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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 of sciatica
When the sciatic nerve is compressed or irritated, it can cause:
- 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. Sometimes they may refer you to a specialist doctor or a physiotherapist for further help.
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
Most cases of sciatica pass in around six weeks without the need for treatment.
A combination of things you can do at home – such as taking anti-inflammatory painkillers for any back pain, staying active and exercising, and using hot or cold packs – may help reduce the symptoms until the condition improves.
Further treatment may be needed in some cases, such as:
- an exercise programme under the supervision of a physiotherapist
- injections of anti-inflammatory and painkilling medication into your spine
- stronger painkiller tablets
- manual therapy (treatments such as manipulating the spine and massage, usually carried out by physiotherapists, chiropractors or osteopaths)
- psychological therapy and support
In rare cases surgery may be needed to correct the problem in your spine.
Read more about treating 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.
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.
There are a number of things you can do yourself to help reduce troublesome sciatica symptoms.
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.
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.
If you have persistent or troublesome sciatic pain, there are a number of stronger medications available on prescription that may help.
- some types of antidepressant, such as amitriptyline and duloxetine –these medications were originally designed to treat depression, but they have since been found to help relieve nerve pain
- anticonvulsants, such as gabapentin and pregabalin – these medications were originally designed to treat epilepsy, but they can also be useful for treating nerve pain
- a medicine 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.
If other methods of pain relief have not worked and your pain is severe, 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.
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.
Your GP may also suggest taking part in a group exercise class led by a physiotherapist.
Read more about physiotherapy.
Manual therapy is the name for a group of treatments where a therapist uses their hands to move, massage and apply careful force to the muscles, bones and joints in and around your spine.
It's usually carried out by chiropractors, osteopaths or physiotherapists, although chiropractic and osteopathy aren't widely available on the NHS.
Manual therapy can help reduce sciatica pain, but it shouldn't be used on its own. It should only be used alongside other measures such as exercise.
Your GP may suggest psychological therapy as part of your treatment plan, in addition to other treatments such as exercise and manual therapy.
Therapies such as cognitive behavioural therapy (CBT) can help you manage your pain better by changing how you think about your condition.
While the pain in your back is very real, how you think and feel about your condition can make it worse.
If you've been in pain for a long time, a specialist treatment programme that involves a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain may be offered.
Surgery is rarely needed for sciatica.
But a type of surgery called lumbar decompression surgery 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
Decompression surgery can involve several different techniques, such as:
- 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.
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