Sciatica - symptoms, pain relief, treatment

Muscle spasms can also cause sciatica by compressing the sciatic nerve as it travels through the muscles. One such condition is piriformis syndrome, where the piriformis muscle irritates the sciatic nerve.  Other less common causes of sciatica include:

• Infection
• Tumours

In older age groups, sciatica commonly occurs as the result of conditions caused by spinal degeneration, such as spinal stenosis. This is where the pathways through which the sciatic nerve travels are narrowed. Again, this causes compression and/or irritation of the sciatic nerve.    

Factors that increase the likelihood of developing sciatica include:

• Age
• Pregnancy
• Being overweight
• Smoking
• Jobs that involve twisting of the back or carrying heavy loads
• Sitting for long periods.

Essentially, any injury or process which causes compression of the sciatic nerve can cause sciatic pain.  In many cases however, no specific cause for the sciatic pain can be identified.

Signs and symptoms

Pain relief and treatment 

The primary goal of initial treatment is the relief of pain. Treatment and relief options for sciatica include:

Moderate activity
Bed rest had traditionally been recommended in the treatment of sciatica but this is no longer the case. Research has indicated that bed rest does not tend to speed recovery, and may in fact hinder it. It is now recommended that heavy physical activity should be avoided, but moderate activity should be maintained. It is thought that maintaining activity assists with overall recovery by helping to reduce inflammation.

Medications
Pain relieving medications such as paracetamol and non-steroidal anti-inflammatory medications (NSAIDs) are commonly used to treat sciatic pain. In cases where muscle spasms are thought to be the cause, muscle relaxant medications may be recommended. When pain is severe the use of opioids (eg: pethidine, morphine) may be necessary. Other medications that may be used are low-dose anti-depressants (these reduce nerve stimulation) and epidural cortisone injections.

Physiotherapy and physical therapy
Manipulation, the use of heat and/or cold and specific exercises may be helpful in the treatment of the condition.  Once the pain has improved, a physical therapist may design a rehabilitation programme to prevent future injury.

Alternative Treatments
Some people may find relief of symptoms through osteopathy, chiropractic, massage or acupuncture.

Surgery 
While most cases of sciatica resolve within four to eight weeks, surgery may need to be considered in severe, prolonged cases where non-surgical treatment has been unsuccessful. Surgery aims to relieve the pressure on the sciatic nerve. This may involve removal of part of one of the intervertebral discs (discectomy) or removing the cause of pressure on the nerve (decompression). Only about five percent of people with sciatica need surgery.  All other forms of treatment should be exhausted before surgery is considered.

Prevention

While back pain due to sciatica, and other causes, is common, there are a number of measures that can help to prevent it occurring or recurring: 

• Maintain correct posture when standing, walking and sitting.
• Undertake exercise that maintains aerobic fitness and strength and flexibility in the abdominal and spinal muscles.
• Practice safe lifting techniques.  When lifting bend the knees and keep the back straight.  By doing this, the strain is taken by the hips and legs, not the back.  Hold the object close to the body.  The further away from the body the object is, the more stress is put onto the lower back.
• Ensure that your back is well supported when seated.  Use chairs that provide good back support and are designed to provide a good seating posture.  A lumber roll or contoured cushion can help to provide lower back support.
• Don’t smoke.
• Maintain a healthy body weight.

References