Sciatica

Sciatica is when the sciatic nerve, which runs from your spine through each of your legs to your feet, becomes irritated due to compression. This can cause you to feel any or all of the following:

• Numbness
• Pain that is burning, shooting or stabbing — pain may worsen when you change posture, cough, move or sneeze; if you only have back pain, you most likely don’t have sciatica as sciatic pain is felt in several areas, not just your back
• Pins and needles
• Weakness

You may experience these symptoms only on one side of your body. Pain usually affects the areas of your body that your sciatic nerve runs through. It can therefore radiate from your lower (lumbar) spine to your buttocks, the back of your thighs, down the back of your legs and to your feet and toes.

Sciatica is more likely to occur if you take part in strenuous activity, such as heavy lifting, or sometimes even driving.

Symptoms usually disappear without needing treatment and there are things you can do at home to help.

Types of sciatica

There are four main types of sciatica: 

• Acute
• Alternating
• Bilateral 
• Chronic (long-term)

Sciatica-like symptoms

Symptoms of some other medical conditions can cause sciatica-like symptoms. These conditions include: 

• Piriformis syndrome — spasms of the piriformis muscle, which sits deep in your buttocks
• Sacroiliac joint dysfunction — irritation of the sacroiliac joint at the bottom of your spine, which can also irritate the nerves in that area

The main causes of sciatica are:

• Back injury or fracture
• Lumbar degenerative disc disease — wear and tear to the vertebrae and vertebral discs in your lumbar spine, usually caused by ageing
• Sacroiliac joint dysfunction — irritation of the sacroiliac joint at the bottom of your spine
• Slipped disc — this accounts for 9 out of 10 sciatica cases and occurs when the soft tissue (vertebral disc) between your vertebrae squeezes out and presses on the sciatic nerve; slipped discs most often occur at the bottom of your spine and the risk of this happening increases as you get older, if you are tall or perform heavy lifting
• Spinal stenosis — your spinal cord has narrowed in the area where the sciatic nerve passes through
• Spondylolisthesis — one of your vertebrae has slipped out of position and is pushing on the sciatic nerve

Inflammation or spasms of the muscles in your lower back and pelvis can also cause sciatica. 

Rare causes of sciatica include: 

• Blood clots
• Build-up of fluid
• Fracture of your lower spine
• Infection  
• Pott's disease
• Scar tissue

Sciatica usually develops gradually and affects 10-40% of the population. In most cases, it gets better in four to six weeks but up to a third of people have sciatica for up to a year.

Risk factors for sciatica include: 

• Age — as you get older, your risk increases
• Being overweight or obese
• Being tall — if you are tall and aged 50-60 you are at greater risk
• Family history — sciatica runs in families, suggesting genetics contributes to your risk
• Medical conditions — this includes: 
• Depression
• Diabetes
• Vitamin B12 deficiency
• Your lifestyle — if you smoke, or spend a lot of time sitting down or being inactive you are at greater risk

Sciatica is also more common in people with certain jobs eg carpenters, machine operators and truck drivers. If your workplace has poor ergonomics (the physical environment of your workplace) you are also at greater risk.

Symptoms for sciatica usually get better in six weeks. However, you should see your GP as soon as possible if your symptoms are stopping you from your everyday activities or they get worse suddenly. 

To help determine the cause of your sciatica, your GP may check your reflexes and muscle strength, and ask you to: 

• Raise your legs while lying down
• Rise from a squatting position
• Walk on your heels or toes

They may also recommend further investigations, such as:

• An X-ray
• CT scan
• Electromyography
• MRI scan

You may: 

• Develop weakness in your affected leg
• Lose feeling in your affected leg
• Lose control of your ability to urinate or have a bowel movement

How to treat sciatica at home

There are a number of things you can do to help relieve sciatica symptoms and aid recovery:

• Apply heat packs
• Continue your normal activities as much as possible — staying active and moving helps
• Maintain good posture especially when sitting
• Perform regular back stretches
• Take non-steroidal anti-inflammatories (NSAIDs) eg ibuprofen — paracetamol is usually not enough on its own to relieve sciatic pain; speak to your pharmacist for advice on NSAIDs for sciatic pain
• When sleeping, place a cushion between your knees if you are on your side or under your knees if you are on your back 

It is also helpful to try to follow good practices when it comes to your body mechanics eg: 

• If standing for a long time, occasionally rest one foot on a small box or stool 
• If lifting something heavy, bend your knees, keep your back straight and hold the object close to you — ideally, find someone to help you lift heavy or bulky objects and avoid lifting and twisting simultaneously

Try to avoid the following to prevent your symptoms from getting worse:

• Sitting or lying down for a long time
• Using hot water bottles — if your skin is numb, you may scald yourself without realising it

If these home treatments do not work, your symptoms suddenly get worse or your symptoms are preventing you from carrying out your everyday activities, see your GP.

Further treatments

Your GP will initially suggest painkillers and exercise for sciatica relief. They may refer you to a physiotherapist to teach you which exercises and massage techniques will be beneficial. However, NHS waiting times for physiotherapy are often long. They may also refer you for psychological support to help you better cope with your sciatica.

If these don't work or your symptoms are exceptionally bad, then your doctor may suggest:

• A procedure to seal off certain nerves in your back
• Spinal decompression surgery to relieve the pressure on your sciatic nerve — this is only recommended in severe cases eg when sciatica causes loss of bowel and/or bladder control, weakness or worsening pain
• Steroid injections to relieve pain and reduce inflammation — these are injected near the start of the sciatic nerve but only provide relief for a few months; repeat injections are not recommended as they can cause serious side effects

Your GP may also suggest alternative medicine treatments, such as: 

• Acupuncture — hair-thin needles are inserted into your skin at specific points to help relieve pain; the effectiveness of acupuncture is currently unknown; always use a licensed acupuncture practitioner 
• Chiropractic treatment — a spinal adjustment carried out by a chiropractor to restore movement to your spine and therefore reduce pain; it is safe and effective for lower back pain but may not be effective for pain that radiates to other body parts

When to seek urgent treatment

Go straight to A&E or call 999 if you have:

• Difficulty controlling when you have a bowel movement, if this is not normally a problem for you
• Difficulty urinating, if this is not normally a problem for you
• Numbness around your anus, buttocks and/or genitals
• Sciatica on both sides
• Weakness or numbness in both your legs which is severe or worsening

These are symptoms of a serious back problem.

Symptoms usually get better in six weeks but in up to a third of cases can last up to a year.

You may want to take a family member or friend with you to your GP appointment. Beforehand, make some notes listing: 

• Any recent accidents or injuries you have had
• Your key medical information eg any health conditions and medication you take
• Your symptoms

Importantly, also make a list of questions you want to ask your GP, such as:

• What is the most likely explanation for my pain? 
• What else could be causing my pain? 
• Do I need to have further tests or be referred to a specialist?
• What are my treatment options? 

Once your GP has explained your treatment options, you may have follow-up questions, such as: 

• If medication is recommended: 
• How long do I need to take it for before I feel better? 
• What are the side effects? 
• Is surgery an option for me and if not, why not? 
• Should I avoid certain activities? 
• What can I do to reduce my symptoms? 
• How can I prevent my symptoms from coming back? 

Your GP will also ask you some questions, such as: 

• Do you have numbness or weakness in your legs?
• Do certain activities, movements or positions worsen your pain? 
• Do you perform heavy manual work?
• Do you exercise regularly and if you do, what activities? 
• Have you tried anything to relieve your symptoms and if so, what and did they work? 
• What effect is your pain having on your ability to carry out everyday activities and/or work?