Sciatica

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Sciatic pain

Sciatica is a condition characterised by pain that radiates along the path of the sciatic nerve. The sciatic nerve is the longest and widest nerve in the human body, running from the lower back, through the buttocks, and down the back of each leg. Sciatica typically affects only one side of the body.

The sciatic nerve is formed by the convergence of 5 nerve roots that exit the spine. The most common cause of sciatica is compression or irritation of one of these 5 nerve roots, often due to an injured, herniated or bulging disc in the lower back. Arthritis of the joints of the lower back can also lead to compression of these nerve roots, causing pain along the sciatic nerve.

There are other potential causes of sciatica, such as lumbar spinal stenosis, where narrowing of the spinal canal in the lower back can put pressure on the sciatic nerve roots. In some cases, it is caused by ‘piriformis syndrome’, where the sciatic nerve is compressed as it passes through a buttock muscle known as the piriformis. Arthritis of the hip can also cause referred pain that mimics sciatica. Rarely, spinal tumours or infections in the spine can affect the sciatic nerve.

Symptoms of sciatica

Symptoms of sciatica can vary in intensity and may include:

• Pain that radiates from the lower back, down the buttock, behind the thigh and calf
• Numbness or tingling in the leg or foot
• Weakness in the affected leg
• Pain that is aggravated by prolonged sitting, standing or certain movements

What can I do to help if I have sciatica?

• Aim to keep moving and remain active.
• Avoid bending and lifting/lifting and twisting
• Try applying ice packs (wrapped in a tea towel) to reduce pain and swelling.
• Use a hot water bottle (wrapped in a tea towel) to ease muscle spasms and relieve joint stiffness.
• If it hurts in bed, try lying on your side with a pillow between your knees, or on your back with 2 pillows under your knees.

Treatment of sciatica

Treatment of sciatica depends on the underlying cause, severity and duration of the symptoms. In most instances, conservative treatments are effective in relieving the symptoms of sciatica. At Castle Clinic our acupuncturists, chiropractor, osteopaths and physiotherapist regularly treat people with sciatica. 

Acupuncture helps sciatica by offering pain relief, reducing inflammation and stimulating muscle relaxation.

Chiropractic relieves sciatica by alleviating pressure on the nerve and aiding the relaxation of any muscle spasm with the application of spinal manipulation.

Osteopathy aids sciatica using joint and spinal manipulation, along with massage and stretch techniques to decompress the trapped nerve, improve spinal movement and posture and restore normal function of the lower back.
Physiotherapy helps sciatica by working with exercises to improve flexibility, strength and core stability of the back in order to reduce the load on the compressed nerve.

Do I need an MRI scan if I have sciatica?

In the vast majority of cases an MRI scan is not necessary. Our practitioners will advise you if they think it will be beneficial. They will facilitate organising this either by contacting your GP or via a private referral.

What happens if conservative treatment doesn’t work?

In the rare case that the sciatic pain isn’t resolved by conservative treatment, neuropathic pain medicine such as amitriptyline, gabapentin or pregabalin can be prescribed. Epidural steroid injections may be used to reduce inflammation and pain. If these treatments are ineffective, or there is a severe underlying condition like a large, herniated disc, surgery may be recommended to alleviate pressure on the nerve.

Cautions

In most cases, sciatica is a painful, but benign condition that can be managed conservatively. There are some signs however that, if present with sciatica, require immediate assessment from a doctor. These signs are:

• A loss of control of your bowel or bladder
• Difficulty initiating urination 
• Severe weakness in the leg (such as foot drop)
• Sciatica in both legs
• Numbness or tingling around the genitals or buttocks
• Sudden, unexplained weight change
• A history of cancer

If you have any further questions about sciatica, please get in touch. If you would like to book an appointment, visit our booking page or call 01423 797800.