Everything you need to know about Sciatica

Sciatica is a very painful condition which occurs when the sciatic nerve, which runs from your hips to your feet, gets irritated. It usually clears up after 4-6 weeks but it can last longer. You can usually feel a tingling, stabbing, burning, shooting, numb or weak pain in your bottom, back of legs or feet and toes.

The NHS recommends to carry on doing your daily activities as much as possible, making sure you do regular back stretches, gentle exercises, pharmacist recommended pain-killers and use heat-packs (not hot-water bottles as you could scald the skin if you’re experiencing numbness) to ease the pain. Sitting and lying down for long periods can often worsen the pain so it’s important to stay active. If symptoms are worsening and aren’t getting any better after a few weeks then you should see your GP.

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What happens after being diagnosed with sciatica

Speaking to consultant spinal surgeon Mr Colin Natali MBBS FRCS FRCS (Orth), the process of being diagnosed and treated for sciatica can be very different depending on your condition.

“Sciatica is severe pain that runs down the leg. It is commonly caused by a prolapsed disc in the lower back that squashes the nerve at the point where it goes into to the leg. While some cases can be mild, others can be extremely severe.

“As a surgeon, treating patients with this condition, I meet patients who are unable to get out of bed, crying with pain and desperate for something to be done as quickly as possible.

“In severe cases, patients may have pain, numbness and weakness in one leg. In extreme cases, where the pain and weakness are in both legs, or if there is numbness around the groin, this constitutes a red flag and needs urgent surgery.

“The discs, called the intervertebral discs, are a beautiful piece of engineering. The outer wall is tough, yet flexible, and surrounds a substance that looks and feels like crab meat that we call the nucleus pulposus. As we get older, the wall may become weaker and break. The nucleus material then pops out and squashes the nerve.

“The good news is that the majority of patients get better with pain killers and exercise. Physical therapy from a physiotherapist, osteopath or chiropractor will help, as might acupuncture and massage. Within a few days or weeks, the pain usually improves and patients can get on with their lives.

“However, a small group of patients don’t get better and come to see people like me who can arrange for MRI scans to understand the extent of the problem. When the scans are completed, we talk to the patients to decide whether their sciatica is enough of a problem to warrant injections or surgery.

“Although people are obviously worried about surgery, when the other treatments have failed, surgery is a really effective way to relieve pain.

“Patients faced with the option of surgery can, understandably, find it hard to make decisions. That’s why at Schoen Clinic London we discuss options with them first as well as directing them to online resources, such as the patient information leaflets on the British Association Of Spine Surgeons website. Our role is to arm patients with everything they need to make an informed decision that’s right for them.

“It is important that patients are able to make the correct decisions in their own time and without pressure. Any surgeon who says a patient will soon be paralysed if an operation is not conducted should responsibly prompt a patient to seek a second opinion before proceeding with the surgery.

“For patients who opt for surgery, the majority are admitted to hospital for 1-2 days. Within a few hours post-surgery, they can move enough to write (as well as Tweet, Instagram, WhatsApp and message of course). Returning to work is of course dependent on the type and length of commute and the nature of the patient’s job, but in general this is a simple operation with good results.

“Although we consider this operation to be safe, it is important to consider that the complication rate is 1-4%, meaning 1-4 patients in every 100 experience a complication. As is the case with any medical procedure, patients need to weigh up their pain with the risks. If the pain is severe, the risks are worth taking, but if it is mild, I would caution against it.”

Mr Colin Natali MBBS FRCS FRCS (Orth), Spine Head of Department, Consultant spinal surgeon, Schoen Clinic London, https://www.schoen-clinic.co.uk/london

Managing the pain

Hopefully, the pain in the legs, bottom and feet that sciatica can cause should clear up in a few weeks but there are a number of things you can do to help relieve the feelings of sciatica.

Exercises to help sciatica

Known as a lower glute stretch or piriformis stretch, this can be performed laying down or sat on a chair. This move can really stretch out the bottom muscles on both sides if the shooting pain is located in your behind.

Find out more about exercises to help sciatica

The cat to camel position is great for alternating the back position. It’s important to repeat this movement as it can help to free up any entrapments along the course of the spinal nerve, and help to provide sciatica pain relief.

The child’s pose will help flex the lower spine and increase the size of passageways that help to reduce pain and irritation. It will also help align the spine, improve circulation and relieve fatigue.

Knee rolling is great if you tend to feel most tension and pain in the lower back as it helps to relax the lower back muscles, helping to ease the pain.

It’s important to perform the seated flex once you’re in the recovery period and it shouldn’t be attempted if you find yourself in a lot of pain or you find it uncomfortable to do. It’s a great way to take pressure off the spine and helps to regain a forward motion.

Massages to help sciatica

Treating yourself to a massage is a great way of relieving pain. Some studies have even found that they could be just as affective as anti-inflammatory drugs. Massages help to soothe the tense muscles which put pressure on the nerves. Relaxing these muscles and reducing how tense they are can relieve the pressure that is placed on the nerves.

What to ask your therapist for…

A deep-tissue massage - This is an aggressive form of massage, targeted at the muscles and connective tissues that could be causing you pain.

Swedish massage - This is ideal if you find the deep-tissue massage a little too painful or intense and still works to reduce tension and increase blood-flow.

Neuromuscular massage - This is a more advanced massage method that attempts to reduce any pressure on the nerves.

Myofascial release - Myofascial refers to the hard membranes that support the muscles and is great if you’re feeling stiff.

Hot stone massage - hot stones are placed on specific areas to ease muscle tension and pain with a Swedish style massage included.

Causes of sciatica

Sciatica is caused by irritation at the root of the lower lumbar and lumbosacral spine. The main causes of this can be lumbar spinal stenosis, degenerative disc disease, spondyloisthesis, pregnancy and muscle spasms.

It’s also very important to exercise regularly to stay healthy and maintain a healthy weight. Wearing high heels can also cause these problems as well as a poor quality or old mattress so it’s important to invest in supportive shoes and a decent mattress and pillows.

Is there a cure for sciatica?

Nonsurgical treatment

Heat and Ice - using heat and ice packs on the affected area for around 20 minutes at a time every 2 hours can help alleviate initial pain. It’s best to alternative between both ice and then heat using a towel between your skin and the heat or ice pack to protect yourself from burning.

Medication - stronger painkillers such as ibuprofen or naproxen can be far more affective than paracetamol. Ask your GP about what the best kind of medication would be best for you to be prescribed.

Steroid injections - if the pain becomes severe, epidural steroid injections can be administered to reduce inflammation. These are far more affective at targeting the direct area.

Chiropractic - professional chiropractors can help to align the spine which can help to address a number of problems associated with nerve problems.

Acupuncture - don’t be afraid of the idea of needles. They’re as thin as hairs and promote the open flow of energy around the area of pain and have been proven to help pain caused by sciatica.

Cognitive behaviour therapy - sessions with a therapist can be extremely beneficial to taking control of your health and changing your behaviours to pain, making it more manageable.