Do I really have sciatica?

Sciatica is a common problem .

The estimation is that about one in 10 of us has chronic pain affecting a daily activity in one way or another Medical intervention can help but only once you know the exact cause of the pain

It could be a tumour about to cause spinal cord compression and paralysis, or an annoying ligament irritating the sciatic nerve and causing almost incapacitating pain.

Lower-back pain and sciatica are relatively common but tumours are rare. It is important to undergo careful assessment and strategic X-rays, CT and MRI to allow for appropriate management

The sciatic nerve is the largest and thickest in the body It is the main continuation of all the nerve roots of the lower back

The nerves come out from the spinal cord in the lumbar portion of the spine. There, they join to form the large nerve and run down through the buttocks and the back of the thigh to just above the back of the knee. And there, it splits into two nerves to serve the lower leg and foot

Anything that hurts the nerve or causes pain coming from the nerve region can loosely be called sciatica The name describes the location but not the cause of the pain

The usual causes of sciatic pain are either a disc rupturing in the lumbar spine, squeezing the nerve against the bone, or arthritis where the bones meet and cause swelling and then pressure on the nerve.

It might feel like the pain is shooting down the leg or coming from a toe

This referred pain can make you feel like there is something wrong in your leg when, in fact, it is the spinal cord, or nerve root causing the problem

And the severity of the pain does not always correspond with the seriousness of the problem Conversely, mild pain might sometimes hide a problem which is serious

Back pain, with radiation down the leg, is the most common presentation of sciatica. Stretching the sore nerve makes it typically more painful because of the compression.

Straight leg-raising is a test used to see if this is happening This is when the leg is kept straight and the heel lifted off the bed to 90 degrees, causing the sciatica sufferer to flinch as the sore nerve is stretched

Pressure on the nerve can also present as loss of sensation or numbness in the buttock or leg Nerve root compression might make the big toe numb . The muscles can be weakened by the nerve pressure and might present as foot drop or limping and quadricep weakness

Conservative management (not surgery) with pain relief and physiotherapy, massage and exercise do not always stop the pain but usually help

If they fail to help, there is the option of an anti-inflammatory injection directly into the point where the nerve root exits. This procedure, now considered safe, comes with the benefit of reducing the swelling around the painful nerve and can be a permanent cure

Surgery is usually reserved for circumstances in which:

• It is clearly evident that either the bone, disc or arthritis is pressing on the nerve.

• There is no chance of fixing the problem without surgically removing the offending material

Orthopaedic surgeons or neurosurgeons carry out the surgery as a last resort They do not take the decision to operate lightly as post-op scar tissue becomes a risk of pressing on the nerve again

Regular exercise and muscle strengthening remain the best ways to look after lower back pain Pilates, yoga, and meditation have their place in limiting the muscle spasm that sore nerves trigger. And help in managing an exercise programme is often necessary

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