Sciatica is pain along the sciatic nerve, from the lower back down the leg. Sciatica symptoms and treatment depend on where the nerve is irritated: most often by a herniated disc in the lower back, less often by a tight muscle in the buttock. People also call it a trapped nerve or nerve root irritation (radiculopathy). It usually affects one leg.
Symptoms
- Pain that starts in the lower back or buttock and runs down the back or outer side of the leg.
- Burning, shooting pain or a feeling like an electric shock down the leg.
- Numbness or pins and needles in the lower leg, foot or toes.
- Pain that gets worse when you sit, cough or bend forward.
- Sometimes weakness in the leg or foot.
The leg pain is often stronger than the pain in the lower back. It can be constant or come in attacks. Many people can’t sit for long, but cope better with standing and walking.
Why it happens
The sciatic nerve is the thickest nerve in the body. It starts in the lower back and runs down to the foot. It hurts when something presses on it or irritates it somewhere along the way. The most common causes are:
- a herniated disc or disc bulge (protrusion) in the lower back;
- narrowing of the spinal canal in older people (stenosis);
- a tight piriformis muscle in the buttock (piriformis syndrome);
- wear of the vertebrae and the small joints of the spine;
- less often, pregnancy, an injury or another illness.
In younger people the most common cause is a herniated disc, and after the age of 60 it is more often stenosis. With stenosis, the pain comes on when you walk and goes away when you sit down or lean forward.
How we treat it
Kaloyan first looks for where the nerve is irritated. Bring your scans and test results if you have them; if you don’t, he will decide whether you need them. He asks when the pain started and in which positions it eases, checks the strength, reflexes and sensation in your leg, and tests how freely the nerve moves. If the problem is in the nerve and the muscles around it, the main treatment is kinesitherapy for nerve pain (neuralgia), which means exercise and manual therapy. It combines nerve gliding (gentle movements that help the nerve slide freely), manual therapy and exercises.
If the nerve is pressed by a tight muscle in the buttock, the work focuses more on that muscle: a manual technique and gentle stretching. When a confirmed herniated disc is behind the sciatica, Kaloyan follows the programme for kinesitherapy for a herniated disc. On days when the pain is strong, he adds electrotherapy to reduce the pain. The course is usually about 5 sessions, 2–3 a week. Many people feel less pain after just the first 2 sessions; the rest are for maintenance and strengthening. As you improve, the pain retreats upwards, from the foot towards the lower back, and the numbness eases more slowly than the pain. If there is no progress after a few weeks, Kaloyan will refer you to a neurologist.
What you can do yourself
- Don’t sit for long. If you have to sit, get up for a moment every half hour.
- Find a position that eases the leg, for example lying on your back with your knees bent.
- Go for gentle walks, as far as the pain allows.
- Sleep on your side with your knees bent and a pillow between them.
- Don’t stretch the leg hard if it makes the pain in it worse. Kaloyan will show you the movements that suit you.
When to see a doctor first
These signs are rare, but they mean that the nerve is badly compressed or that the cause is something else:
- Numbness in the groin or around the anus.
- Problems with urinating or with bowel movements. You need an urgent examination by a neurologist and imaging (MRI, CT scan or X-ray).
- Weakness that is getting worse, for example your foot starts to drag.
- Pain in both legs at the same time.
- Pain after a fall or a blow, a fever or unexplained weight loss.
