often improves naturally within around six weeks.

However, if your symptoms are severe or persistent, a number of treatments are available.

These usually include self-help and conservative treatments, such as medication and physiotherapy, although it's not clear exactly how effective many of these treatments are in treating sciatica.

In a small number of cases, surgery may be recommended to correct the problem in your spine that is thought to be causing your symptoms.

Self-help

There are a number of things you can do yourself to help reduce troublesome sciatica symptoms. These include remaining as active as possible, using hot or cold compresses, and taking simple painkillers, such as paracetamol or ibuprofen.

Exercise

If you have sciatica, it's important for you to remain as physically active as possible.

Simple exercises, such as walking and gentle stretching, can help reduce the severity of your symptoms and strengthen the muscles that support your back.

While bed rest may provide some temporary pain relief, prolonged bed rest is often considered unnecessary and unhelpful.

If you have had to take time off work due to sciatica, you should aim to return to work as soon as possible.

Read more about exercises for sciatica.

Compression packs

Some people find that using either hot or cold compression packs on painful areas can help to reduce the pain.

You can make your own cold compression pack by wrapping a pack of frozen peas in a towel. Hot compression packs are usually available from pharmacies.

You may find it effective to use one type of pack followed by the other.

Painkillers

If you have persistent or troublesome sciatic pain, there are a number of painkilling medications that may help. These include:

  • paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • opioid medication, such as codeine or, in severe cases, morphine
  • tricyclic antidepressants (TCAs), such as amitriptyline – these medications were originally designed to treat depression, but they have since been found to help relieve nerve pain
  • anticonvulsants, such as gabapentin – these medications were originally designed to treat epilepsy but, like TCAs, they can also be useful for treating nerve pain

These medications are not suitable for everyone, particularly when used in the long term, so it's important to discuss all available options with your GP. Some of these medications can also cause significant side effects in some people.

If the painkilling medications your GP prescribes don't help, you may be referred to a specialist pain clinic for further treatment.

Spinal injections

If other methods of pain relief have not worked, your GP may refer you to a specialist for a spinal corticosteroid and/or local anaesthetic injection.

This delivers strong anti-inflammatory and painkilling medication directly to the inflamed area around the nerves of your spine, which may help release the pressure on your sciatic nerve and temporarily reduce your pain.

Physiotherapy

In some cases, your GP may recommend a suitable exercise plan for you, or they may refer you to a physiotherapist.

A physiotherapist can teach you a range of exercises that strengthen the muscles that support your back and improve the flexibility of your spine.

They can also teach you how to improve your posture and reduce any future strain on your back.

Read more about physiotherapy.

Surgery

Surgery is rarely necessary to treat sciatica, although it may be considered if the condition has an identifiable cause, such as a herniated or "slipped" disc, the symptoms have not responded to other forms of treatment, or the symptoms are getting progressively worse.

The type of surgery recommended will depend on the cause of your sciatica. Some surgical options include:

  • discectomy – where the part of the herniated disc pressing on your nerve is removed (this is the most common type of surgery required)
  • fusion surgery – it may be possible to fuse a vertebra that has slipped out of place by using a metal or plastic cage between the vertebra, supported with metal rods and screws
  • laminectomy – a procedure often used to treat spinal stenosis, where a section of vertebrae called the lamina is removed

Many people have a positive result from surgery but, as with all surgical procedures, spinal surgery carries some risks. Potential complications range from the relatively minor, such as an infection at the operation site, to the more serious, such as permanent damage to the spinal nerves.

Before choosing spinal surgery, your surgeon will discuss the relative risks and benefits with you.

Preventing sciatica

Lifting and handling

One of the biggest causes of back injury, particularly at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent sciatica.

  • Think before you lift – can you manage the lift? Are there any handling aids you can use?
  • Start in a good position – your feet should be apart, with one leg slightly forward to maintain balance. When lifting, let your legs take the strain – bend your back, knees and hips slightly, but do not stoop or squat. Tighten your stomach muscles. Do not straighten your legs before lifting, as you may strain your back on the way up.
  • Keep the load close to your waist – keep the load as close to your body for as long as possible, with the heaviest end nearest to you.
  • Avoid twisting your back or leaning sideways – especiallywhen your back is bent. Your shoulders should be level and facing in the same direction as your hips. Turning by moving your feet is better than lifting and twisting at the same time.
  • Keep your head up – once you have the load secure look ahead, not down, at the load.
  • Know your limits – there is a big difference between what you can lift and what you can safely lift. If in doubt, get help.
  • Push, don't pull – if you have to move a heavy object across the floor, it's better to push rather than pull it.
  • Distribute the weight evenly – if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.

Posture

How you sit, stand and lie down can also have an important effect on your back. The following tips should help you maintain a good posture:

Standing

Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet, and keep your legs straight.

Sitting

You should be able sit upright, with support in the small of your back. Your knees and hips should be level, and your feet should be flat on the floor

.

Driving

Make sure that your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Foot controls should be squarely in front of your feet. If driving long distances, take regular breaks so that you can stretch your legs.

Sleeping

Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight.

Exercise

Regular exercise can help reduce your risk of developing a herniated disc by slowing down the age-related deterioration of the discs in your back. It can also help keep your supporting back muscles strong and supple.