What is Sciatica?
Medically Reviewed by Dr Ali Zavery
Last updated on 11.06.2024
The sciatic nerve is the longest nerve in the body, and extends from the lower back, through the hips and buttocks, down each leg. “Sciatica” refers to pain that radiates along the path of the sciatic nerve. Sciatica tends to primarily affect one side of the body, and is most often seen in adults between 30 and 50 years old. Sciatica is typically a continuous burning sensation or a shooting pain, starting in the lower back/ buttock and radiating down the front or back of the thigh and leg, and/or foot. You may notice is positional/postural, getting worse when you try to sit, stand, walk, bend, twist or while coughing.
Sciatica describes the presence of pain in the path of the sciatic nerve, but it is not a diagnosis in itself.
Common causes of sciatica
Any situation or condition which leads to pressure or compression of the sciatic nerve can cause sciatica.
- A herniated disk: This is the most frequent cause, where a disk in the spine bulges out, pressing on the sciatic nerve.
- Bone spurs: Overgrowths of bone on the vertebrae can impinge on the nerve.
- Spinal stenosis: Narrowing of the spinal canal can lead to nerve compression.
- Piriformis syndrome: A condition where the piriformis muscle (located in the buttocks), spasms and irritates the sciatic nerve.
- Tumors or infections: Though much less common, these conditions can also affect the nerve.
Symptoms of sciatica
- Pain: This can be infrequent or constant, varying in intensity. It might worsen with movements like sneezing or coughing.
- Numbness and tingling: These sensations typically occur in the leg or foot on the affected side.
- Weakness: There might be a noticeable reduction in strength in the affected leg or foot.
Certain symptoms may indicate more serious nerve compression- these require immediate medical attention. This includes: if you experience severe pain following an injury/fall, if you have trouble controlling your bowels or bladder, if you have pins and needles or numbness around the genital region, progressive weakness in the legs, or if the pain persists/worsens and does not improve with rest and over-the-counter medications.
Diagnosis of sciatica
Diagnosing sciatica involves physical examination and may also necessitate imaging tests like MRI scan. Sometimes a diagnostic nerve block may be considered. A diagnostic nerve block is when a pain-killer/anaesthetic drug is injected into the affected area of the lower back, to help pinpoint more precisely the nerve that is affected. There is a small risk of bleeding, nerve damage, and spinal cord damage with diagnostic nerve block injections.
Treatment options
To optimise chances of good recovery, treatment should be commenced immediately. Non-invasive, non surgical treatments are appropriate and effective in most cases, within 4-6 weeks.
- “Over the counter” pain relief medication can help.
- Physical therapy: Guided exercises can alleviate pain and prevent future issues.
- Manual therapy or massage may be helpful, as long as carried out by a trained professional (these should not feel overly painful).
- Prescription medications: sometimes stronger anti-inflammatories or other pain relievers are beneficial. Examples of medications that may be considered include NSAIDS, opioids, oral steroids, anticonvulsant or tricyclic antidepressant medications (to target nerve pain).
- Epidural injections or selective nerve root blocks (these should only be carried out by a well-trained specialist).
- Surgery: In severe cases, especially those affecting bowel or bladder function, surgery might be necessary.
Maintaining a healthy weight, undertaking regular exercise, maintaining proper posture and strengthening your core muscles can reduce the risk of developing sciatica over time.
Patient resources
- Pain Australia: Offers comprehensive resources on managing chronic pain, including sciatica (Pain Australia Website).
- Health Direct Australia: Provides health information and services, including a directory to find physiotherapists and exercise physiologists (Health Direct Service Finder).
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