What doctors wish patients knew about sciatica

From ama-assn.org

Imagine a sharp, shooting pain that starts in your lower back and travels like an electric shock down your leg, making it difficult to stand, sit or even walk. This is the reality of sciatica, which is a condition that affects millions of people and can turn even the simplest daily tasks into a painful struggle. But sciatica doesn’t have to be a life sentence of pain. There are ways to manage the symptoms and regain control. 

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

In this instalment, Kevin Taliaferro, MD, an orthopaedic surgeon at Henry Ford Health, took time to discuss what patients need to know about sciatica. Henry Ford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Sciatica is often misattributed

“Sciatica is a big catchall term that’s frequently got multifactorial issues, but is often misattributed,” Dr. Taliaferro said. “Generally, what people would call sciatica is pain in the back and buttock that could—or could not be—radiating down further into the leg.”

“That’s why it’s this weird thing that everybody thinks any back pain is sciatica,” he said. “The sciatic nerve comes from the nerve roots of the back, but it doesn’t necessarily mean it always causes back pain. That’s why it’s this catchall term that frequently gets misattributed, similar to what happens with the flu.”

Symptoms can be acute or chronic

“Most people, when they have sciatica, it’s acute to start off. It’s acute, sudden back pain that can sometimes radiate into the buttocks and generally develops into leg pain,” Dr. Taliaferro said. “That’s the typical pattern that people experience—that pain where it’s either something flares up or you have a disc herniation, you have a sudden onset and then it slowly evolves into leg pain if it’s a pinched nerve.”

“Atypical symptoms that you should see a doctor about are anything where there’s numbness or weakness in the legs, or bowel or bladder dysfunction,” he said. “Those are red flags that are not typical of sciatica and should be evaluated.”

“Generally, numbness and weakness in the legs means that the nerve is getting very compressed where it’s not functioning; it’s not just irritated and causing pain. It means that there’s enough compression to cause it to be dysfunctional,” Dr. Taliaferro said. “Then the bowel and the bladder function, that’s usually a very large disc herniation that’s pushing on the nerve roots, specifically the sacral nerve roots that are running through the low back. 

“Those are the nerve roots that control the bowel and the bladder,” he added, noting that “those are symptoms that are not normal and should be evaluated.”

It is extremely common

In the U.S., about 40% of people experience some form of sciatica during their lifetime. Yet it rarely happens before 20 years old unless it is injury related.

“Most studies say people will experience back or buttock pain at least once in their life,” said Dr. Taliaferro. “Certainly, there are people who experience it more than others. 

“But unfortunately, one of those unifying things of being human is having back and or buttock pain in the sciatica family,” he added.

There are different types

“It’s people who have back-predominant or buttock-predominant pain,” Dr. Taliaferro said. “In my practice, those people are generally more in pain from the joints of the lower back. That’s the more common of the two. 

“When people have sciatica that radiates down the legs, usually past the knee, that usually can be more coming from a pinched nerve in the back,” he added, noting “they overlap each other significantly.”

Sciatica has common causes

“Typically, it’s degenerative changes that can happen as we age,” said Taliaferro. “That’s one of the more common types where if you have arthritis in the back, that can cause the back and butt pain.”

“But that arthritis can also irritate the nerve roots going to the legs, especially if they’re causing narrowing or stenosis,” which is a condition that occurs when the space inside the backbone is too small, he said. “The other common cause is a disc herniation where people have a small disc herniation or even a large disc herniation that pinches the nerve up in the back. But because that nerve is wired in our brain to our legs, our brain interprets that as leg pain.”

Age is a main risk factor

“As we age, gravity is constant, so it wears and tears on the low back and that’s the biggest risk factor for sciatica,” Dr. Taliaferro explained. “But certainly, young people can have disc herniations as well.”

“So, in general, it is aging and wear and tear on the structures of the low back, but certainly can happen in younger patients as well,” he said. 

Pregnant people can have sciatica

“When you have the child, that’s away from your centre of gravity and pulling everything forward,” Dr. Taliaferro said. “Having a large mass at your waist that’s forcing you forward is going to put a lot of stress on the joints of the low back.”

