Sciatica is the pain, tingling, or numbness produced by an irritation of the nerve roots that lead to the sciatic nerve. The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. It goes down through the buttock, then its branches extend down the back of the leg to the ankle. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and can radiate down below the knee. The sciatic nerve is the largest nerve in the body. The pain of sciatica is sometimes also referred to as sciatic nerve pain.
Well! If you have Sciatica, your:
Bottom Back of your legs Feet and toes
May feel: Painful - the pain may be stabbing, burning or shooting Tingling - like pins and needles Numb Weak
What causes sciatica?
The most common cause of sciatica is a bulging or ruptured disc (herniated disc) in the spine pressing against the nerve roots that lead to the sciatic nerve.
In rare cases, sciatica can also be caused by conditions that do not involve the spine, such as tumors or pregnancy.
Sciatica also can be a symptom of other conditions that affect the spine, such as narrowing of the spinal canal (spinal stenosis), bone spurs (small, bony growths that form along joints) caused by arthritis, or nerve root compression (pinched nerve) caused by injury.
Irritation of the nerve from adjacent bone, muscle, internal bleeding, infections in or around the lumbar spine, injury, and other causes.
What are the symptoms?
Symptoms of sciatica include pain that begins in your back or buttock and moves down your leg and may move into your foot. Weakness, tingling, or numbness in the leg may also occur.
Sitting, standing for a long time, and movements that may cause the spine to flex for a longer period of time(such as knee-to-chest exercises) may make symptoms worse.
Walking, lying down, and movements that extend the spine (such as press-ups) may relieve symptoms.
How is sciatica diagnosed?
Sciatica is diagnosed with a medical history and physical exam. Sometimes X-rays and other tests such as magnetic resonance imaging (MRI) are done to help find the cause of sciatica.
How is it treated?
In many cases, sciatica will improve and go away with time. Initial treatment usually focuses on medicines and Physiotherapy or Physical therapy to relieve pain. You can help relieve pain by
Incorporating a combination of strengthening, stretching exercises and aerobic conditioning are a central component of almost any sciatica treatment plan.
When patients engage in a regular program of gentle exercises, they can recover more quickly from sciatica pain and are less likely to have future episodes of pain.
It is very important that the patient is physically an active participant in therapy and can take responsibility in the treatment process.
One needs to get EXCLUSIVE exercise sessions from a physiotherapist.
Sciatica can have an adverse effect on everyday life, causing pain that can radiate from the lower back through the hips and buttocks and down the legs
The largest nerve in the human body is the sciatic nerve, which originates in the lower back and travels through the back of each leg. Injury or pressure on this nerve can lead to a type of pain known as sciatica.
Sciatica can have an adverse effect on everyday life, causing pain that can radiate from the lower back through the hips and buttocks and down the legs. People experiencing pain in these areas should consult a physician immediately, as the American Academy of Orthopaedic Surgeons notes that between 80 and 90 percent of people diagnosed with sciatica get better over time without surgery. Many typically feel better within several weeks of beginning treatment.
The first step toward diagnosing sciatica begins at home. People who learn to recognize potential symptoms of sciatica may be more likely to seek immediate treatment than those who might mistake their pain for something else.
What are the symptoms of sciatica?
The AAOS notes that sciatica may feel like a bad leg cramp that lasts for weeks before it goes away. According to Spine-health.com, a property of the health publisher Veritas Health, sciatica pain is often described as burning, tingling or searing as opposed to a dull ache. In addition, pain resulting from sciatica may be worse when sitting, even though sharp pain associated with sciatica can make it difficult to stand up or walk. Numbness characterized by a “pins and needles” feeling, weakness or a burning or tingling sensation down the leg are some additional symptoms of sciatica.
Does sciatica affect both legs?
WebMD notes that sciatica usually affects only one leg, though the buttock or leg on the affected side may feel like it is in constant pain.
What causes sciatica?
Spine-health.com notes that the following five lower back problems are among the most common causes of sciatica:
Lumber herniated disc: This occurs when the soft inner material of the disc herniates, or leaks out, through the fibrous outer core, irritating or pinching the nerve root.
