Sciatica is a symptom and not a disease. It just describes the pain. Sciatica simply means “pain along the sciatic nerve”. It is a type of pain that comes from the irritation or inflammation of the sciatic nerve.
Sciatic nerve is the longest and thickest nerve in the human body starting from the spine. It runs under your buttock and back of the leg to end up at the back of your knee. The branches of the sciatic nerve supply sensation to the calf muscle, ankle and heel, and the entire foot.
What triggers Sciatica?
1) Disc Prolapse:
The soft cushions between the bones of the spine bulges out and irritates the sciatic nerve. Occasionally, the disc ruptures and exerts pressure on the spinal nerve causing tingling and numbness in addition to pain along your leg.
2) Inflammation of Facet joints:
Facet joints are small joints in the spine that connect the spine together. Due to wear and tear of the spine, these joints get inflamed and cause irritation and inflammation of the sciatic nerve. This therefore leads to sciatica.
3) Spinal Stenosis:
This is narrowing of the spinal canal that traps the spinal nerves as they come out of the spine. As age advances as well as with chronic wear and tear of the spine, the spinal canal gets narrowed and become eventually blocked.
4) Sacroiliac joint Inflammation:
Sacroiliac joint connects the spine with the pelvis. Sometimes this joint gets inflamed and the swelling around the joint irritates the sciatic nerve. The sciatic nerve lies in front of the sacroiliac joint and therefore any inflammation of the sacroiliac joint affects the sciatic nerve causing sciatica.
5) Pyriformis Tightness:
Pyriformis is a muscle that is deep in your buttock. The sciatic nerve passes between the fibres of this muscle and therefore there is a chance that the sciatic nerve gets trapped inside that muscle. This causes the pain, tingling and numbness along the back of the leg and foot
How is pain and numbness caused in Sciatica?
1) Chemical Inflammation:
When there is injury to the tissues of our back or in the case of a ruptured disc, that is the release of chemicals from these injured tissues. These chemicals are like acid and when they touch the sciatic nerve, it irritates the nerve which is felt as pain down the leg. In addition, you may also get ‘pins and needles’ sensation along your leg in sciatica.
2) Direct Compression:
In the case of a ruptured disc, the disc material traps the sciatic nerve and this causes numbness down the back of your leg in sciatica. Also, in case of severe spinal stenosis, the spinal nerves are trapped in the spinal canal for a long time. This causes back pain and sciatic leg pain along with numbness of one or both legs.
What cause Sciatica pain to flare up?
Usually find that the sciatica pain flares up around the age of 40. It is known that 40% of patients over 40 years old are commonly affected. Sciatica pain is also seen the jobs that require to bend forwards or sideways, lifting weights and rotating your body. This puts extra strain on the soft cushions (discs) between the bones of your spine.
How long does Sciatic pain last?
Most of the time sciatica lasts for a short period of time about 2 to 3 weeks. Sometimes it can last for 4 to 6 weeks. Sciatica pain that lasts less than six weeks is called acute sciatica. Pain lasting more than six weeks is known as chronic sciatica. One third of patients suffer from chronic sciatica. There are a lot of treatment options available for the management of acute and chronic sciatica in London.
How to manage sciatic at home?
1) Bed Rest - Reduce physical activity:
Stop physical activity for a few days. Bed rest for more NOT than 3 days to control Sciatica pain. A few days rest will help calm your back pain and leg pain (sciatica) as more rest is bad for back pain.
This will help you manage the sciatica pain and move around as the pain is well under control.
2) Apply Heat or Ice to your Back and leg:
This helps control your sciatica symptoms. Some are comfortable with a hot water bottle as it helps muscles to relax. But others find a cold compress useful as it reduces the inflammation.
Choose what you feel that is comfortable for you. Both methods give the same result in sciatica. Do not use them for more than 5 minutes at a time.
3) Over the counter Medications:
Most of us try an anti-inflammatory gel or ointment that can be applied over the painful area (back and leg). This is a very safe practice and it also helps to massage the area gently to relieve the sciatica pain. It works directly all the skin and muscles. The side-effects are far less than oral medications.
The most commonly used over the counter pain medications are non-steroidal anti-inflammatory drugs (NSAIDs) like Paracetamol and Neurofen (Brufen).
4) Mild Stretches for Sciatica pain:
Mild stretches loosens your tense back and leg muscles that are in spasm (tight feeling) in Sciatica pain. It is a good idea to take each step gently as any stretches may worsen the sciatica pain can cause damage to the muscles.
