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Sciatica Content Supplied by NHS Choices
Introduction

Sciatica is the name given to any sort of pain caused by irritation or compression of the sciatic nerve.

The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.

The pain of sciatica is usually felt in the buttocks and legs.

Most people find it goes away naturally within a few weeks, although some cases can last for a year or more.

This topic covers:

Symptoms

When to seek medical advice

Causes

Treatment

Prevention

Symptoms of sciatica

When the sciatic nerve is compressed or irritated, it can cause:

  • pain
  • numbness
  • a tingling sensation that radiates from your lower back and travels down one of your legs to your foot and toes
  • weakness in the calf muscles or the muscles that move the foot and ankle

The pain can range from being mild to very painful, and may be made worse by sneezing, coughing or sitting for a long period of time.

While people with sciatica can also have general back pain, the pain associated with sciatica usually affects the buttocks and legs much more than the back.

When to seek medical advice

See your GP if your symptoms are severe, persistent or getting worse over time.

Your GP can usually confirm a diagnosis of sciatica based on your symptoms and recommend appropriate treatment.

A simple test known as the passive straight leg raise test can also help your GP identify whether you have sciatica.

This test involves lying flat on your back with your legs straight, and lifting one leg at a time. If lifting one of your legs causes pain or makes your symptoms worse, this usually suggests sciatica.

You should immediately call 999 for an ambulance if you experience all of the following:

  • tingling or numbness between your legs and around your buttocks
  • recent loss of bladder or bowel control, or both
  • sciatica in both of your legs

Although it's rare, these symptoms can be a sign of a serious condition called cauda equina syndrome.

Causes of sciatica

In the vast majority of cases sciatica is caused by a slipped disc. A slipped disc occurs when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves.

It's not always clear what causes the damage, although as you get older your discs become less flexible and more likely to rupture.

Less common causes include:

  • spinal stenosis - narrowing of the nerve passages in the spine
  • spondylolisthesis - when a vertebra slips out of position
  • a spinal injury or infection
  • a growth within the spine - such as a tumour
  • cauda equina syndrome - a rare but serious condition caused by compressed and damaged nerves in the spinal cord

Treating sciatica

Most cases of sciatica pass in around six weeks without the need for treatment.

However, a combination of things you can do at home - such as taking over-the-counter painkillers, exercising, and using hot or cold packs - may help reduce the symptoms until the condition improves.

Further treatment may be recommended for more persistent cases, such as:

  • following a structured exercise programme under the supervision of a physiotherapist
  • having injections of anti-inflammatory and painkilling medication into your spine
  • taking stronger painkiller tablets

In rare cases surgery may be needed to correct the problem in your spine.

Read more about treating sciatica.

Preventing sciatica

You can minimise your risk of a further episode of sciatica by:

  • adopting a better posture and lifting techniques at work
  • stretching before and after exercise
  • exercising regularly

While sleeping, your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight.

If your mattress is too soft, place a firm board under the mattress. Support your head with a pillow, but make sure your neck isn't forced up at a steep angle.

Read about:

How to lift correctly

How to sit correctly

How to warm up before exercise

Stretching after exercise

'I used to wake up five times in the night with aching pain'

Robert's sciatica caused him intense pain in his right leg. He describes how the condition affected his life and mobility, and what treatment options were available to him.

Treatment

Treatment for sciatica isn't always necessary, as the condition often improves naturally within around six weeks.

If your symptoms are severe or persistent, your GP may recommend self-help measures and treatments such as medication and physiotherapy.

However, it's not clear exactly how effective many of these treatments are at treating sciatica.

In a small number of cases, surgery may be recommended to correct the spinal problem thought to be causing your symptoms.

Self-help

There are a number of things you can do yourself to help reduce troublesome sciatica symptoms.

These include:

  • remaining as active as possible
  • using hot or cold compresses
  • taking simple painkillers, such as paracetamol or ibuprofen

Exercise

It's important for you to remain as physically active as possible if you have sciatica.

Simple exercises, such as walking and gentle stretching, can help reduce the severity of your symptoms and strengthen the muscles that support your back.

While bed rest may provide some temporary pain relief, prolonged bed rest is often considered unnecessary and unhelpful.

If you've had to take time off work because of sciatica, you should aim to return to work as soon as possible.

Read more about exercises for sciatica.

Compression packs

Some people find that using either hot or cold compression packs on painful areas can help to reduce the pain.

You can make your own cold compression pack by wrapping a pack of frozen peas in a towel. Hot compression packs are usually available from pharmacies.

You may find it effective to use one type of pack followed by the other.

Medication

If you have persistent or troublesome sciatic pain, there are a number of medications that may help.

These include:

  • opioid medication, such as codeine, or morphine in severe cases
  • tricyclic antidepressants (TCAs), such as amitriptyline - these medications were originally designed to treat depression, but they have since been found to help relieve nerve pain
  • anticonvulsants, such as gabapentin - these medications were originally designed to treat epilepsy but, like TCAs, they can also be useful for treating nerve pain
  • a benzodiazepine called diazepam if you have muscle spasms

These medications aren't suitable for everyone, particularly when used in the long term, so it's important to discuss all available options with your GP. Some of these medications can also cause significant side effects in some people.

If the painkilling medications your GP prescribes don't help, you may be referred to a specialist pain clinic for further treatment.

Spinal injections

If other methods of pain relief have not worked, your GP may refer you to a specialist for a spinal corticosteroid or local anaesthetic injection.

This delivers strong anti-inflammatory and painkilling medication directly to the inflamed area around the nerves of your spine.

Spinal injections are very effective at releasing the pressure on your sciatic nerve and temporarily reducing your pain for a few months.

Physiotherapy

In some cases, your GP may recommend a suitable exercise plan for you, or they may refer you to a physiotherapist.

A physiotherapist can teach you a range of exercises that strengthen the muscles that support your back and improve the flexibility of your spine.

They can also teach you how to improve your posture and reduce any future strain on your back.

Read more about physiotherapy.

Surgery

Surgery is rarely necessary to treat sciatica, although it may be considered if:

  • the condition has an identifiable cause, such as a slipped disc
  • the symptoms haven't responded to other forms of treatment
  • the symptoms are getting progressively worse

The type of surgery recommended will depend on the cause of your sciatica. Some surgical options include:

  • discectomy - where the part of the herniated disc pressing on your nerve is removed; this is the most common type of surgery required
  • fusion surgery - it may be possible to fuse a vertebra that has slipped out of place by using a metal or plastic cage between the vertebra, supported with metal rods and screws
  • laminectomy - a procedure often used to treat spinal stenosis, where a section of vertebrae called the lamina is removed

Many people have a positive result from surgery but, as with all surgical procedures, spinal surgery carries some risks.

Potential complications range from the relatively minor, such as an infection at the operation site, to the more serious, such as permanent damage to the spinal nerves.

Before choosing spinal surgery, your surgeon will discuss the relative risks and benefits with you.

Read about lumbar decompression surgery for more information about what surgery involves.

 
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