Sciatica
What is sciatica?
Sciatica refers to pain in your leg which is often caused by irritation or pressure on one or more of the nerves in your low back.
This pain usually travels through the buttock and down the leg, often reaching the foot as it follows the path of the sciatic nerve.
It can affect anyone, at any age. It can be mild but usually is rather severe. It is often felt along with tingling and numbness too.
Most times the issue goes away with no specialist help at all. Lots of people see improvements within 4 weeks but the average for significant ease can be 6-12 weeks.
What is Sciatica?
Our discs are the spacers of our spine and are well anchored to the bones so do not slip. They do bulge and we see this in most people even when they have no pain. It is thought that sudden and more active bulges can be a cause of many sciatic episodes. These do resolve as our discs continually change (bulge but then reabsorb).
Facts (and myth busting) about back pain
- An MRI is not needed to diagnose sciatica as this can be done with a clinical examination.
- An MRI scan may be used to exclude serious causes of pain and to check if invasive treatment is an option but is usually not considered until pain relief and physiotherapy has been tried for at least 6-8 weeks.
- If concerned, seek an expert assessment from a healthcare professional.
- Most people with sciatica start to feel better within 3 months.
- If time, pain relief and physiotherapy hasn’t helped then a referral to see a spinal specialist team to discuss treatment may be useful.
- Discs in your spine are firmly attached to the bones above and below
- They don’t ‘slip’
- Sometimes the disc can bulge outwards, often known as a ‘herniated’ or ‘prolapsed’ disc
- These are seen in people with no pain at all so are not always painful as such
- Some can be painful and irritate or press the nerve next to them but the good news is that most people with this find that their pain improves over time.
- The pain may make you feel like there is damage, but usually shows how sensitive it has become
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Moving and doing gentle exercises is one of the best ways to help your sciatica
- It’s safe and normal to feel some pains as you get active. This should settle over time as you manage to do more
- Movement, activity and exercise are the main recommended treatments for back and sciatic pain of all severities. If you need guidance with this – seek a professional opinion
- Flare ups can be distressing and demoralising but are not usually related to any tissue damage
- Common triggers can include poor sleep, fatigue, low mood, tension, worries, less activity or a sudden spike in activity that you’re not accustomed to. Focussing on these triggers can help
- Trying to return to relaxed, calm, natural movements is recommended to get through flare ups quicker
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Staying in work usually helps your long-term health and wellbeing
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But if you can’t safely do your job though, it may be best to take a short time off whilst the pain settles but still remain as active as your pain allows
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Medicines, like duloxetine, amitriptyline, gabapentin, or pregabalin, are sometimes prescribed for nerve pain, but current evidence suggests they don’t help long term for people experiencing sciatica
- These carry increasing risks and side effects to weigh up too
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Your GP or pharmacist can offer advice yon your options for short-term pain relief
Ask for an urgent GP practice appointment or call 111 if:
You have back pain and
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- a high temperature
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- you’ve lost weight without trying to
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- there’s a lump or swelling in your back or your back has changed shape
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- the pain does not improve with relative rest and is much worse at night
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- you have new and significant weakness of the muscles in your leg
Call 999 or go to A&E if:
You have back pain and:
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- Chest pain
- It started after a serious, recent accident, such as a car accident
- New (past 2 weeks) loss of feeling/pins and needles between your inner thighs, genitals, back passage or buttocks
- New (past 2 weeks) difficulty when you try to pee or less able to feel the wee coming out.
- Not knowing when your bladder or bowel is full or empty
- Recent (past 2 weeks) inability to stop a bowel movement, leaking poo or not able to feel poo coming out
- Recent (past 2 weeks) change in ability to get an erection or ejaculate (come).
- Loss of sensation in genitals during sex
- For more information please read this leaflet.
- For information in more languages on these matters please visit this page.
- Or watch this informative video
Imaging
It’s important to stress that imaging of the spine is not indicated for the majority of cases as it is so likely to get better. Also, the culprit of the pain if often not seen on imaging. Nerve irritation is commonly the issue with nothing structurally pressing on it so there is often nothing to see.
In some cases, if sciatica goes on for a long time (usually longer than 2-3 months), or is very severe, you may be referred to a specialist team who may discuss imaging with you.
GPs and Physiotherapists do not need an MRI scan to start actively treating you. The main aim of an MRI is to see if a referral to a consultant surgeon may be useful.
With simple advice and by keeping moving as much as your pains allow you to, most people will see a great improvement in their sciatica and back pain within a few weeks of it starting and will settle fully.
For those who unfortunately have persisting or progressive pains then consider seeking specialist advice for the appropriate help and guidance.