What is sciatica?
Sciatica refers to pain that radiates along the path of the sciatic nerve, which is the longest nerve in the human body. The sciatic nerve runs from the lower back, past the pelvis, hips and buttocks, and down each leg. The term sciatica does not refer to a specific problem but a symptom- a feeling or complaint in a certain area. A bit like the term toothache. Often the underlying problem is related to irritation or injury of part of the sciatic nerve.
A nerve is a sensitive phone line
The sciatic nerve acts line a phone line- sending and receiving messages about movement, touch, hot/cold and pain. This helps us to move our limbs and body in response to our environment. When this phone line is acting normally it sends and receives consistent messages so that our brain can make sense of what’s happening to our body and react.
Unlike a phone line though, the nerves are sensitive tissue- think about when you hit your funny bone. Ouch! At times these phone lines can become either irritated, injured or both. This is normally caused by them becoming stretched, compressed or less commonly severed.
If the nerves are only irritated then we can experience pain. The important thing to remember though is although the pain feels like it is coming from the leg itself, it is due to irritation of the sensitive phone line and not the part of the body that phone line transmits messages to/from. If the nerves are injured then the messages can stop travelling along the phone line consistently and we can experience numbness, weakness and pins and needles. Both of these things can occur together or separately.
How do you know if you have sciatica?
Many people are told they have sciatica and probably don't, while many others don't know what the issue is. While low back pain is very common- it is thought up to 85% of the population will have lower back pain at some time, sciatica is less common. It is estimated that only 5-10% patients with lower back pain will have sciatica.
If you do have sciatica normally you would have pain at buttock, the back or outside of your thigh, and perhaps also your lower leg and foot. The vast majority of time in one leg. This can come on with lower back pain but not always, and the leg pain would normally be worse than the back pain.
As the issue is within the nerve/phone line itself you would normally experience quite a distinct type of painful sensation- this could be a fairly persistent burning, tingling, electrical type of pain. It would normally feel worse with immobility, certain stretches/movements and positions. It generally feels better to take some stretch off the leg. You may also notice numbness to touch, a sense of weakness, and/or pins and needles.
What can or should you do about it?
It is important to remember that just like the rest of our body nerves have a good ability to heal and adapt, although this can take longer than other tissue like skin and muscle. Most people will see some improvement within 12 weeks however sometimes it can take a year or longer to get a good recovery.
A lot of people will improve over a few weeks without needing any other specific input than staying active and maintaining a healthy lifestyle.
There are some things within your control and others outwith your control that contribute to sciatica. The things you can’t control are as follows:
And the things you have some control over are:
Doing the best you can to manage these factors will go a long way in preventing episodes of sciatica and helping with recovery.
It is important not to afraid to move and exercise with sciatica as this is unlikely to be harmful and actually is likely to help give you the best possible recovery. You may have to modify or adapt your activities a little in the short-term to manage your symptoms.
Physiotherapy can be helpful if your symptoms are moderate to severe, increasing, affecting your ability to function normally, or not improving after a few weeks. This would normally involve a combination of help to address the factors mentioned above, specific exercises to aid the recovery of the nerve and to increase strength and mobility, and hands on treatment for pain relief and to promote movement.
Sometimes speaking to your GP about certain types of medication can be helpful, particularly if the pain is affecting your ability to function or sleep normally.
Its is rare that other interventions are needed like scans or surgery. In fact for most people with sciatic there is little difference between those who have and haven’t had surgery after a period of 1 year.