“Also, during childbearing in preparation for delivery, ligaments in the woman’s body generally get more lax to allow for childbirth and sometimes that can allow for a little bit more instability of the low back,” he said. “Now, you could also have compression of nerves where people have disc herniations in pregnancy, so that’s slightly different. 

“But for the most part, run-of-the-mill sciatica in pregnancy is just due to the fact that you have a large mass in front of you that puts a lot of stress on the joints of the low back,” Dr. Taliaferro added.

You don’t always need an MRI

“People think that for any back and leg pain that you need to run to get an MRI [magnetic resonance imaging] immediately, but that has led to a lot of overuse of MRIs and a lot of extra cost to the system,” Dr. Taliaferro said. “It’s not great for looking at bones very well. It looks more at soft tissues than anything else.

“There’s information that you can get out of a plain old X-ray that you can’t get out of an MRI,” he added. “So, what’s really important is not all diagnoses need to be made with an MRI. It certainly has its role but talking to an orthopaedic or spinal surgeon—either operative or nonoperative—is important and not just rushing to get an MRI.” 

“Most of sciatica improves no matter what you do, especially the run-of-the-mill low back pain when you overdo it,” Dr. Taliaferro said. “That gets better no matter what you do and running to get an MRI every time is really overkill and a pretty big cost to the system.” 

Treatment is mainly non-operative

“The vast majority of run-of-the-mill sciatica—where it’s back and buttock pain—can be treated nonoperatively,” said Dr. Taliaferro, noting that “multimodal pain therapy is the best for that.”

For example, “if people have inflammation, you want to treat that with anti-inflammatory medications such as Aleve, Motrin, Mobic, ibuprofen,” he said. “But we also know that people get really stiff because if they’ve had back pain, their back doesn’t want to move.”

That is when “muscle relaxants are used to allow your back to start moving again because the key is getting moving again,” said Dr. Taliaferro. “And then sometimes if it’s really bad nerve pain, we add gabapentin or neurontin to improve nerve pain.”

Another option is “topicals such as lidocaine, which absorbs through the skin and numbs up the area,” he said. But “the vast majority of these episodes will be treated with physical therapy.”

“There are also other nonoperative treatments—and this is where our pain-management colleagues come into play—where you can do epidurals or you can do more joint-based injections, depending on what the symptoms are,” Dr. Taliaferro said. “Most people get better over two to six weeks, but surgery in this scenario, if there’s no neurologic findings, generally is always the last option and that’s after you’ve exhausted other treatments.”

Get up and move

“A lot of people think that you should stay in bed for a long time if you have sciatica pain,” Dr. Taliaferro said. “It’s fine to relax and take it easy for a day or two, but you really want to start getting up and moving because that shortens the length of duration of symptoms.”

“It’s fine to take a break, but then you need to start getting up and moving to keep that light aerobic activity working,” he emphasized.

Stretch hamstrings, strengthen core

“When our back tightens up and we have pain, our hamstrings get really tight because we don’t want our pelvis moving very much,” Dr. Taliaferro said. “So, doing hamstring stretches is really important.”

“Then isometric core strengthening is also important,” he said, noting that means “strengthening the abdominal and back muscles without moving the joints of the low back.”

For example, that’s “planks, which everybody hates. No one is super comfortable, but that gets your back muscles strong,” Dr. Taliaferro said. But the key is without moving the joints because the whole goal is to keep you steady.”

Beyond that is “light aerobic activity. When people are actively hurting, the best thing is if you can get into a pool because that takes the weight of gravity off, but allows you to keep moving against resistance,” he explained. “Other ones that are great are yoga and Pilates for the same reasons—it’s a lot of isometric holds and a lot of stretching.  

“And that’s been shown to get people a shorter timeframe of pain in this scenario is the quicker return to light aerobic activity,” he added. 

Avoid poor lifting techniques

“Always lifting properly is really important, not deadlifting with your back. Instead, soft lifting with your legs, not with your back,” Dr. Taliaferro said. “If you’re lifting a laundry basket off to the side and twisting at the same time, it’s usually a combination of things that provokes this pain or twisting while doing something active. 