Degenerative disc disease: Discs in the back can degenerate naturally with age and never contribute to a problem like sciatica. However, degeneration in one or more discs in the lower back can sometimes irritate a nerve root and lead to sciatica.
Isthmic spondylolisthesis: This occurs when a small stress fracture allows one vertebral body to slip forward on another. The combination of collapsing disc space, a fracture and the slipping forward of the vertebral body can pinch the nerve and cause sciatica.
Lumbar spinal stenosis: In this condition, which is relatively common among people older than 60, a narrowing of the spinal canal can contribute to sciatica.
Piriformis syndrome: A muscle found deep within the buttocks, the piriformis connects the lower spine to the upper thighbone, running directly over the sciatic nerve. Spasms in the piriformis can put pressure on the sciatic nerve, triggering sciatica.
Treating sciatica
Sciatica often can be treated successfully without surgery. Doctors may recommend applying heat and/or ice packs for acute sciatic pain. In addition, over-the-counter and prescription pain medications can effectively reduce or relieve sciatic pain. Doctors also may explore other treatments, including chiropractic manipulation, acupuncture, massage therapy and surgery.
There are various treatment options available to ease sciatica pain. These include over-the-counter (OTC) medications, creams, exercises, massage, and surgery
Sciatica, or sciatic nerve pain, is a nonspecific term that describes a variety of leg or back symptoms. It may refer to a sharp or burning pain that radiates down the legs from the buttocks.
Sciatica is not a diagnosis in itself but the result of an underlying condition.
This article will examine the evidence for some of the common treatments for sciatica.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, could help ease the pain of sciatica. These are available over the counter from drugstores.
However, it is worth noting that there is limited evidence to suggest that these medications work for sciatica. As with all drugs, they have some possible side effects. For example, drowsiness is a common side effect of some muscle relaxants.
If the pain does not get better, doctors might suggest injecting steroids into the spine. Steroid injections can help with the pain by reducing swelling. However, this only works for a short time, and some people find that it can make the pain worse.
Creams
Some, though not many, people find that creams can help ease sciatica pain. However, it is important to note that these creams are not curative and will only temporarily mask the pain.
In 2017, scientists carried out a review of creams to help relieve nerve pain such as sciatica. They found that there was not enough evidence to be sure that they worked.
Staying active is also very important and can help ease the inflammation that can cause sciatica pain.
People can try gentle exercises, such as walking and swimming, as much as the pain allows.
Typically, physiotherapists also recommend that people with sciatica try to do exercises that increase core strength, improve the mobility of the hips and spine, and maintain or improve flexibility in the lower body.
However, in rare cases, a physiotherapist may actually remove stretching from a person’s sciatica treatment program if they are hypermobile. This means that the person can move their joints beyond the typical range of movement.
It is also very important never to exercise or stretch to the point that it makes the sciatica pain worse.
Exercises that can help ease sciatica pain include:
Plank
To perform a plank:
Lie face down on the floor.
Keeping the whole trunk and legs in a straight line, lift up onto the forearms and toes, making sure to keep the elbows directly underneath the shoulders.
Hold for as long as possible.
Knee-to-chest stretch
To perform a knee-to-chest stretch:
Lie on the back with a small cushion under the head, the knees bent, and the feet flat on the floor, hip width apart.
Bend one knee up toward the chest and hold it with both hands.
Hold for 20–30 seconds.
Swap sides.
Repeat twice on each side.
Sciatic nerve mobilization
To perform a sciatic nerve mobilization:
Lie on the back with a small cushion under the head, the knees bent, and the feet flat on the floor, hip width apart.
Bend one knee toward the chest and hold the back of the knee with both hands.
Slowly straighten the leg up. Stop at the point of sciatic nerve pain. Going beyond this point could worsen the pain.
In most cases, sciatica will go away on its own within several weeks. If pain is still present after about 12 weeks and conservative treatments have not helped, doctors might recommend surgery, depending on the cause of a person’s sciatica symptoms.
One surgical example is a microdiscectomy. During a microdiscectomy, a surgeon removes the damaged parts of the spinal disk that are pressing on the nerve. This procedure takes place under general anaesthetic and requires a short stay in the hospital.
