Sciatica
What is sciatica?
Back pain is very common and between 12-40% of people with back pain will experience nerve pains that travel into their leg. This pain 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 alongside tingling and numbness too.
90% of cases resolve with no specialist help at all. Over 70% of people report improvements in symptoms within 4 weeks but the average for meaningful ease can be 6-12 weeks.
Our nerves leave the spine through small tunnels made up mostly by the bones of the spine. Some of these nerves in our lower back then merge to form the sciatic nerve. This happens on both sides of the spine and we therefore have a sciatic nerve running down each leg. If these nerves leaving the spine are irritated by the surrounding tissue it can cause us pain anywhere along the nerve.
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
- The intensity of some back pain can be so high that people worry about it being dangerous.
- Over 99% of times, there is no serious cause, even if your pain is very intense.
- Lots of back pain begins with no injury or with simple day to day movements. These occasions may link with stress, fatigue, tension, less activity or an unprepared spike in activity. This can make the back more sensitive to movement or loading.
- Backs do not wear out.
- Movement, including lifting & bending, is essential to keep it healthy and help recovery.
- Back pain is felt in all age groups.
- Getting older does not mean back pain will start or get worse.
- People respond the same to evidence-based treatment irrespective of age.
- How you sit, stand or bend does not cause back pain.
- When painful, these activities can be challenging but they are not the cause as such.
- Variety is key. Your next posture is your best posture (keep changing your position).
- Relaxed movement, wherever possible, is key.
- Sitting and bending with a rounded back is actually more efficient.
- The pain may make you feel like there is damage, but usually shows how sensitive it has become.
- 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 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.
- Scan show what structures look like but not what they feel like.
- Only a small minority of cases will benefit from imaging and need an expert opinion to trigger this if needed.
- Scans show changes in people with no pain at all.
- Changes on a scan do not match how the spine feels or how much it is impacting on you.
- These carry increasing risks and side effects to weigh up.
- They do not provide very effective help in the long term for persistent back pains.
- If you feel you need to be considered for such options, ask your local healthcare professional who can access expert guidance on these topics.
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 accident, such as a car accident
- pain, tingling, weakness or numbness in both legs
- numbness or tingling around your genitals or buttocks
- difficulty peeing
- loss of bladder or bowel control (peeing or pooing yourself)
- New inability to gain or maintain an erection.
For more information please read this leaflet.
For information in more languages on these matters please visit this page.
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.