“It’s the combination that causes this to flare up, but it’s hard to predict because I’ve had people get flareups sneezing,” he added. “We use our back for everything and that's the problem. You use it to sleep, use it to eat, you use it to do anything. There’s never really one thing, but generally the main provocateur is the bad lifting techniques.”

Visit your doctor if pain persists

“Whenever anybody feels uncomfortable, it’s a good idea to visit your doctor,” said Dr. Taliaferro. “I don’t think people need to run to spine surgeons by any stretch of the imagination, but at the same time, whenever someone’s not getting better with routine care—taking an anti-inflammatory over the counter, relax for a few days, stretch, keep aerobic activity going—over a course of a week or two, then that’s the time to involve your physician.”

“Most sciatic cases get better with time, but the caveat to that is numbness, weakness, bowl or bladder dysfunction. That’s never normal, so that’s always when you go in sooner,” he reiterated. “But if nothing is working and it’s still severe, that’s the time to 

https://www.ama-assn.org/delivering-care/prevention-wellness/what-doctors-wish-patients-knew-about-sciatica 

What doctors wish patients knew about sciatica

From ama-assn.org

Imagine a sharp, shooting pain that starts in your lower back and travels like an electric shock down your leg, making it difficult to stand, sit or even walk. This is the reality of sciatica, which is a condition that affects millions of people and can turn even the simplest daily tasks into a painful struggle. But sciatica doesn’t have to be a life sentence of pain. There are ways to manage the symptoms and regain control. 

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

In this instalment, Kevin Taliaferro, MD, an orthopaedic surgeon at Henry Ford Health, took time to discuss what patients need to know about sciatica. Henry Ford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Sciatica is often misattributed

“Sciatica is a big catchall term that’s frequently got multifactorial issues, but is often misattributed,” Dr. Taliaferro said. “Generally, what people would call sciatica is pain in the back and buttock that could—or could not be—radiating down further into the leg.”

“That’s why it’s this weird thing that everybody thinks any back pain is sciatica,” he said. “The sciatic nerve comes from the nerve roots of the back, but it doesn’t necessarily mean it always causes back pain. That’s why it’s this catchall term that frequently gets misattributed, similar to what happens with the flu.”

Symptoms can be acute or chronic

“Most people, when they have sciatica, it’s acute to start off. It’s acute, sudden back pain that can sometimes radiate into the buttocks and generally develops into leg pain,” Dr. Taliaferro said. “That’s the typical pattern that people experience—that pain where it’s either something flares up or you have a disc herniation, you have a sudden onset and then it slowly evolves into leg pain if it’s a pinched nerve.”

“Atypical symptoms that you should see a doctor about are anything where there’s numbness or weakness in the legs, or bowel or bladder dysfunction,” he said. “Those are red flags that are not typical of sciatica and should be evaluated.”

“Generally, numbness and weakness in the legs means that the nerve is getting very compressed where it’s not functioning; it’s not just irritated and causing pain. It means that there’s enough compression to cause it to be dysfunctional,” Dr. Taliaferro said. “Then the bowel and the bladder function, that’s usually a very large disc herniation that’s pushing on the nerve roots, specifically the sacral nerve roots that are running through the low back. 

“Those are the nerve roots that control the bowel and the bladder,” he added, noting that “those are symptoms that are not normal and should be evaluated.”

It is extremely common

In the U.S., about 40% of people experience some form of sciatica during their lifetime. Yet it rarely happens before 20 years old unless it is injury related.

“Most studies say people will experience back or buttock pain at least once in their life,” said Dr. Taliaferro. “Certainly, there are people who experience it more than others. 

“But unfortunately, one of those unifying things of being human is having back and or buttock pain in the sciatica family,” he added.

There are different types

“It’s people who have back-predominant or buttock-predominant pain,” Dr. Taliaferro said. “In my practice, those people are generally more in pain from the joints of the lower back. That’s the more common of the two. 

“When people have sciatica that radiates down the legs, usually past the knee, that usually can be more coming from a pinched nerve in the back,” he added, noting “they overlap each other significantly.”