Surgical treatments can potentially lead to further pain, but this is uncommon.
Sciatica is a nonspecific term that describes pain in the sciatic nerve. The sciatic nerve runs along the back or side of the leg, usually to the foot or ankle.
If something pinches the sciatic nerve anywhere along its path, it can cause sciatica.
The most common cause of sciatica is a disk herniation with nerve root compression. Some other causes of sciatica include:
piriformis syndrome
lumbar stenosis
lumbar spondylolisthesis
hamstring syndrome
In most cases, the pain will affect just one side of the body. Some people with sciatica also experience the following symptoms:
weakness
a tingling feeling, known as pins and needles
a burning sensation in the leg
People between the ages of 30 and 50 years are most likely to develop sciatica. Age-related wear and tear and injury are the most common causes of a slipped disk that can lead to sciatica.
Sciatica will usually get better on its own within 4-6 weeks. In the meantime, people can use OTC medications, such as NSAIDs, and home remedies, such as ice packs, to control the pain.
A person should contact a doctor if these measures do not work or if the pain lasts for longer than several weeks.
Sciatica pain refers to the pain a person can feel in the sciatic nerve, which runs along the leg, if something presses on it.
In most cases, the pain will get better by itself in about 4-6 weeks. In the meantime, people should try to stay active and avoid sitting or lying down for too long.
Using OTC pain medications, ice packs, heat pads, and nerve mobilizations can help people deal with the pain while they are recovering.
Sometimes, doctors might recommend taking stronger pain medications or trying steroid injections. In rare cases, an operation might be necessary.
As a non-invasive treatment option, virtually anyone can benefit from chiropractic care, including babies, children, pregnant women, office workers, factory workers, professional musicians, athletes, accident victims and the elderly.
Dr Elga Drews said any condition that is nerve, muscle or joint-related may be helped by chiropractic treatment and with few practitioners available, she said it is an option to tap into that.
“Neck pain, headaches, migraines, shoulder pain, arm pain, elbow pain, tingling in arms and hands, back pain, hip pain, leg pain, sciatica, knee pain and even foot pain have been reported to be helped by chiropractic,” she detailed.
Drews, who is also the president of the Namibian Chiropractic Association, said today, chiropractic is an evidence-based, people-centred, inter-professional and collaborative health care profession.
For a few years, the Namibian Chiropractic Association has been organising outreach programmes in the Kavango, assisted by chiropractors from overseas.
“We are hoping to continue these efforts as soon as international travel allows. The Association also contributes to the global drive of World Spine Day, where we have run many varied projects to create awareness about spinal health,” said Drews.
One of these projects is the Straighten-Up exercise programme, which we have presented in schools, sports clubs, old age homes and other public platforms.
“A chiropractor’s main concern is the spine and the nervous system, as well as all other joints of the body and how these are functioning,” shared Drews.
Chiropractic is derived from the two Greek words “cheir”- meaning hand and “praktikas”- meaning work or practice. Therefore, chiropractic implies “done by hand”! Bone manipulation has been practised for thousands of years.
“A chiropractor is a primary contact physician who will take a full medical case history, perform a physical examination and refer for special investigations if indicated. Once the chiropractor has made a diagnosis and determines that the case can be treated chiropractically, the treatment primarily consists of highly specialised manipulative techniques, referred to as adjustments,” she commented.
Drews added: “Adjustments are safe and some patients can experience immediate relief as the normal joint motion and function is restored. A chiropractor will employ different soft tissue/massage therapies, prescribe rehabilitative exercises, give postural advice, suggest orthotic devices and educate regarding necessary lifestyle changes.”
Through chiropractic care, patients are shown to take fewer days of sick leave, spend less time incapacitated, use less medication for pain relief, have less chance of needing back surgery and have less chance of the problem becoming a chronic condition.
She stated that there are varied reasons and causes for neuro-musculoskeletal conditions and pain syndromes, which includes daily poor postural habits, a fall, an accident, lifting heavy objects, any sports injuries or even high-stress levels can result in pain from joint irritation, inflammation, nerve irritation, and muscle spasms.