These stretches need to be simple with gentle forward bending, backward bending and mild twisting within the limit of your pain. Once you get used to it, regular stretching can ease your back pain and sciatica pain effectively.
5) Improve your posture:
We all spend most of your time sitting down. This may be during eating, reading, watching TV or at work. Your posture may be more harmful than you realise and contributes to making your sciatica pain worse.
Look carefully at your posture, pay a little attention and make sure that your back are lined up nicely in a straight line while standing, sitting and during all the activities of daily living.
What is the immediate relief for sciatica pain?
The 5 ways mentioned above does help to get immediate relief for sciatica pain. Reducing normal physical activity, Applying heat or ice over the back and leg, Over-the-counter pain medications, Mild and gentle stretches and Improving your posture helps in the management of sciatica pain.
What are the quick stretches for Sciatica?
These are 6 Quick stretches for Sciatica:
1) Hamstring Stretches:
Keep your back straight and bend at your hips. This gently stretches the muscles at the back and also the muscles at back of the leg (Hamstrings).
2) Pelvic Tilt:
Lie flat on your back. Tuck your tummy in and pull your hips off your bed. This stretches the muscles of your back and relaxes them. It helps reduce your back and leg pain.
3) Extension Curl:
Lie on your tummy. Raise your shoulders off your bed and arch your back. This will help the back muscles to work and get the tone and strength back.
4) Trunk Rotation:
Lie flat on your back. Roll your hips and knees to the side so that your knee touches the bed. This gives a gentle twisting motion to the muscles of your back. It works on different muscles in your back.
5) Pelvic Bridge:
Lie flat on your back. Raise your hips off the bed as far as you can manage. Don’t worry if you are not able to raise higher. In time, you will be able to raise your hips higher. Hold it as long as you can.
6) Sciatic Stretch:
Lie flat on your back. Lift your good leg first and see if you can pull it up as high as you can. You may need some assistance as it may be too painful to do this on your own.
What can you do for unbearable sciatica leg pain?
Caudal Epidural injection can instantly control unbearable sciatica after all treatment with physiotherapy and medications fail. Caudal epidural injections are steroid injections that help control inflammation around the sciatic nerve from the chemicals released from the injured tissues. It also stops the pain signals from the injured and inflamed tissues from reaching the brain.
What are the ‘Red Flag’ signs in Sciatica pain?
Unexplained pain under 20 or over 55 years of age
Back pain not settling after injury
Back pain that is constant and getting worse
A cancer patient or cancer survivor
High of long time steroid treatment
Sudden loss of weight
Intravenous drug abuse suggesting decreased immunity
HIV positive with immunosuppression
What is the success rate for Caudal epidural steroid injection for sciatica?
The reported results from large clinical trials show that about 80% of patients had more than 50% relief in their sciatic pain. This pain relief lasted from three months to 1 year. An average of three injections were given to these patients in a year (Manchikanti). They also found that they had a good outcome for patients who had suffered sciatica pain recently and also had a mild degree of compression of the spine (Pandey).
How painful is a Caudal epidural steroid injection?
Caudal epidural injection is painless. The Consultant anaesthetist will make sure that you are well sedated and relaxed. You will not feel any pain before, during and after the procedure. The Spine surgeon will ensure that you have the best possible care and experience from this procedure.
How can I prevent my Sciatic pain from getting worse?
Avoid sudden jerky movements. Sudden jerky movements release chemicals from the injured and sore soft cushion pads (discs) between your spine bones. This irritates the nerves going to your leg from your back. Make sure that you learn the right technique of lifting and getting out of bed. Some unexpected actions like sneezing and coughing may your sciatic pain worse.
Can I ignore my Sciatica pain?
No, you cannot ignore your sciatica pain. There is a possibility that a prolonged pressure on your sciatic nerve will cause some changes inside the nerve. Therefore, the numbness and weakness along your legs may become permanent if you continue to ignore your sciatica. The trouble is that then it may take a long time to recover the sensation in your legs completely.
When can Sciatica become an emergency?
When your back-pain spreads to both your legs, it can cause numbness right down to both feet. This may be accompanied by decreased sensation in your private areas causing the urine to leak away from you without your knowledge. This is an emergency situation and you need urgent medical attention. If you feel this occurs call the ambulance and seek help ASAP. The above-mentioned symptoms is a medical condition called “cauda equina syndrome”.