Sciatica has common causes

“Typically, it’s degenerative changes that can happen as we age,” said Taliaferro. “That’s one of the more common types where if you have arthritis in the back, that can cause the back and butt pain.”

“But that arthritis can also irritate the nerve roots going to the legs, especially if they’re causing narrowing or stenosis,” which is a condition that occurs when the space inside the backbone is too small, he said. “The other common cause is a disc herniation where people have a small disc herniation or even a large disc herniation that pinches the nerve up in the back. But because that nerve is wired in our brain to our legs, our brain interprets that as leg pain.”

Age is a main risk factor

“As we age, gravity is constant, so it wears and tears on the low back and that’s the biggest risk factor for sciatica,” Dr. Taliaferro explained. “But certainly, young people can have disc herniations as well.”

“So, in general, it is aging and wear and tear on the structures of the low back, but certainly can happen in younger patients as well,” he said. 

Pregnant people can have sciatica

“When you have the child, that’s away from your centre of gravity and pulling everything forward,” Dr. Taliaferro said. “Having a large mass at your waist that’s forcing you forward is going to put a lot of stress on the joints of the low back.”

“Also, during childbearing in preparation for delivery, ligaments in the woman’s body generally get more lax to allow for childbirth and sometimes that can allow for a little bit more instability of the low back,” he said. “Now, you could also have compression of nerves where people have disc herniations in pregnancy, so that’s slightly different. 

“But for the most part, run-of-the-mill sciatica in pregnancy is just due to the fact that you have a large mass in front of you that puts a lot of stress on the joints of the low back,” Dr. Taliaferro added.

You don’t always need an MRI

“People think that for any back and leg pain that you need to run to get an MRI [magnetic resonance imaging] immediately, but that has led to a lot of overuse of MRIs and a lot of extra cost to the system,” Dr. Taliaferro said. “It’s not great for looking at bones very well. It looks more at soft tissues than anything else.

“There’s information that you can get out of a plain old X-ray that you can’t get out of an MRI,” he added. “So, what’s really important is not all diagnoses need to be made with an MRI. It certainly has its role but talking to an orthopaedic or spinal surgeon—either operative or nonoperative—is important and not just rushing to get an MRI.” 

“Most of sciatica improves no matter what you do, especially the run-of-the-mill low back pain when you overdo it,” Dr. Taliaferro said. “That gets better no matter what you do and running to get an MRI every time is really overkill and a pretty big cost to the system.”

Treatment is mainly nonoperative

“The vast majority of run-of-the-mill sciatica—where it’s back and buttock pain—can be treated nonoperatively,” said Dr. Taliaferro, noting that “multimodal pain therapy is the best for that.”

For example, “if people have inflammation, you want to treat that with anti-inflammatory medications such as Aleve, Motrin, Mobic, ibuprofen,” he said. “But we also know that people get really stiff because if they’ve had back pain, their back doesn’t want to move.”

That is when “muscle relaxants are used to allow your back to start moving again because the key is getting moving again,” said Dr. Taliaferro. “And then sometimes if it’s really bad nerve pain, we add gabapentin or neurontin to improve nerve pain.”

Another option is “topicals such as lidocaine, which absorbs through the skin and numbs up the area,” he said. But “the vast majority of these episodes will be treated with physical therapy.”

“There are also other nonoperative treatments—and this is where our pain-management colleagues come into play—where you can do epidurals or you can do more joint-based injections, depending on what the symptoms are,” Dr. Taliaferro said. “Most people get better over two to six weeks, but surgery in this scenario, if there’s no neurologic findings, generally is always the last option and that’s after you’ve exhausted other treatments.”

Get up and move

“A lot of people think that you should stay in bed for a long time if you have sciatica pain,” Dr. Taliaferro said. “It’s fine to relax and take it easy for a day or two, but you really want to start getting up and moving because that shortens the length of duration of symptoms.”

“It’s fine to take a break, but then you need to start getting up and moving to keep that light aerobic activity working,” he emphasized.

Stretch hamstrings, strengthen core

“When our back tightens up and we have pain, our hamstrings get really tight because we don’t want our pelvis moving very much,” Dr. Taliaferro said. “So, doing hamstring stretches is really important.”

