Sciatica Leaflet

Sciatica This leaflet provides information, answers and self-help strategies regarding Sciatica.

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What is Sciatica?

If you’re feeling pain in your lower back or hip that radiates to the back of your thigh and into your lower leg, you may have sciatica. This is an umbrella term for any condition that is causing irritation of the sciatica nerve. Despite what you’re told and read, nerves are very rarely ‘trapped’. Pain will usually be worse in the leg than in the back and you may also have some tingling, pins and needles or numbness in the leg or foot.

What are the symptoms?

This picture illustrates the common areas that sciatica may refer pain into the leg.

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Sciatica

What factors are involved?

Many physical or psychological factors can cause sciatica and often a combination of these are involved.

They could be: Physical factors, such as ‘protecting’ the back and avoiding movements, or a simple strain.

Psychological factors, including a fear of damage or not getting better, feeling down or being stressed.

More general health and lifestyle factors, like being tired and rundown, not getting enough good quality sleep, being overweight or not getting enough physical activity Social triggers, such as difficult relationships at work or home, low job satisfaction or stressful life events, like a family death or illness.

Each of the factors can turn up the volume on your pain and gaining a greater understanding of when that can happen puts you in a stronger position to recognise them and learn how to turn down the dial again.

Nerves are connected to the brain, so if the brain is stressed or overworked, the nerve might not get a chance to calm down either.

Why might the symptoms persist?

Sciatica only happens in less than 5% of back pain cases and usually gets better within 8 to 12 weeks but can last longer. The reasons for the pain lasting longer could be related to your thoughts and feelings about the problem and how you are approaching it. For further information relating to this, please visit our website - www.providephysio.org.uk

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Can medication help?

Painkillers or anti-inflammatories may be necessary for a short period if your pain is severe, although this will not speed up your recovery. If these are proving ineffective for your pain, other medications such as antineuropathic pain relief e.g. Amitriptyline, Gabapentin and Pregabalin may be considered as an alternative.

These should only be used in conjunction with other measures, such as exercise, and even then just as a short to medium term as they can cause side effects.

Exercise is considered the better option and is safer and cheaper.

Movement is the best medicine for sciatica.

What can I do to help get better?

Evidence has shown that people who understand their MSK health problem and take an active involvement to help themselves have a much better outcome. Here are some really helpful tips to get you back to normal.

Regular exercise is the most effective strategy for tackling sciatica.

Staying as active as possible and returning to normal daily activities is important in aiding recovery. Like any other part of the body, nerves also like movement, a good stretch helps to improve their general health.

Avoiding aggravating activities for 1-2 days may help to relieve pain in the first instance but prolonged rest and avoidance of activity can lead to higher levels of pain, poorer recovery and longer absence from work.

Start slowly and build up both the amount and intensity of what you do and don’t worry if it’s sore to begin with – you won’t be damaging your back or the nerve itself.

No one type of exercise is proven to be more effective than others so just pick an exercise you enjoy, that you are able to maintain in the long-term and that fits in with your daily schedule.

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Sciatica

What are the signs and symptoms to look out for?

Remember that most causes of back pain are not due to anything serious, although there are rare cases where you would need to seek urgent medical help. Contact your GP or NHS 111 for immediate advice if you have any of the following symptoms that have started around the same time as your back pain: Numbness or tingling around your genitals or inner thighs Difficulty passing urine Loss of bladder or bowel control Unexplained weight loss Fever or chills Significant trauma e.g. car accident, fall Previous history of cancer

Do I need a scan?

In acute sciatica the diagnosis is based on history taking, physical examination and the treatment is conservative. A scan is not usually needed in these early stages unless your GP or clinician suspects any untoward causes of your sciatica (as mentioned above).

However, if your symptoms fail to improve within an 8-12 week period with conservative management then an MRI scan may be warranted. In this case it is important to remember that disc herniations are highly common in people without any symptoms who do not have sciatica.

Also in many people with clinical symptoms of sciatica, no lumbar disc herniations are present on scans.

Therefore, it is important as part of the decision to consider further invasive options, that the clinical findings and symptoms correspond well with the scan findings. This may then help to identify a specific structural cause in some cases where usual conservative management hasn’t been successful.

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WHAT EXERCISES SHOULD I DO? Exercise is shown to be very helpful for sciatica and is also the most effective approach to prevent future episodes.

Here are some examples that may be helpful for you:

Knee to chest stretch ring one knee and hug it towards your B chest, as far as you can comfortably.

Hold for 20-30 seconds and then slowly lower. Repeat 2 to 3 times, alternating legs. 2-3 times during the day.

Back rotation in lying ying on your back with your knees L bent up and feet flat on the bed or floor.

Keeping your knees together, roll them from one side to the other. Aim to keep both shoulders on the floor. Hold the stretch for 1-2 seconds and the roll your knees to the other side. Repeat 1012 times. 2-3 times during the day.

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Sciatica

Sciatic nerve gliding Sitting on the edge of a bed or chair in a slumped position. With your hands relaxed by your side. Practice straightening out your affected leg whilst bringing your head and body into an upright position. Make sure your head and leg are moving together. Repeat 1020 times. 2-3 times during the day.

Back Extension Lying face down with your hands shoulder width apart. Keeping your bottom and back relaxed, push through your hands to gently arch your lower back. Breathe and hold for 5-10 seconds. Return to the starting position. Repeat 5-10 times. 2-3 times during the day.

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ADDITIONAL INFORMATION ON EXERCISE It is important to know that when you are performing these exercises you may feel some discomfort which is normal. The pain or discomfort you might be noticing is not causing any damage.

However, if you feel that the pain or discomfort you are experiencing is unmanageable and it feels as though your symptoms may be continually worsening it may be advisable to discuss this further with a physiotherapist who may be able to suggest some suitable replacements.

To find out more information, videos and exercises for your sciatica, please visit the ‘Back Pain’ section of the website below.

www.providephysio.org.uk

If you need this leaflet in braille, audio, large print or another language, please contact our Customer Service Team on: 0300 303 9951 / 0300 303 9952 or by email at: provide.customerservices@nhs.net

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Provide Corporate Offices 900 the Crescent Colchester Business Park Colchester Essex C04 9YQ

T: 0300 303 9999 E: provide.enquiries@nhs.net www.provide.org.uk

PFS-3514-2009-01 ME-LE-015