Sciatica

Sciatica is a very common condition. It relates to pain in the leg, where the nerves that travel from the lower back down the leg become irritated and very sensitive. Occasionally people with sciatica can also have back pain. It is important to remember that although sciatica can be very scary, painful and can affect many aspects of a person’s life it is rarely serious. Also, most sciatica will normally resolve without any treatment within 6-12 weeks.

Common causes

The sciatic nerve from lower back can become irritated or inflamed. A number of factors have been associated with sciatica; these often include:

A sprain/strain e.g., lifting something awkwardly or something that is too heavy for what you are physically used to doing.
A sudden increase or decrease in your normal activity or exercise levels.
Disc related changes that cause sciatic nerve irritation, inflammation and or compression.
Other conditions such as osteoarthritis, rheumatoid arthritis, or fibromyalgia.
Following a period of increased stress, worry or low mood.
Following a period of poor sleep, fatigue or feeling run down.
Other lifestyle factors such as being overweight and smoking.
A flare up of longstanding sciatica and or back pain.

Common symptoms

These include:

Pain that you may feel in your back, buttock, hip and down the back of the leg, sometimes travelling as far as your foot.
Burning or electric shock pain.
Tingling, numbness, coldness, cotton wool or heaviness feelings in your leg and or foot.
Back pain, but the pain in the leg is often worse.
Difficulty sitting, standing, bending, kneeling, walking and or lying down.
Disturbed sleep.

You may experience constant or intermittent (come and go) symptoms, that are aggravated by certain activities (or no obvious activities) and reduced by others.

What can I do to help it?

In the first few days after an onset of sciatica changing or reducing your usual activities may help. However, there is strong evidence that trying to keep active and gradually returning to all your usual activities and exercise will help you recover.
It is normal to experience some pain during your recovery, but it does not mean that you are causing harm or damage to your sciatic nerve or back.
Try to stay at work or return as soon as you are able to. Your employer, GP or health practitioner will be able to advise on how to return to your normal work duties and support you with any adjustments you might find helpful in the short-term.

Try some of these self-help tips.

Apply a heat or icepack to the painful area – for up to 15 minutes. Never apply heat or ice directly to the skin.
A short course of simple pain medication as advised by your pharmacist or GP may help reduce pain and allow you to move more comfortably.
Finding a balance between taking some rest and regular movement in the early days is often important.
Regular movement and exercise is safe and helpful for sciatica in the long run. It is important to build up gradually – the exercise or activity you enjoy most, is likely to help your recovery.
If sitting causes pain and your job involves long periods of sitting, adopting varied and or relaxed postures may be helpful.
Good sleep habits and managing stress may help you cope better with your pain.

Facts about Sciatica

Sciatica is RARELY linked to serious tissue damage or a life-threatening condition.
Sciatica is often caused by nerve irritation and or inflammation.
If the sciatic nerve is compressed, you may experience numbness and weakness in your leg(s).
Discs DO NOT ‘slip’ in or out of place, as they are strongly attached to the bones in your back.
Discs are STRONG round structures that sit between the bones in your back.
If there is a disc prolapse – it often shrinks and returns to normal over time (around 6 months). In fact, the bigger the disc prolapse usually means the better and faster a person is likely to recover.
X-rays and scans are NOT always needed to show the cause of your pain or to help your recovery.
Regular movement, exercise, good sleep, relaxation, managing stress and improving your general health CAN HELP reduce inflammation and help sciatic nerve related pain.
Gradually loading your back by including bending and lifting movements is SAFE. In fact, running exercise has been shown to strengthen discs.
There is NO perfect posture, slouching will NOT damage your back or discs.
Treatments such as medications and injections CAN HELP in some cases, but surgery is rarely needed.
Your sciatica can often improve with the right management. So even if you have had it a long time regardless of your age, DO NOT give up and try to work with a healthcare professional who can guide you with a self-management plan that you can stick to.

When should I seek medical advice?

Call your GP surgery if

Your leg pain is getting worse.
You have tried the self-help tips for 3-4 weeks and your symptoms have not improved.
You have any of the following symptoms.
- An unexplained onset of leg and or back pain accompanied by a history of Tuberculosis, HIV, cancer or rheumatoid arthritis.
- Feeling unwell with your leg and or back pain and have a fever or significant sweating that is keeping you awake at night.
- Feeling unwell with your leg and or back pain and have a history of cancer, loss of appetite or unexplained weight loss.

When to seek immediate medical advice

Cauda Equina Syndrome is an extremely rare but serious back condition. It can cause permanent damage and disability. It is important to seek immediate medical advice if you have a combination of the following symptoms:

Pain in both legs accompanied by weakness and/or a loss of feeling/pins and needles.
Loss of feeling/pins and needles between your inner thighs or genitals.
Numbness in or around your back passage or buttocks.
Altered feeling when using toilet paper to wipe yourself.
Increasing difficulty when you try to urinate.
Increasing difficulty when you try to stop or control your flow of urine.
Loss of sensation when you pass urine.
Leaking urine or recent need to use pads.
Not knowing when your bladder is either full or empty.
Inability to stop a bowel movement or leaking.
Loss of sensation when you pass a bowel motion.
Change in ability to achieve an erection or ejaculate.
Loss of sensation in genitals during sexual intercourse.

To see this information in another language click here. You can print out and keep this information to help you explain your symptoms.

Watch this video When should you seek urgent help for your backpain? (macpweb.org)

Do I need an X-ray or scan?

X-rays or scans or are NOT usually required to diagnose sciatica.
X-rays or scans are NOT able to tell us how much pain you are experiencing. They often show normal age-related changes and often this DOES NOT change how you manage your pain.
X-rays and scans are best used where a serious injury (e.g. a broken bone) or conditions such as cancer, infection or cauda equina syndrome are suspected.
A scan may be used if you experience weakness and pain in your leg(s) that is worsening and is significantly affecting your daily function.

Do I need a fit note?

If you’re sick and off work for seven days or less, your employer will normally ask you to complete a self-certificate for sick leave as soon as you return to work.
If you're sick and off work for more than seven days your employer will normally ask for a fit note (or Statement of Fitness for Work) from your GP.
You can read more information here https://www.nhs.uk/common-health-questions/caring-carers-and-long-term-conditions/when-do-i-need-a-fit-note/