Sciatica

Sciatica is a condition involving a painful in sciatica nerve, which runs from the lower back, through the buttock and down the leg to the foot. It is often confused with other conditions where the sciatic nerve is not directly affected.

It is a relatively common condition and up to 40% of people may experience it at some time in their life, it is rarely seen in people under the age of 20, more common between ages 40 and 50 and then the frequency declines.

Most sciatica is caused by the development of a herniated or prolapsed (slipped disc) and as we get older the narrowing of spaces in the spine where the roots of the sciatic nerve are found. Rarely there is a more sinister cause and this should be kept in consideration. It is hard to establish who is at risk of developing sciatica especially different jobs but smoking, pregnancy, extreme height and morbid obesity are associated with increased incidence of the condition.

The pain of sciatica is related to swelling and inflammation of one or more roots of the sciatic nerve in the spine. This can be part due to disc material from a herniated disc (slipped disc), or other degenerative changes reducing the room for this nerve root and irritating it.

Pain from sciatica can be mild or severe and can come on suddenly or gradually. It may be cramping, stabbing or burning. It may involve the low back but typically involves the buttock, back or side of the leg to below the knee even as far as the foot. Other causes of buttock and thigh pain usually reduce at the knee. Usually it affects one leg but sometimes both legs can be affected. Pain may be made worse by coughing, sneezing, bending and sitting especially with the leg out straight. There may also be pins and needles sensations, numbness of the foot or even weakness of the foot muscles. All of this should be examined by a clinician who in addition to asking about the symptoms, should check if the nerve can be stretched and test the reflexes and strength of the muscles.

The person may lean to avoid compressing the painful nerve root and avoid movements that stretch it, and an MRI scan is sometimes indicated to show the state of the discs and nerve roots and also if they are being compressed.

My approach to the treatment of sciatica.

Where possible I distinguish true sciatica directly involving the sciatic nerve and other conditions that give some similar symptoms, this is done by asking the relevant questions and carrying out a skilled examination. MRI scanning is not usually necessary early on and is reserved for complicated cases. The first goal of treatment is to settle down the acute symptoms using various methods aimed at reducing muscle spasm and mobilising stiff joints such as manual therapy, exercises or sometimes acupuncture. Advice is given to help gain comfort, avoid aggravating the problem and encourage resolution of the cause and reduce the likelihood of it becoming ongoing. Next come methods to help free any trapped nerve root and rehabilitate any weakness associated with the condition.

Most cases of sciatica resolve albeit sometimes very slowly, and this should be understood when seeking treatment. Some find medications prescribed by the GP helpful, sometimes injection methods are useful, occasionally surgery is warranted to free the nerve root.