“Then isometric core strengthening is also important,” he said, noting that means “strengthening the abdominal and back muscles without moving the joints of the low back.”

For example, that’s “planks, which everybody hates. No one is super comfortable, but that gets your back muscles strong,” Dr. Taliaferro said. But the key is without moving the joints because the whole goal is to keep you steady.”

Beyond that is “light aerobic activity. When people are actively hurting, the best thing is if you can get into a pool because that takes the weight of gravity off, but allows you to keep moving against resistance,” he explained. “Other ones that are great are yoga and Pilates for the same reasons—it’s a lot of isometric holds and a lot of stretching.  

“And that’s been shown to get people a shorter timeframe of pain in this scenario is the quicker return to light aerobic activity,” he added. 

Avoid poor lifting techniques

“Always lifting properly is really important, not deadlifting with your back. Instead, soft lifting with your legs, not with your back,” Dr. Taliaferro said. “If you’re lifting a laundry basket off to the side and twisting at the same time, it’s usually a combination of things that provokes this pain or twisting while doing something active. 

“It’s the combination that causes this to flare up, but it’s hard to predict because I’ve had people get flareups sneezing,” he added. “We use our back for everything and that's the problem. You use it to sleep, use it to eat, you use it to do anything. There’s never really one thing, but generally the main provocateur is the bad lifting techniques.”

Visit your doctor if pain persists

“Whenever anybody feels uncomfortable, it’s a good idea to visit your doctor,” said Dr. Taliaferro. “I don’t think people need to run to spine surgeons by any stretch of the imagination, but at the same time, whenever someone’s not getting better with routine care—taking an anti-inflammatory over the counter, relax for a few days, stretch, keep aerobic activity going—over a course of a week or two, then that’s the time to involve your physician.”

“Most sciatic cases get better with time, but the caveat to that is numbness, weakness, bowl or bladder dysfunction. That’s never normal, so that’s always when you go in sooner,” he reiterated. “But if nothing is working and it’s still severe, that’s the time to visit your doctor because then we can get a little bit stronger medication and try other things such as injections.”

https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-sciatica 

Running and sciatica: Everything you need to know

From uk.style.yahoo.com

Most runners have been confronted with the term ‘sciatica’ – whether it's via a quick Google search to try and identify that nagging back/leg pain or just a running mates' attempt at diagnosing you.

It may come as a surprise that sciatica is not actually a medical diagnosis. It is a very old term that encompasses quite a few different and sometimes overlapping conditions, and can mean different things to different people.

So, let's run through the different types of sciatic nerve pain and how runners can potentially be affected.

What is sciatica?

‘Sciatica’ gets its name from the sciatic nerve. This nerve originates from the bottom of the back, known as the lumbar spine, and the sacrum. Specifically, it is formed from a plexus, which is a group of nerves, from L4-S3, and then comes out by the buttock. And, yes, very close to the piriformis (all runners seem to have heard of this muscle), going all the way down the back of the leg.

The term ‘sciatica’ is normally used when someone has leg and/or back pain. As medical professionals, however, we want to be more specific about what is causing the pain as this will give us our treatment options. We would tend to use these terms:

• Referred pain: as its name suggests, this is pain felt in an area other than where it originates. The back is made up of joints, ligaments, discs and muscles, and these are all capable of referring pain. This is often described as a ‘dull’ pain.

• Radicular pain: this is the word we use when we have pain in the nerve itself and is more commonly described as a ‘sharp’ or ‘burning’ pain. This can occur when a disc has prolapsed or ‘slipped’ and presses on a nerve.

• Radiculopathy: is when the nerve is not sending information in the way it should do. This can be picked up by clinical tests. When medics use this term they are talking about how the nerve is functioning rather than the pain itself.

The difficult thing is that all of these – referred pain, radicular pain and radiculopathy – can occur at the same time or separately. It is one of the reasons the term ‘sciatica’ continues to be popular, but also why it may not be that helpful as a diagnosis.

Can running cause sciatica?

