Sciatica

The common signs and symptoms of sciatica are:

• Pain that radiates down the buttocks and thighs, often beyond the knees
• Numbness or tingling in the legs, or a feeling of ‘pins and needles’ in the lower back, buttocks, legs or feet.
• A burning or shooting pain sensation down the leg or back.
• Inflammation of the leg
• Pain may be constant or it may come and go.

Please seek urgent medical attention if you have any of the following:

• Numbness in your genital area
• Difficulty controlling your bowels
• Difficulty controlling urination
• Weakness of the legs or feet
• Night pain – waking up in the middle of night in pain

The sciatic nerve is the longest and thickest nerve in body, running through your hips, buttocks and down each leg, ending just below the knee, then branches into other nerves, which continue down your leg and into your foot and toes.  When something presses on or pinches this nerve such as a slipped disc or a bone spur, it can cause sciatica.

The most common cause for sciatica is lumbar disc herniation. Discs are the cushioning pads between each vertebrae of the spine.  Long standing ‘wear and tear’, or a sudden injury can cause the gel-like centre of the disc to be pushed through the outer layer, causing a bulge and pressing on the sciatic nerve.

Another potential cause for sciatica is foraminal stenosis. This is the narrowing of the channel from where the spinal nerves exit the spinal column.  Foraminal stenosis is also commonly caused by wear and tear of your lower (lumbar) spine.  This is called lumbar degeneration.

Your GP can make the diagnosis of sciatica by asking questions about your symptoms and by performing a physical examination that tests physical sensation, muscle strength, and your reflexes.

An MRI is used to confirm a herniated disc or foraminal stenosis.  Plain X-rays of the spine or CT scan will check the alignment of your spine and look for bony spurs that may contribute to spinal nerve compression.

Most people with sciatica get better on their own with time, pain medication and physical therapy.  Taking some time to allow the symptoms to improve is often helpful.

Medications: Your doctor may prescribe anti-inflammatory medications (NSAIDs) to reduce the inflammation and to relieve pressure around the compressed nerves.

Physical therapy: Avoid activities that may worsen your symptoms such as lifting. It is however important to remain active as a long period of bed rest can cause muscle stiffness and weakness, making things worse. If you don’t feel up to your usual exercise regime, it’s important to listen to your body’s signals.  If your pain isn’t too severe, it’s helpful to stretch, go for short walks, and do any other physical activities that you feel up to. Your doctor or physiotherapist may suggest exercises to keep the back muscles strong and help protect against future injury.

Epidural injection: Your doctor may also recommend an epidural steroid injection. This is targeted at the area where the nerves are compressed, to reduce inflammation around the nerve and help with sciatica pain.

Surgery:  Most people with sciatica don’t need surgery. But your doctor may suggest it if you have trouble walking, lose control of your bladder or bowels, or your pain gets worse and other treatments don’t help. The best treatment will depend on what is causing your symptoms.  Surgery may be considered only if conservative therapy does not adequately relieve sciatica symptoms over a substantial period of time.  For disc herniation, a partial microdiscectomy, may be performed to remove the bulging portion of the disc. In some cases spinal reconstruction may be performed for patients with foraminal stenosis.

Sciatica that doesn’t resolve itself after a few days needs medical attention.