Drews said when it comes to career choices, there are many options to deepen one’s studies in different areas, like sports chiropractic, paediatric care, neurology, radiology, chiropractic education and research.
“There are many chiropractic educational institutions around the world, most of which are accredited by specific education accreditation boards. South Africa has two chiropractic schools, one at the Durban University of Technology and another at the University of Johannesburg. Both courses offer a master’s degree in chiropractic, which is internationally accredited,” shared Drews.
Low-back pain? Not anymore! Mike Bosh, a certified postural alignment specialist known as “postureguy” on TikTok, has a simple, effective tip for lower-back pain. He tells Well+Good that pain in the lower back, and even sciatica, is very common thanks to numerous causes that could contribute to said conditions. According to Bosh, these include:
Sedentary behaviour for long periods of time (hello, desk job!)
Dysfunctional movement patterns (you may not even be aware of these!)
Tight psoas muscles (one of the hip flexor muscles)
Poor posture (extremely common!)
Alignment issues (again, you might not even be aware you have this)
Because so many people have poor posture, are sedentary, and have tight hips and alignment issues, chances are you have experienced back pain, if not outright sciatica. ICYDK, sciatica is pain from a compressed sciatic nerve, “commonly caused by asymmetry in the hips and pelvis,” says Bosh. If you’re experiencing this, or any other type of chronic pain—especially related to the back—he advises you seek out a healthcare provider immediately.
As for general pain, this likely comes from the aforementioned psoas muscle. “The psoas muscle starts at the medial part of your femur, then runs through the abdominal wall, and connects to the T-12 vertebrae,” explains Bosh. “The psoas muscle is the only muscle that connects the upper half of the body to the lower half." If you're sedentary for extended periods of time, your psoas muscle will shorten and tighten because it's in a flexed position, and "its entire muscular function becomes compromised,” according to Bosh. Enter: back pain.
So what can you do at home to get some relief? Bosh presents: the wall sit with a pillow squeeze!
“The wall sit, together with the pillow squeeze, activates the inner thigh muscles and eliminates hip rotation,” he explains, “while restoring pelvis symmetry, ultimately aligning the body and putting it in an optimum neutral position for relief of lower-back pain.” In essence, this simple exercise gets you back in alignment for “immediate” relief, he says.
How to do the wall sit with a pillow squeeze
1. Grab a pillow and line your back up against a wall. Slide down until you're in a "sitting" position, with your hips slightly above your knees. Your knees should be at about an 80-degree angle.
2. Keeping your back against the wall with your stomach relaxed and your feet flat on the ground, begin to squeeze the pillow between your knees.
3. Hold for two minutes. If it's too challenging to hold this position for two minutes without resting, you can perform it in intervals.
“You can do this every single day—twice a day, for extra credit!” says Bosh. But a word of caution: “Use pain as your guide. If you do not experience relief, only pain, then stop immediately.” Hint: This is when you go to see a doctor or posture specialist.
Bosh also says that consistency is key to ensure you’re in the right alignment while you do this exercise. “Your body may not hold the correct position, and instead will most likely retreat to its previous misalignment,” he says. “That’s why it’s important to continue to do this exercise consistently, feeding your body the correct stimulus to stabilize and secure positive change.”
Add the wall sit with a pillow squeeze to your morning routine or do it throughout your day when you need a movement break. And don't forget to keep at it to eliminate pain. “Postural therapy is foundational training,” Bosh says. “It’s the starting point, and will partner with any other treatment methods you decide to do.”
When it hurts to walk, bend or even sit, it’s tempting to lie down until your spine sorts itself out. But moving can be the key to getting better
Turns out pandemics can be atrocious for our backs. By last October, more than a third of people in the UK had reported increased back pain, according to one study – and that was before an intense winter lockdown, followed by a month-long storm. We’ve been doing online yoga without an instructor’s watchful eye and lunging with Joe Wicks without warming up, but mostly slouching over laptops feeling tense or depressed.
