Sciatica

The sciatic nerve is the largest nerve in the body - it runs from the spinal cord through the buttock and down into each leg. Sciatica refers to pain that radiates along this nerve from the buttock and down into the leg.

Sciatica is a symptom of another problem, such as a prolapsed disc or a “pinched nerve”. The pain of sciatica can be extremely uncomfortable and unrelenting.

 

Symptoms of Sciatica

 

The pain travels down from the lower spine into the buttock and down the back of the leg. The distribution of the pain and discomfort can be anywhere along the nerve pathway. The pain can vary from mild ache to sharp or even excruciating discomfort. Occasionally there may a sudden feeling like an electric shock. Occasionally there may be a feeling of numbness and or muscle weakness along the nerve pathway in the leg and foot. There may also be a feeling of tingling or pins and needles in the foot and toes.

 

Cauda Equina Syndrome

 

This is a very rare complication of sciatica in which you may lose control of bladder and or bowel function. This is a serious medical emergency which requires immediate medical intervention.

 

Causes of Sciatica

 

Sciatica frequently occurs when a nerve root exiting the spinal column in the lower back is compressed. This is often the result of a herniated disc in the lower back. The disc is made of a jelly like substance surrounded by a hard fibrous outer shell. It acts like a shock absorber to the spinal canal.

 

Other causes of sciatica can be Lumber spinal stenosis. This is where the spinal canal, which houses the spinal cord and nerve roots, can be come narrowed. If this narrowing occurs at the lower lumbar area, sciatica can result.

Spondylolisthesis can also cause the symptoms of sciatica. This is where one lumbar vertebra slips forward over an adjacent vertebra and pinches the nerve.

Piriformis syndrome is also a cause of sciatica. This is the name of a muscle in the buttock extending from the lower spine to the top of the femur. This lies directly above the sciatic nerve. If it shortens or goes into spasm, it causes pressure on the sciatic nerve and then the resultant pain.

Rarer causes of sciatica are spinal tumours and or spinal trauma.

 

Tests and investigations

 

Investigations into sciatica include physical examination including muscle strength of lower limbs and reflex testing of nerves. Straight leg raising whilst lying flat. The latter test usually aggravates the sciatica pain. Spinal x-rays are of limited value, as they cannot detect herniated discs, although they could highlight any cancers affecting the bones of the lower spine. MRI scans (see left) are of most value because they can identify any damage to soft tissues such as ligaments and discs.

 

Treatments of Sciatica

 

In the first instance sciatica often responds to medication including analgesics such as paracetamol or co-codamol. Non-steroidal anti-inflammatory medication such as Ibuprofen is also usually effective in mild cases. Sometimes in more severe pain situations, prescribed medication from the doctor is required.

 

Physical therapy such as osteopathy, physiotherapy, massage and Bowen therapy can be extremely beneficial. Acupuncture has also been shown to relieve the symptoms.

[Just recently, (May 2009), the National Institute of Clinical Excellence, (NICE), has recommended that Osteopathy should play a big part in the treatment of low back pain. NICE is the government medical body that looks at various treatments for various conditions and illnesses and then recommends them if they are seen as effective.]

 

More aggressive treatments may include spinal steroid injections of spinal surgery such as disc trimming or removal. These measures are used as a last resort. They are usually only employed if the sciatica does not respond to the other more conservative approaches mentioned earlier. They are used in conditions where the pain is intractable or complications such as balder or bowel control is affected.

 

Self Help

 

Exercise regularly! This is the most important thing one can do to try and prevent back discomfort and problems happening in the first place. It is also useful to try and reduce the pain, if the problem has already arisen. Swimming is an excellent all round good exercise for maintaining muscle strength and improving suppleness of the joints, including the spinal joints. Other exercise such as cycling and walking are very beneficial. Paying special attention to the core muscles in the abdomen helps to maintain the strength of the small back muscles.
Maintaining good posture when sitting at work or a computer will help you to prevent slouching and putting more pressure on the low back.

 

If you would like some advice or further information please contact us here at the Earlsdon Practice by completing the form on our contact page or call us on 02476 691100.