Sciatica, or sciatic neuritis, is a selection of symptoms (most notably characterised by pain) that tend to affect the lower back, the buttocks and one or both legs. Sciatica, the earliest recorded mention of which was made in 1451, must be distinguished as different to being a specific condition – the effects can vary from case to case.
The term ‘sciatica’ does not refer to the cause of lower back or leg pain (but is often misquoted as such) and instead is indicative of the effects of the condition which causes lower back or leg pain.
The effects that characterise sciatica can include pain (which may be severe or intense) numbness, weakness of the leg muscles, a tingling sensation in the affected area, pins and needles and difficulty in controlling or even moving the limb. These effects – particularly the pain – may be exacerbated by cold weather.
The discomfort experienced by sciatica patients is often ‘referred pain’ – pain which doesn’t actually stem from an injury to the area that seems painful. The cause of the pain is often in the back itself, and simply radiates lower, until it reaches the buttocks and legs.
Sciatic conditions are fairly common, but depending on the severity of the condition, may require medical attention. If you are concerned that you may be experiencing sciatic symptoms, you may find that your doctor chooses to apply Lasègue’s sign, or straight-leg rise, in order to diagnose you.
This technique, named after Charles Lasègue, requires the patient to lie flat on the floor, on his or her back, while the doctor gradually lifts the affected leg (straightened at the knee.) If the patient reports pain when the straightened leg is lifted to an angle between thirty and seventy degrees, a herniated disc is pronounced present, and the test is declared positive.
Treatment for sciatic injuries differs, depending on the injury in question. Symptoms can be caused by compression of the lumbar or sacral nerves, or by compression or irritation of the sciatic nerves themselves. Where the source of pain is a herniated or prolapsed lumbar disc, treatment is rarely required at all; the injury will simply mend by itself. In cases of minor discomfort, over-the-counter painkillers may help to reduce soreness, and use of both hot and cold compression packs (used alternatively) can help to prevent swelling and stiffness.
When suffering from acute sciatica, one of the most important things a patient must do is remain active. Although it may at first seem beneficial to spend the day in bed, resting the injury, in the long run, you are likely to find that this only increases the intensity of the condition. Gentle exercises, like stretching and walking at a steady pace, will gradually increase mobility of the affected joints and limbs.
Chronic sciatica, on the other hand, is a more serious matter, and may require a combination of self-medication and medical attention. Painkillers are regularly prescribed for cases such as this, although the extended use of NSAIDs is best avoided, due to links to stomach ulcers and intenstinal bleeding. As such, prolonged use of medications like Aspirin and Ibuprofen is discouraged – patients instead are recommended to take Paracetamol, Codeine or Amitriptyline. Care must be taken with these drugs, however, as they can all have side-effects.
Should further action be required, an epidural injection of a corticosteroid may be recommended. Strong anti-inflammatory drugs are injected directly into the tissue surrounding the patient’s spinal nerves, helping to alleviate pressure on the sciatic nerve. Physiotherapy is also highly recommended for cases of chronic sciatica, as the gentle stretching motions can help to reduce pain and increase flexibility of the affected area, while prompting the body to release endorphins – its own natural painkillers.
In the most extreme cases, surgery may be required. Depending on the severity of the condition, one of three main procedures will be suggested. A discectomy will see the surgeon remove part of the herniated disc that is pressing on your nerve; fusion surgery attempts to bind a slipped vertebra back to the vertabrae around it via a bone graft, and a laminectomy is used to remove the arch of a vertebra which is placing uncomfortable pressure on your nerves.
If you are concerned that you are experiencing sciatic symptoms, make an appointment with your GP for a consultation. Depending on the severity of the condition, you may be referred to a specialist for more in-depth treatment. If you are diagnosed with acute sciatica, however, then consider booking sessions with a physiotherapist. Through gentle stretching and simple exercises, pain can be alleviated, and full use of the affected limb restored.
Dan Hart has contributed this article on behalf of the London Physio Centre – expert practitioners of physiotherapy in London. For more information of sciatica and how the London Physio Centre can help you, you can visit the website.