Steven Gregor/The Guardian
While the onset of back, shoulder or neck pain can feel like the last straw, the good news is that it probably isn’t as bad as you think. “It’s not likely to be serious,” says Chris Mercer, an NHS consultant physiotherapist in Sussex who specialises in back pain. It was not uncommon to keep an old door under the bed, upon which to lie when your back “went”. But the latest evidence indicates that being active is essential for both avoidance and recovery. “Keep moving, keep active and things will settle,” he says.
Embracing activity when you’re hurting can be scary, but Jack Noonan, an 80-year-old retired English professor who lives in Philadelphia, has learned the benefits first-hand. He did, in fact, have something serious – sciatica, intense pain, usually in the back of one leg, caused by the compression or irritation of the sciatic nerve – but is now as fit as a fiddle and believes the exercise regime he developed for himself not only cured his back pain, but helped him avoid surgery.
‘I worked really, really hard, and it worked’ ... Jack Noonan, exercising at home. Photograph: Provided by Jack Noonan
When he first developed sciatica he says he was “hit over the head with the pain”, adding that it was so bad at one point that he couldn’t even go for a walk. An orthopaedic surgeon told Noonan that he had a hardened perineural cyst in his spine, and the only lasting solution was surgery. But to Noonan, it felt “intuitive that if you can, by stretching, raise those collapsed vertebrae a little better, that might solve the problem. So I worked really, really hard. And it worked.”
A physiotherapist taught him how to do pelvic tilts – lying flat on your back and lifting the pelvis up off the floor. “It felt really good to learn how to move my pelvis,” he says, “and I became kind of driven about that.” He devised a series of 15 exercises – some from physiotherapists, some from yoga, some he has tweaked himself. He does them when he gets up, and again later in the day, each repeated 15 times, breathing through each one. “I’ve learned from experience that it’s easier to fake your way through 10,” he says. “But you want to be thoughtful and deliberate about every one of them.”
Noonan’s regime will not suit everyone but, crucially, he found what worked for him. Mercer’s good news continues, however, because it doesn’t matter what type of exercise you do, as long as you like it and you are sensible. “There is loads of evidence that exercise is good for back pain,” he says. “But none of the research points to one form of exercise being better than another. So the advice is to do something you enjoy because you’ll keep doing it. For me, that would be surfing or a bike ride, but for somebody else that could be doing Zumba, yoga or pilates. The evidence just says you’re better to move and do stuff than not. It’s a lot simpler than people think.”
Caroline Atkinson is living proof of such a philosophy. She is 55, 6ft 1in and has always been an athletic, mountain-climbing, sports-playing, distance-swimming kind of woman. In 1999, she had back surgery for disc degeneration, and is an advocate for exercising to manage ongoing back and shoulder problems, as well as an active member of the National Back Pain Association community.
“Within six months of the operation,” she says, “I was back in a pool. I’ve continued to have a gym membership. I started doing long-distance bike rides and hikes of 25 to 50 miles in one day.” She wanted to get back into tennis, too, but realised, “You don’t play tennis to get fit. You get fit so you can play the sport you love.” To do that, she started pilates, and continues a “regimental” daily routine. “Whether I’m in a hotel room or a tent or working in an office, I get my mat out and do pilates every morning to remobilise myself. If I didn’t do my stretching in the morning and I didn’t get up throughout the day, I would really suffer.”
While an entire industry has sprung up around the notion of special exercises for individual conditions, says Mercer, “the evidence doesn’t stack up behind them”. There has, for example, been great emphasis on improving core strength to support good posture, but even this can be a red herring. “Sometimes it causes people to focus on tightening their abdominals, so everything’s really tight instead of moving normally. You can end up teaching people unhelpful ways of moving,” he says.
‘It doesn’t matter what type of exercise you do, as long as you like it and you are sensible.’ Photograph: Posed by model/Silke Woweries/Getty
To put it in perspective, he suggests you think of back pain like a sprained ankle. “The tissues in your back that can cause irritation with the discs and nerves and joints are like tissues in the rest of the body and they react in the same way,” he says. “A sprained ankle might be a bit sore to walk on but you can hobble around a little, while it gets better slowly.” So the message is, essentially, don’t freak out? “That should be the headline of your article. Perfect advice,” he says.
