Back Pain

Sciatica

What is sciatica?

If you start feeling pain in your lower back or hip that radiates to the back of your thigh and into your lower leg, you may have a protruding (herniated) disc in your spinal column that is inflaming the nerve roots in the lumbar spine. This condition is known as sciatica.

What Causes sciatica?
  • You are most likely to get sciatica between the ages of 30 and 50 years.
  • It may happen as a result of the general wear and tear of ageing, plus any sudden pressure on the discs that cushion the bones (vertebrae) of your lower spine.
  • Sciatica is most commonly caused by a herniated disc.
  • The gel-like centre (nucleus) of a disc may protrude into or through the disc's outer lining. This herniated disc may press directly on the nerve roots that form the sciatic nerve.
  • Nerve roots may also get inflamed and irritated by chemicals from the disc's nucleus.
  • Approximately 1 in every 50 people will experience a herniated disc at some point in their life. Of these, 10% to 25% have symptoms that last more than 6 weeks.
  • In rare cases, a herniated disc may press on nerves that cause you to lose control of your bladder or bowel, referred to as cauda equina syndrome. If this happens, you may also have numbness or tingling in your groin or genital area. This is an emergency situation that requires immediate hospital care

What are the symptoms of sciatica?

  • Sciatica may feel like a bad leg cramp, with pain that is sharp ("knife-like"), or electrical.
  • The cramp can last for weeks before it goes away.
  • You may have worse pain when you move, sneeze, or cough. You may also have weakness, "pins and needles" numbness, or a burning or tingling sensation down your leg.
  • The Picture below may shed some light on the progression of low back pain and sciatica. As illustrated in the picture below true sciatica begins when your symptoms are felt below the knee in the leg, ankle and foot. Any symptoms above the knee cannot be termed as Sciatica.

Sciatica 3Sciatica 5

 

What are the treatments available for sciatica?

Nonsurgical Treatment

  • The condition usually heals itself, given sufficient time, good posture and the right exercise. Approximately 80% to 90% of patients with sciatica get better over time without surgery, typically within several weeks.
  • Non-surgical treatment is aimed at helping you manage your pain without long-term use of medications.
  • Non-steroidal anti-inflammatory drugs such as ibuprofen or muscle relaxants may also help. In addition, you may find it soothing to put gentle heat or cold on your painful muscles.
  • It is important that you continue to move. Do not remain in bed, as too much rest may actually worsen the outcome in the long term.
  • Find positions that are comfortable, but be as active as possible. Movement helps to reduce inflammation. Most of the time, your condition will get better within a few weeks.

Rehabilitation

  • Your clinician may give you exercises to strengthen your back. It is important to walk and move while limiting too much bending or twisting.
  • Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it is always possible for your disc to cause problems again.
  • Please refer to attached documents for details of self help exercises to help with your sciatica pain 

Spinal Injections

Sometimes, your clinician may decide to inject your spinal area with a cortisone-like drug. After this you will need to start stretching exercises so you can resume your physical activities without sciatica pain.

Surgical Treatment

  • You might need surgery if you still have disabling leg pain after 3 months or more of nonsurgical treatment. A part of your surgery, your herniated disc may be removed to stop it from pressing on your nerve.
  • The surgery (laminotomy with discectomy) may be done under local, spinal, or general anesthesia. This surgery is usually very successful at relieving pain, particularly if most of the pain is in your leg. 

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