What is sciatica?
Sciatica is defined as pain or discomfort associated with the sciatic nerve, which runs from the lower back down the back of the legs to the feet. It most commonly occurs in adults in the 20 to 60 year age group and in older people.
Sciatica most commonly occurs as the result of conditions caused by spinal degeneration, such as spinal stenosis. This is when the pathways through which the sciatic nerve travels are narrowed. Again, this causes compression and/or irritation of the sciatic nerve.
What are the symptoms of sciatica?
The pain caused by sciatica can range from being mild to being very severe and can occur suddenly or come on gradually.
Sciatic pain is commonly described as a cramp-like pain that can be burning or sharp in nature and is typically felt in the lower back and hip, and going down the back of one leg. It may be associated with sensations such as:
Pins and needles
Numbness and weakness
The characteristic that distinguishes sciatic pain from other types of back pain is that the pain travels below the knee, and pain may be aggravated by specific actions, such as sneezing, coughing, lifting or sitting.
How is sciatica treated?
The main aim of initial treatment is the relief of pain. Bed rest was traditionally recommended but this is no longer the case and may in fact hinder recovery.
✔️ Moderate activity: It is now recommended that heavy physical activity should be avoided, but moderate activity should be maintained. It is thought that maintaining activity assists with overall recovery by helping to reduce inflammation.
✔️ Medicines: Pain relieving medications, such as paracetamol and non-steroidal anti-inflammatory medications (NSAIDs), are commonly used to treat sciatic pain. Other medications that may be used are low-dose antidepressants (these reduce nerve stimulation) and epidural cortisone injections.
✔️ Muscle relaxant: In cases where muscle spasms are thought to be the cause, muscle relaxant medications may be recommended. When pain is severe the use of opioids, eg pethidine and morphine may be necessary.
✔️ Physiotherapy: This may also be helpful in the treatment of the condition and some people may relieve of their symptoms using osteopathy, massage or acupuncture.
✔️ Surgery: While most cases of sciatica resolve within four to eight weeks, surgery may need to be considered in severe, prolonged cases where non-surgical treatment has been unsuccessful.
Surgery aims to relieve the pressure on the sciatic nerve. This may involve removal of part of one of the intervertebral discs (discectomy) or removing the cause of pressure on the nerve (decompression). Only about five percent of people with sciatica need surgery. All other forms of treatment should be exhausted before surgery is considered.