If it hurts too much to carry out your usual tasks and activities, the NHS recommends taking over-the-counter painkillers and remaining “active within the limits of your pain”, says Mercer. If pottering around and changing sitting position regularly is all that is possible for a while, then at least do that. “What can happen if people have had a severe episode of pain is that they stop walking, gardening, going for a bike ride and doing all the things that they like to do. They become less and less active, and more and more disabled by their worries.”
If, after a few weeks, there’s no improvement, he suggests talking to your GP about some stronger anti-inflammatory tablets. Then, if it still hasn’t settled down after a few more weeks of being as active as possible, this is when, he says, “seeing a healthcare professional is probably helpful. They can see how you are doing the exercise and might be able to advise you on how to pace it, and how to adapt so that you can still do it without causing pain.”
Victoria Tzortziou Brown, the joint honorary secretary of the Royal College of General Practitioners, agrees that exercise, “perhaps counterintuitively”, is the best treatment, such as “walking, swimming or safe stretching exercises. Back pain episodes can be disabling and worrying but they are common and usually people recover reasonably quickly. If, however, the pain persists or is severe, patients are advised to discuss their symptoms with their GP.” More serious conditions, such as a slipped disc or sciatica, usually cause extra symptoms such as numbness, weakness or a tingling sensation, and would need to be investigated by your doctor. “If you are developing clear weakness in your legs you should also seek advice,” says Mercer. Very rarely, he adds, the nerves in the spine that connect the bladder, bowels and sexual organs, and provide sensation around the genitals and back passage can be compressed. “If you develop any changes in these functions, you should seek immediate advice.”
Exercise is about more than physical fitness. “Back pain is heavily linked to depression and mental health problems,” says Mercer. And exercise is, of course, brilliant for helping to maintain mental health. So while Noonan’s exercises have improved his strength and balance, they have also boosted his confidence. “I think I’ve become more open to the world around me,” he says. “And I’ve certainly become more open to how my body works.”
Yoga has long been associated with improved mental health as well as improving back pain symptoms. In 2011, Alison Trewhela, a yoga teacher who specialises in classes for people with back pain, was approached by researchers at the University of York to collaborate on a study, funded by Arthritis Research UK, to test yoga’s efficacy in relieving symptoms. They found that on average, yoga was more effective than the “usual care”, and similar research has continued to show promising results ever since.
Trewhela was asked to double the duration of the course for the study because the researchers told her, she says, “If you want to see behavioural change, get muscles to understand how to fit differently, expand differently – and you want to breathe differently and be aware of when you get tension – you need 12 weeks to integrate those changes into your daily life.”
She wouldn’t recommend suddenly launching into a dynamic yoga class to alleviate back pain, or to force your body into uncomfortable poses. “If you try something too intense,” she says, “you’ll avoid using your weaker muscles and they will carry on getting weaker.” Find a gentle class (Trewhela’s social enterprise, Yoga for Healthy Lower Backs, now has 500 practitioners nationwide) and, she says, “A good adage I like is: try to find the optimum position, not the maximum.”
Her top three poses for back pain start with standing near a wall, feet hip distance apart and toes turned in slightly. “Reach arms up high to the top of a door frame or up a wall for 10-20 seconds.” The second is a standing shoulder stretch. “Interlock hands behind the back,” she says. “Open the chest by taking the elbows back, then slowly and gently straighten the arms behind you for 10-20 seconds.”
Relaxation is integral to yoga and is perhaps a key element of back care that is often overlooked. “All these layers of stress and tension build up,” says Trewhela. The following modified version of savasana (or “corpse pose”) – which ends all yoga classes – she says “works like magic to take off the top layers of pain, discomfort and stress. Lie down on your back with your calves up on a chair seat and your head and neck supported on a folded towel or blanket for about 10 minutes.”
It is estimated that 80% of adults in the UK will experience back pain at some point, but almost everyone can do “something” about it, says Trewhela. Noonan’s sciatica disappeared a few years ago. “Maybe once a year I wince,” he says, “but nothing that debilitates me.”