There will certainly be instances when an episode of pain is triggered by running and there is evidence that the discs sustain considerable compression and rotational forces during running. However, there is also evidence that loading the discs in activities such as running can be helpful. Some surgeons are very cautious about running when it comes to back pain, but in my clinical practice I have not associated a strong link between running being the cause of a patients' back/leg pain; in fact, in some patients running is something that makes them feel better.

New runners

That said, in the example of referred pain, those who are new to running may be at risk. That's because injuries to the muscles, joints or ligaments in the back tend to be caused by a person doing something outside of the norm and straining something.

People tend to have better tolerance of movements and activities they are trained for or accustomed to, so in the case of running, beginner runners can reduce their risk of this type of injury by starting slowly and building up their distance/duration/intensity gradually.

Poor recovery

At the other extreme, an injury can occur if a runner is under-recovered. It may be that you have had a heavy block of training or have returned too quickly to training after a race. These factors in themselves cannot be blamed for causing ‘sciatica’ but they can increase the risk of injury. 

Strength training can be helpful to reduce injury risk and improve running economy. But it is obviously not something to start doing if you have a new episode of pain.

Combined factors

The reality is, there are often a combination of factors that cause the pain including:

• Relative inactivity (obviously less likely in runners), but a recent break in training may mean you are less accustomed to running than usual

• Social stress – things happening at work/home

• A past history of back pain

• Increase in training

• Genetics

• Poor sleep/recovery

• Biomechanics (how we move). This could be related to deficits or asymmetries in strength, balance and/or flexibility

This is where listening to the history of pain and issues helps us, as medics, understand the specific components that may lead up to an episode of pain. The more we understand the causes, the more specific we can be in directing treatment.

How do you know if the pain in your bum/leg is sciatica or another running injury?

If the pain feels like a burning or is sharp, it is likely that there is some nerve irritation. This can occur when the nerve is compressed, inflamed or overstretched at the root causing what we call radicular pain. This type of nerve pain is typically too severe to run through.

If you have tendon pain, it is generally less severe and in the beginning can ‘warm up’ during a run and then become sore afterwards. Though as tendon pain progresses it will become more painful and tolerate less – ie, it comes on earlier in the run and doesn't warm up as much.

Runners who are suffering from hamstring tendinopathy will feel pain in the buttock and may wonder whether their pain is nerve-related or symptoms of the tendon. Confusingly, it can actually be both. But this type of nerve irritation is not the same as the radicular pain, which happens when the root of the nerve is irritated, and it tends to cause less severe symptoms.

Piriformis syndrome – which also presents as pain deep in the buttock – is a controversial diagnosis for patients with ‘sciatica'. Pain in the buttock can come from many sources, and it is rare as a primary cause of pain.

Sciatica treatment

Sciatica treatment depends on what the source of the pain is (referred, radicular, radiculopathy or something else). Nerve pain and tendon pain tend to take longer to recover from than muscle pain. How quickly you get better will depend on the degree of your injury – muscle and ligament injuries are graded and can last a couple of weeks or longer, and most episodes of back pain tend to clear up in around six weeks. If there is a component of nerve pain, however, it will take longer.

If you think you have radicular pain (burning/sharp and typically feels quite severe), you will normally need to modify your activity and rest. We don't advise bed rest but mostly you are not be able to do what you normally do for a few days. Heat and ice may help so it is reasonable to try both. You should also speak to your GP/pharmacist about using medication if your sleep is affected or you are not coping despite reducing your activity. Once the pain settles, it is helpful to build up to your activity, and walking is a good place to start. As a guide, you should not return to running until you are back to your normal day-to-to day activities and off medication.

If you have referred pain, it is typically duller and a bit more mechanical – so it hurts when you do specific things. Your body will still need to recover but are you are likely to be able to continue doing your normal day-to-day activities. You can decide whether you should be running based on the severity and if the pain has a trend of improving or not.

Another thing to remember is that you may also have radiculopathy – this is not pain but when the messages the nerve normally sends are not being picked up. It can occur by itself but more commonly with pain in the nerve itself (radicular pain). It is something that can cause muscle weakness, numbness and/or changes in reflexes and needs to be assessed by a professional.

Should you keep running if you have sciatica/sciatic nerve pain?

