Low back related Leg pain – Sciatica
Occasionally patients with low back pain will have low back related leg pain. Some patients will only have leg pain and not experience low back pain. If you have low back related leg pain you may have sciatica.
10 facts about Sciatica
What is sciatica?
Sciatica is a term used to describe nerve pain in the leg that is caused by a problem in the lower back.
The sciatic nerve is a large nerve that starts in the buttock and travels into the leg. This nerve is formed by smaller nerves known as nerve roots that enter and exit the spine in the lower back. Irritation of these nerve roots can cause pain in the buttock, thigh, calf and foot.
What are symptoms of sciatica?
As well as pain travelling down the leg, people with sciatica can experience burning pain, electric shock type sensations and pins and needles.
More unusual symptoms include a sensation of coldness and running water. This is because irritated nerves send more signals. Some people may also experience numbness or muscle weakness in the leg. This is because some signals in the nerve can be blocked.
What causes sciatica?
Anything that irritates a nerve root can cause sciatica. A common cause of irritation is compression associated with disc related changes*. The good news is that nerve roots are resilient, they nearly always have wiggle room and some disc related changes shrink over time allowing nerve roots to recover. In some cases, nerve roots are irritated by inflammation without any compression and this can be just as painful. Importantly, not all disc related changes will compress or irritate nerve roots. Many people of all ages have disc related changes but do not experience any pain.
*Discs are tough circular structures that separate the bones of the lower back. They attach strongly to the bones meaning they cannot ‘slip’.
Pain can also be influenced by general factors such as reduced sleep, stress and emotional wellbeing.
Who gets sciatica and how long does it last?
Sciatica affects people of all ages but is most commonly seen in forty and fifty-year-olds.
Pain is usually worse in the first few weeks and reduces the most over the first few months. At twelve weeks, about half of people with sciatica will have significantly improved. At a year, three quarters of people with sciatica will have recovered. For a group of people though, pain may not improve as expected or recovery may take a long-time. This is because people adapt and cope in different ways.
Discuss how you can assist recovery with your health professional.
How painful is sciatica?
Sciatica symptoms range from mild to severe and can vary from day to day. Symptoms can be intense, unpredictable and very distressing. This can be very scary, but sciatica is rarely dangerous.
Symptoms can be all consuming. It can be tough to focus on other things Whilst being supported to manage pain, try to maintain things that bring value to your life. This might include things like going for a walk on the beach, playing with grandchildren, going for a meal with a friend or staying in work. This may be difficult at times but it can help with coping and emotional wellbeing.
Discuss any worries you have with your health professional.
Do I need a scan to diagnose sciatica?
Scans are not usually required to diagnose sciatica.
Sciatica is a clinical diagnosis based on history, symptoms and physical examination. In many cases scans do not influence treatment plans. For a small group of people with sciatica, scans are appropriate as a part of surgical planning or when considering a specialist nerve injection.
Scans are also appropriate when we suspect a person’s pain is due to a serious medical condition. Thankfully, these conditions are rare and an assessment with your health professional will help determine if you require a scan.
Discuss any concerns you have with your health professional.
Is the pain travelling down my leg sciatica?
Only 8-10% of back related problems are thought to be truly nerve related. Pain from sensitive muscles and joints of the back and hip can also cause leg pain.
Your health professional can carry out a physical examination to find out if you have sciatica.
Although very rare, sciatica can be a symptom of a more serious condition. Please check our webpage on cauda equina syndrome for further information or speak to your health professional.
Sitting and sleeping with sciatica
People with sciatica often find sitting, sleeping or driving postures painful.
Maintaining these postures is not harmful but during times of intense pain it can be helpful to explore different postures or move more regularly.
As pain becomes more tolerable, it can be helpful to relax, move and explore a variety of postures as a part of recovery or rehabilitation programme.
Exercising with sciatica
When pain persists, it is common that nerves become sensitive to movement.
While it can be sensible to rest to begin with or during a flare-up, exercising in a gradual, progressive way is safe and helpful. For many people it helps reduce inflammation and helps to maintain function.
There is no best exercise for people with sciatica so choose activities which you enjoy. The aim is to perform a tolerable level of activity a number of times per week. Examples include a walking programme, swimming, gym or specific rehabilitation programme offered by a health professional.
How is sciatica managed?
There is a range of management options available for people with sciatica.
These include time to recover, exercise, lifestyle advice (e.g smoking cessation, weight management) and pain relief medicines. In a small group of people specialist nerve injection or surgery may be discussed.
Discuss management options with your health professional.
Simple painkillers
Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.
Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions
However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.
Up to date guidelines can be found on the NHS website:
Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.
Nerve pain control: In line with NICE guidance doctors can prescribe drugs to help reduce nerve pain e.g. Amitriptyline
If you are unsure and concerned about your symptoms, please see our ‘when to seek medical advice’ section on the back pain home page
Exercises
Your GP or physiotherapist will be able to recommend activities that will help you keep moving and stop your muscles getting out of shape
It’s normal to feel some discomfort during recovery – but this is not harmful.
Try these simple exercises to keep the back moving. Do these little and often through the day
Back stretch
Lie on you back, either on a mat or your bed. Bend your knees, keep the back relaxed. Roll your knees from side to side.
Hold the stretch for 10 seconds and repeat 3 times on each side.
Pelvic tilt
Lie down with your knee bent. Tighten your stomach muscles, flattening your back against the floor (or bed)
Hold for 5 seconds and repeat 5 times.
Deep lunge
Kneel on one knee, the other foot in front. Facing forwards, lift the back knee up off the floor.
Hold for 5 seconds and repeat 3 times
Thigh stretch – One leg stand (front)
Holding onto support if needed, bend one leg up behind you. Feel a stretch in the front of the thigh.
Hold for 5 seconds and repeat 3 times on each side.
Knee to chest
Lie on your back, knees bent. Bring one knee up and pull it gently to your chest for 5 seconds.
Repeat up to 5 times.
If these exercise are too painful. You could use diaphragmatic (abdominal) breathing in this positions or in sitting to help relax and reduce your pain.
For a description and video on abdominal breathing follow this link
Understanding the complexity of pain and other influencing factors
What we have learnt through research is that pain, especially persistent pain is more complex than just what is going on locally to where you feel the pain. It can be affected by many things including poor sleep, poor general health, reduced fitness, stress, past experience of pain and our beliefs about pain and our physical structure. The links below provide some insight into understanding pain, understanding your own beliefs around your pain and then looking at positive changes you can make that can in turn have a positive effect on your pain and levels of function.
Understanding pain in less than 5 minutes
Facts about back pain and exercise
10 things you need to know about your back
Abdominal breathing, relaxation and sleep
Stress and tension are common with persistent pain. For some it may be part of the underlying cause for many it’s a consequence as pain itself causes more stress and anxiety. What we know is that if we can use tools to help reduce our muscle tension and stress this can help with pain, sleep and function. Below are links you may find useful
Online video describing abdominal breathing
Breathe2relax. This is an APP specifically for abdominal/diaphragmatic breathing – go onto your smart phones APP store for more details
Understanding persistent pain – this booklet is commonly used by the Pain Management Service.
Physiotherapy
If you find that you are not improving after following the above self management information, some advice from a physiotherapist can be helpful in managing sciatica pain.
** 10 facts about sciatica – has been adapted for this website from the booklet ‘10 Sciatica Facts’ with the permission of the author Adam Dobson and South Tees Hospital NHS