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Sciatica is nerve pain that travels down the back of the leg. It is less commonly known as either sciatic neuritis, lumbar radiculopathy or sciatic neuralgia. This is a particular set of symptoms that includes pain and is caused by an irritation or compression of the sciatic nerve. Some of the symptoms can include pain in the lower back and/or buttocks as well as pain, weakness and/or numbness of varied parts of the foot and leg. There are times when tingling or pins and needles are felt in the foot or leg. In rare cases, patients report a burning pain or a spider type tickle in the leg. Generally this occurs only on one side and it may or may not radiate beyond the knee.
Sciatica Anatomy
The sciatic nerve happens to be the longest and largest nerve in the body. At the point where it is the largest, it has the width of a thumb.
The sciatic nerve begins in the lower back as the nerve roots leave the spinal cord through the gaps in between the bones in the lower (lumbar) spine. The nerve then extends the entire length of the leg and into the foot.
The sciatic nerve is made up of five nerve roots, which start at the bottom two lower vertebrae.
The sciatic nerve travels down the back of the leg and then it branches out to different parts of the leg providing sensory and motor functions along the way all the way down to the foot.
Common Causes of Sciatica
- Disc prolapse – a “slipped disc” is one of the most common causes of sciatica. As the disc bulges or prolapses backwards, it can touch the sciatic nerve sending pain down the back of the leg.
- Spondylolisthesis – this is a slippage in the vertebrae (usually a slippage forwards) which can pinch the sciatic nerve or narrow the spinal canal.
- Piriformis syndrome – the sciatic nerve can become trapped by the piriformis syndrome if the piriformis (buttock) muscle becomes too tight.
- Space occupying lesion – anything that occupies a space around the nerve could cause sciatica, such as a tumour or cyst. This is less common that the three causes above.
How to Treat Sciatica:
There are several methods to treat sciatica at home. However, because sciatica can be complicated it is recommended to see your GP or physiotherapist first for an examination. In some cases of sciatica, no treatment is required and the condition will go away by itself.
- In the short term, you could take anti-inflammatory medication and they are usually prescribed by your GP; one example is Naproxen. Over the counter medications such as ibuprofen or aspirin could be another option. You may also want to treat the area with ice and heat. If treating in this method you should apply ice to the injured site for 5 – 10 minutes at a time three to five times per day. Do that for the first 2 or 3 days and then switch to heat.
- Reduce your activity for a few days and then begin to slowly work back up to your usual level.
- Avoid twisting your back or any heavy lifting for at least 6 weeks after the pain starts.
- Avoid ALL forward bending (or as much as possible).
- In 12 weeks you can resume exercising paying special attention to movements that will strengthen both your abdomen and the flexibility of the spine.
- Physical therapy, osteopathy and/or chiropractic is also an option that is recommended.
- If physical therapy is unsuccessful, it may be that the nerve is too severely pinched. The next step is usually an MRI scan to determine how bad the pathology is.
- Following an MRI, a consultant may wish to do an injection or epidural into the spine to reduce inflammation on the sciatic nerve roots.
Tips:
- Don’t sit for more than 20 minutes without getting up and moving around for a few minutes.
- Don’t forward bend – that includes leaning over a sink to wash your face, bending to pick objects from the floor, reaching across a table, or making the bed.
- Do move. Exercise usually helps.
- Do go to work. Resuming normal day-to-day activities and a normal routine can help after the acute stage.
- Do cycle and swim as part of your rehabilitation and under guidance from your doctor or therapist.
- Don’t lift anything heavy.
- Don’t bend and twist at the same time.
- Be careful running – it can cause compression through the spine and might make some people worse.