Sciatica - A Brief Insight

Adam Dobson, a Specialist Back Pain Physiotherapist, with the help of an expert team, developed the ‘Ten Sciatic Facts’ (downloadable) patient information leaflet for NHS patients in Middlesbrough. It has also been taken on board by Greater Glasgow & Clyde NHS MSK Physiotherapy and has a link on their website. We shall highlight some of the points from the leaflet later.

I was talking with a physiotherapy colleague recently, who was just getting over a recent episode of sciatica, which he described as ‘Brutal’. He is in his mid-thirties and has had recurrent bouts of sciatica for about 5 years, which normally last a few weeks then eases. He said each time he forgets how painful and disabling it can be at the time; as well as being dependent on his wife to do simple tasks such as putting his socks on. He also described how frustrating it was not being to help with their young children and it came on just bending to pick up a cushion.

However, he has learnt that even severe pain does not mean he has damaged or harmed his spine. He was aware gradually getting moving as normally as possible, when the pain allowed, helped him. He couldn’t believe a week ago he couldn’t stand straight and feared most movements, whereas now he was much better and planning a gentle trip to the gym.

I remember my sister a few years ago having to be pulled on a rug to the toilet, by her husband, as it was too painful to walk due to sciatica. Again, after a week or two her symptoms gradually settled. My wife had an episode of sciatica a during lockdown, which took several weeks before it gradually settled.

She was left with a little bit of numbness on the outside of her foot and occasionally fleeting leg pain that comes out of the blue. These are just a couple examples of sciatica; how it can vary from person to person. Some of the information in the patient information is highlighted below. Hopefully it shall give an insight into sciatica and answer some of your questions.

Navigating Sciatica

So, what is Sciatica?

Sciatica is a term used to describe nerve pain in the leg that is caused by a problem in the lower back.

The sciatic nerve is a large nerve that starts in the buttock and travels into the leg. This nerve is formed by smaller nerves known as nerve roots that enter and exit the spine in the lower back. Irritation of these nerve roots can cause pain in the buttock, thigh, calf and foot.

As well as pain travelling down the leg, people with sciatica can experience burning pain, electric shock type sensations and pins and needles.

More unusual symptoms include a sensation of coldness and running water. This is because irritated nerves send more signals. Some people may also experience numbness or muscle weakness in the leg. This is because some signals in the nerve can be blocked.

Sciatica symptoms range from mild to severe and can vary from day to day. Symptoms can be intense, unpredictable, and very distressing. This can be very scary, but sciatica is rarely dangerous.

Symptoms can be all consuming. It can be tough to focus on other things. Whilst being supported to manage pain, try to maintain things that bring value to your life. This might include things like going for a walk on the beach, playing with grandchildren, going for a meal with a friend or staying in work. This may be difficult at times, but it can help with coping and emotional wellbeing.

What causes it?

Anything that irritates a nerve root can cause sciatica. A common cause of irritation is compression associated with disc related changes*. The good news is that nerve roots are resilient, they nearly always have wiggle room, and some disc related changes shrink over time allowing nerve roots to recover.

In some cases, nerve roots are irritated by inflammation without any compression, and this can be just as painful. Importantly, not all disc related changes will compress or irritate nerve roots. Many people of all ages have disc related changes but do not experience any pain.

*Discs are tough circular structures that separate the bones of the lower back. They attach strongly to the bones meaning they cannot ‘slip’.

Pain can also be influenced by general factors such as reduced sleep, stress and emotional wellbeing.

Who does it effect?

Sciatica affects people of all ages but is most commonly seen in forty and fifty-year-olds. Pain is usually worse in the first few weeks and reduces the most over the first few months. At twelve weeks, about half of people with sciatica will have significantly improved. At a year, three quarters of people with sciatica will have recovered. For a group of people though, pain may not improve as expected or recovery may take a long-time. This is because people adapt and cope in different ways. Only 8-10% of back related problems are thought to be truly nerve related. Pain from sensitive muscles and joints of the back and hip can also cause leg pain.

Although very rare, sciatica can be a symptom of a more serious condition. Please check the NHS GG&C webpage regarding Cauda Equina Syndrome Self-help and information - Lower Back - NHSGGC for further information or speak to your health professional.

Are scans needed?

Sciatica is a clinical diagnosis based on history, symptoms and physical examination. In many cases scans do not influence treatment plans. For a small group of people with sciatica, scans are appropriate as a part of surgical planning or when considering a specialist nerve injection.

Scans are also appropriate when we suspect a person’s pain is due to a serious medical condition. Thankfully, these conditions are rare and an assessment with your health professional will help determine if you require a scan.

Do Exercises help?

When pain persists, it is common that nerves become sensitive to movement.

While it can be sensible to rest to begin with or during a flare-up, exercising in a gradual, progressive way is safe and helpful. For many people it helps reduce inflammation and helps to maintain function.

There is no best exercise for people with sciatica so choose activities which you enjoy. The aim is to perform a tolerable level of activity a number of times per week. Examples include a walking programme, swimming, gym or a specific rehabilitation programme offered by a health professional.

There is a range of management options available for people with sciatica.

These include time to recover, exercise, lifestyle advice (e.g smoking cessation, weight management) and pain relief medicines. In a small group of people specialist nerve injection or surgery may be discussed. Sciatica can be very challenging both physically and emotionally to cope with, hopefully this has given some insight to help in the journey.

Our Physiotherapy team at Hampden Sports Clinic use a variety of techniques to reduce pain, improve function and rehabilitate you and your injury. To treat any issue correctly, our physiotherapists will carry out a detailed assessment which involves testing musculoskeletal structures, observing movement patterns and performing functional tests to establish the exact nature of your issue.

If you think it will help, Why not book an appointment to see or speak to one of our experienced team? Click HERE to book or call 0141 616 6161 for more information...