sciatica - sussex community
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Sciatica
Does it have other names? Nerve root pain, Lumbar radiculopathy, Lumbar referred
pain, Sciatic neuralgia,
About:
Many nerves branch off from the spinal cord in the lower back and bundle together to form
the sciatic nerve in the leg. Sciatica is a general term referring to irritation of any of the
nerves forming this bundle.
Sciatica can involve pain and
‘nerve symptoms’ in the lower
back and down the legs. This
most commonly affects the back
of the leg sometimes as far down
as the foot. Nerve symptoms can
include changes in sensation, pins
and needles or weakness in the
legs.
Sciatica is usually caused by
irritation of the nerves as they exit
the spine. This irritation can be caused by nerve compression (sometimes called a ‘trapped
nerve’) or inflammation around the nerve. This inflammation is part of the body’s natural
protective system. As the body clears this inflammation the sciatica symptoms usually begin
to settle.
- In younger individuals the most common cause of sciatic is injury to the intervertebral
discs which can then irritate the nerves as they leave the spine.
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- In older individuals the tissues around the spine gradually thicken and stiffen. This is
part of normal ageing. However, in some people these changes can irritate the nerves
as they leave the spine.
Research shows multiple factors can contribute to experiencing sciatica. These include:
Being unfit
Being overweight
Smoking
Depression and emotional distress can trigger or increase sciatic pain for some
people. This is because emotions, beliefs and worries can affect how we feel pain.
In the early stages of a sciatica ‘flare up’ many people will experience moderate-severe pain
in their leg and/or back. For most people, sciatica will settle on its own over time without any
need for specific treatment. This will most often occur within a period of 6-16 weeks.
However, because nerves can be very some people may have some symptoms for a
number of months.
Management:
Sciatica is a common condition. It is rarely dangerous or serious (unless combined with
symptoms outlined under CES). Your spine will remain resilient and strong even if it may not
feel that way when you are in pain.
back pain myths link
10 facts back pain link.
Medication and therapies can help but there is not usually a ‘quick fix’, especially in the
short term. During the early stages evidence shows that:
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maintaining movement
staying active
managing effective pain control
reducing negative emotions/concerns regarding the outlook and causes of the
problem
can help achieve better outcomes and recovery.
Very few people with sciatic require scans such as X-rays or MRIs (magnetic resonance
imaging) to manage their pain and symptoms. Accurate diagnosis can be made via a
thorough clinical exam. MRI is only well utilised to:
Investigate a strong clinical suspicion of more serious spinal conditions
Determine the potential benefits of spinal injections or surgery
Very few people who do have an MRI scan go on to have any further injection or surgery.
This is because:
the symptoms often get better in the meantime
no target for injection or surgery was identified
further invasive treatment is agreed to be inappropriate for that individual.
Furthermore, up to 80% of people over the age of 60 will have visible signs of age-related
changes on an X-ray and MRI. Most of these individuals do not have any symptoms.
What can I do to help myself?
Pain Relief Medication – Over the counter painkillers may be helpful, such as
Paracetamol, or Ibuprofen that you can buy at the chemist. However, Paracetamol alone
is not recommended to manage sciatica. Nonsteroidal anti-inflammatory drugs
(NSAIDs), such as Ibuprofen, should be considered as the first-line response (at the
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lowest effective dose for the shortest time possible). Your pharmacist/GP will be able to
give you expert advice if you have any concerns regarding medication. It should be
considered that pain ‘killers’ are unlikely to take away your pain completely but allow it to
feel more settled.
Heat or Cold Packs – Apply either a hot or cold pack (whichever you prefer) to the
painful area for 10-15 minutes. Ensure you wrap any pack in a damp tea towel to avoid
direct contact burning the skin. This process can be repeated multiple times a day as
long as the skin returns to normal temperature between applications. You should not
use hot or cold packs in the presence of any altered sensation.
Exercise – It may feel daunting to exercise with nerve pain but there is lots of research
showing that gentle exercise within the limits of your pain can help you recover more
quickly. Therefore, it is important to remain active. This will not cause damage or harm to
the tissues. People who excessively avoid normal movement are more likely to
experience pain for a longer period of time. This is called persistent pain. Therefore, try
to avoid bed rest throughout the day time and try some of the recommended gentle
exercises below.
You can expect some discomfort when doing exercises but it is important that this is kept
within a tolerable level. Any increased discomfort should settle within 20-30 minutes of
completing the exercise.
Modifying Activities –
It is important to exercise but in the short-term it can be helpful to modify your activities.
This is to help prevent further aggravating your back pain.
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o Pacing activities by striking a balance between rest and activity. Do not try to
‘push through pain’ because this can make it more irritated. It can be useful to
breakdown you activities in to more manageable chunks.
o Regular gentle movement every 30-40 minutes can help keep your joints and
muscles moving and prevent increased back pain caused by staying still for too
long.
o Most people find nerve pain feels worse at night because they are staying still for
a longer time. Try changing your sleep positions regularly. There is no perfect
position for easing sciatica and it varies for each person. Find what is most
comfortable for you. If you are waking with nerve pain you may find it helpful to do
some gentle movements before trying to resettle again.
o If you are limping because of your back pain then using a walking aid can help
you feel more comfortable and balanced when walking. This could allow you to
continue with your day to day activities more easily.
o You may need to talk to your employer/occupational health department to see if
any adjustments can be made to help you continue work throughout this period.
Weight Loss – There is evidence that being overweight can affect the pain people
experience from their lower back. If weight loss has been discussed with you by a GP
or other healthcare professional useful resources to help achieve effective weight
loss can be found here
Education – It is well researched that having a better understanding of your
condition helps reduce worries about this. This can help you manage your condition
more effectively and return to function more quickly.
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Smoking- Evidence suggests that smokers are more likely to suffer more severe and
persistent pain than non-smokers. For advice on quitting smoking click here
Rehabilitation Exercises:
Knee rolls
knee hugs
cat-cow stretch
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Exercise dose:
- Little and often 1-2/day as able
- Only perform as pain allows
- Increase as you feel able
What to do if I’m in need of more help?
• Review your Medication – If your pain is still not well controlled despite the above
strategies it is recommended you consult with your GP/Pharmacist to review your current
medication. Your GP or pharmacist may discuss neuropathic pain medication with you
depending on prescribing policies.
• Review with your physiotherapist – Should you continue to be significantly limited
with your day to day activities or would like some further advice please feel free to contact
your Physiotherapist who can expertly review your rehabilitation options.
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Cauda Equina Syndrome
In extremely rare cases (1 in 100,000 people with lower back pain) individuals
can develop Cauda Equina Syndrome (CES). Cauda Equina Syndrome occurs
when the deep spinal nerves below the spinal cord become severely
compressed. These nerves are essential for controlling, bladder and bowel,
sexual and some pelvic organ function. Without early intervention CES can lead
to irreversible changes to these functions. Specific symptoms are associated with
CES and any combination of the following symptoms Immediate Medical
Attention must be sought. – either attend A&E or call NHS Direct on 111.
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.
Fortunately these symptoms are rare and when recognised early lead to
favourable out comes with urgent specific medical intervention.