If the pain is low level and is not getting worse during the run or afterwards, it is fine to continue to run. But if there is a trend of it getting worse with the passage of time or you have to change how you run to tolerate the pain, you should not be running.

What are the best exercises for sciatica/sciatic nerve pain?

The real answer to this is that there are no ‘best’ exercises. Every month, 4,0oo people Google search if they can ‘cure sciatica in 8 mins’, so we are clearly desperate to find a quick fix... if only it were that simple!

If the pain is severe, as it can be with radicular pain, you need to let your body recover and want to find positions that are comfortable in the beginning. These are often:

• Side lying with the painful side on the top and a pillow between your knees.

• Lying on your back with a support underneath your knees so that your back can relax.

There is no evidence that a particular type or set of exercises are right if you are recovering from radicular pain or have had referred pain from your back. But it is reasonable to see if your body can tolerate more movements as the pain improves. These are not stretches but a relaxed way to explore whether your body is ready to do more.

The repetitions are a guide and should be dictated by how you feel.

Cat/camel

                                                                                                                                                Hearst Owned

• In a table-top position on the floor, come onto your hands and knees.

• Relax your breathing and monitor for any tension.

• Gently curl and move as far as feels comfortable.

• Repeat in the opposite direction.

• Repeat this 6 times.

Knee rolls

                                                                                                                                           Getty Images

• Lie on a mat on the floor, with your hands placed comfortably across your stomach.

• Draw up your knees to form a bend in your legs and roll your knees from side to side.

• Do this 6 times.

If these are well tolerated, you can try the following movements with more range.

Prone extension

                                                                                                                                                                                     Hearst Owned

• Lie on your stomach with your legs fully extended and arms out into a push-up position.

• Gently push up as far as feels comfortable

• Pause for 2 seconds, then return to the starting position.

• Repeat 6 times.

Child’s pose

                                                                                                                                               Hearst Owned

• Start on all fours.

• Send hips back so your glutes rest on your heels.

• Lower your chest to the floor and stretch your arms out in front of you.

• Hold for 6 and repeat 6 times.

SLR mobilisation

                                                                                                                                                Hearst Owned

• Lie on your back and link your arms through one thigh with the knee bent.

• Gently straighten out the leg as far as comfortable and lower – you should only feel something in the back of the thigh.

• Repeat 6 times.

Any exercises you do should not increase pain so they should only be continued if you feel they are helping.

My best advice, if you are concerned, would be to get an assessment from a medical professional, like a physiotherapist. You will get a thorough assessment and a specific diagnosis. This is both reassuring and will help tailor advice and treatment to ensure you improve at the quickest possible rate and do not miss something more serious.

https://uk.style.yahoo.com/running-sciatica-everything-know-193900233.html 

Sciatica: What It Is, Causes, Symptoms, Treatment & Pain Relief

From my.clevelandclinic.org

Sciatica happens when irritation, inflammation, pinching or compression affect one or more nerves that run down your lower back and into your legs. It’s usually not a serious or dangerous condition, and most people with sciatica get better on their own with time and self-care treatments. But severe cases may need surgery.

What is sciatica?

Sciatica is nerve pain from an injury or irritation to your sciatic nerve. In addition to pain, it can involve tingling or numbness in your back or butt that may also radiate down your leg. More severe symptoms are also possible.

Your sciatic nerve is the longest and thickest nerve in your body. It’s up to 2 centimetres wide (a U.S. penny or a United Kingdom 1 pence coin are about the same width). Despite its name, it’s not just one nerve. It’s actually a bundle of nerves that come from five nerve roots branching off from your spinal cord.

You have two sciatic nerves, one on each side of your body. Each sciatic nerve runs through your hip and buttock on one side. They each go down the leg on their side of your body until they reach just below your knee. Once there, they split into other nerves that connect to parts farther down, including your lower leg, foot and toes.

Having sciatica means you can experience mild to severe pain anywhere with nerves that connect to the sciatic nerve. The symptoms can affect your lower back, hips, buttocks or legs. Some symptoms may extend as far down as your feet and toes, depending on the specific nerve(s) affected.

