Sciatica

Cause

Sciatica is caused by pressure on the nerve. It can be obtained by pregnancy and childbirth and by heavy lifting. In rare cases, sciatica can be caused by a hernia or a tumor. Stress can also play a role, because it makes the body change posture, causing a too heavy load on the back.

Symptoms

The following signs and symptoms are most characteristic for sciatica:

• Shooting, aching to violently stabbing, radiating pain in the course of the nerve in one leg or buttock. The pain may also have a burning nature. The aches can make it difficult to stand upright.
• Apart from the pain, there may be muscle weakness, numbness or tingling in the leg, foot or toes.
• Possible muscle cramps in the buttock or leg.
• Possible decreased reflexes in knees and ankles.

Even though there is severe pain, sciatica is almost never permanent. The pain will pass on its own. Pain in the lower back is often incorrectly called sciatica.

Diagnosis

The doctor will determine whether there is sciatica, based on the symptoms and physical examination. In some cases, the diagnosis is not easy to make and an MRI or CT scan provides the necessary additional information.

Treatment

In case of sciatica, it's wise to go to the doctor. It is thought that sciatica is a warning for an impending hernia, although not all doctors would agree. The pain may also be associated with a narrowing of the spinal canal (the Verbiest syndrome). The general practitioner will often recommend both dosed rest and exercises for the back muscles. He will also prescribe painkillers and refer the patient to a physical therapist. It’s wise to do no heavy lifting for a while. If the pain disappears and then numbness in the leg arises or if the patient is incontinent of urine, this should in any case be reported to the general practitioner. When, in rare cases, a hernia is the cause of the sciatica and there is no treatment that helps, hernia surgery may be needed.

Prognosis

Most back problems will pass on their own. With pain relief (only in the acute stage), rest and a responsible way of moving, a person can control back pain. However, the symptoms also recur regularly.

Considerations

• Don’t lift too heavily. If this really needs to be done, try to keep the back as straight as possible and go down through the hip and knee joints. Keep the object close to the body and turn from the feet and not from the back. The best option is to train these skills with a remedial therapist.
• When having to stand for a long time, sit in between for a while if possible. Otherwise, stand and move to and fro.
• Sit well supported, but not for too long. Try to stand up, if possible, and to move (after about half an hour). Sitting may soon irritate the sciatic nerve.
• Take enough rest and relaxation when feeling tired at the back.
• Keeping muscles active ensures a good muscle condition.
• Ensure a proper body weight.
• Painkillers, such as paracetamol, relieve the pain.
• Rather don’t sleep on the belly, but on the back or side.
• A hot bath, hot bottle or infrared lamp on the lower back can help to relieve the pain.
• It’s important to keep moving.

Facts

• The term ‘sciatica’ is derived from the Greek word ischion (hip) and means ‘lumbar pain, gout’.
• The prevalence of sciatica is 4.5%.
• Men and women are about equally likely to have sciatica.
• The condition is rare in people younger than 20 years. The peak is around the age of 50 years, then it diminishes.