Sciatica is pain caused by problems with the sciatic nerve, which runs from the lower back, down the back of each leg to the feet.
Sciatica may occur in people in their 30s and 40s as a result of strenuous physical activity like sports or heavy lifting, or older people as a result of ageing and degeneration of the spine. It is estimated that up to 40% of the New Zealand population will experience sciatica at some point in their lives.
- Older age
- Being overweight
- Jobs that involve twisting of the back or carrying heavy loads
- Sitting for long periods.
Signs and symptoms
The primary goal of initial treatment is the relief of pain. Treatment and relief options for sciatica include:
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.
Pain relieving medications such as paracetamol and ipuprofen 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 to reduce nerve stimulation, and cortisone injections near the spine to reduce pain and inflammation.
Physiotherapy and physical therapy
Manipulation 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.
Home care and alternative treatments
Applying cold or hot packs to the painful area may help with pain relief, as might stretching exercises for the lower back. Some people may find relief of symptoms through osteopathy, chiropractic, massage or acupuncture.
While most cases of sciatica resolve within 12 weeks, surgery may need to be considered in severe, prolonged cases where non-surgical treatment has been unsuccessful or where rapid pain relief and mobility improvement is required. Surgery aims to relieve the pressure on the sciatic nerve. This may involve removal of abnormal disc material (discectomy) or bone spurs. All other forms of treatment should be exhausted before surgery is considered.
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 fitness, strength and flexibility in the abdominal and spinal muscles
- Practice safe lifting techniques. When lifting bend the knees, keep the back straight and hold the object close to your body. By doing this, the strain is taken by the hips and legs, rather than 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
- Quit smoking
- Maintain a healthy body weight.
Mayo Clinic (2018). Sciatica (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435. [Accessed: 19/06/19]
O’Toole, M.T. (Ed.) (2017). Sciatica. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.Ropper, A.H., Zafonte, R.D. (2015). Sciatica. N Engl J Med. 2015 Mar 26;372(13):1240-8