Types of sciatica

There are two types of sciatica. Regardless of what type you have, the effects are the same. The types are:

• True sciatica. This is any condition or injury that directly affects your sciatic nerve.
• Sciatica-like conditions. These are conditions that feel like sciatica, but happen for other reasons related to the sciatic nerve or the nerves that bundle together to form it.

Healthcare providers tend to refer to both types as just “sciatica.” The differences between them usually only matter when your healthcare provider determines how to treat it.

How common is sciatica?

Sciatica is a very common condition. About 40% of people in the U.S. experience some form of sciatica during their lifetime. It rarely happens before age 20 unless it’s injury-related.

What are the symptoms of sciatica?

Sciatica symptoms can include:

• Pain. Sciatica pain happens because of pressure on the affected nerve(s). Most people describe sciatica pain as burning or like an electric shock. This pain also often shoots or radiates down the leg on the affected side. Pain commonly happens with coughing, sneezing, bending or lifting your legs upward when lying on your back.
• Tingling or “pins and needles” (paresthesia). This is similar to the feeling you have when a leg falls asleep because you sat cross-legged.
• Numbness. This is when you can’t feel sensations on the skin in the affected areas of your back or leg. It happens because signals from your back or leg are having trouble reaching your brain.
• Muscle weakness. This is a more severe symptom. It means that muscle command signals are having trouble reaching their destinations in your back or legs.
• Urinary incontinence or faecal incontinence. This is a very severe symptom. It means signals that control your bladder and bowels aren’t reaching their destinations.

What causes sciatica?

Sciatica can happen because of any condition that affects the sciatic nerve. It can also happen because of conditions affecting any of the five spinal nerves that bundle to form the sciatic nerve.

Conditions that can cause sciatica include:

• Herniated disks.
• Degenerative disk disease.
• Spinal stenosis.
• Foraminal stenosis.
• Spondylolisthesis.
• Osteoarthritis.
• Injuries.
• Pregnancy.
• Tumours, cysts or other growths.
• Conus medullas syndrome.
• Cauda equina syndrome.

What are the risk factors for sciatica?

Because sciatica can happen for so many reasons, there are many potential risk factors, which include, but aren’t limited to:

• Having a current or previous injury. An injury to your spine or lower back increases your risk of developing sciatica.
• Normal wear-and-tear. As you get older, normal wear-and-tear on your spine can lead to pinched nerves, herniated disks and other conditions that can cause sciatica. Age-related conditions like osteoarthritis can also play a role.
• Having excess weight or obesity. Your spine is like a construction crane when you stand upright. The weight you carry in the front of your body is what your spine (crane) has to hoist. Muscles in your back are like the winch and cable, pulling to keep you vertical. The more weight you have, the more your back muscles have to work. That can lead to back strains, pain and other issues.
• Having insufficient core strength. Your “core” is the term for the muscles of your back and abdomen (stomach area). Like in the crane analogy, having a stronger core is like upgrading the crane’s components to handle a heavier load. The muscles of your abdomen are important because they help anchor your back muscles.
• Your job. Jobs that require heavy lifting, a lot of bending, or working in awkward or unusual positions may increase your risk of low back problems. However, jobs with prolonged sitting — especially without proper back support — may also increase your risk of low back problems.
• Not using good posture and form when lifting. Even if you’re physically fit and active, you can still be prone to sciatica if you don’t follow proper body form during weight lifting, strength training or similar activities.
• Having diabetes. Type 2 diabetes increases your risk of diabetes-related peripheral neuropathy. That damages your nerves, including any of the nerves that can cause or contribute to sciatica.
• Physical inactivity. Sitting for long periods and a lack of physical activity can contribute to an increased risk of sciatica.
• Using tobacco. Nicotine use can affect circulation and increase your risk of chronic pain. That includes conditions like sciatica.
• Unknown causes. Many cases of sciatica don’t have a cause that healthcare providers can find.

What are the complications of sciatica?

Most people recover fully from sciatica. However, a possible complication of sciatica is chronic (long-term) pain.

If there’s serious damage to an affected nerve, chronic muscle weakness, such as a “drop foot,” might happen. That’s when nerve damage causes numbness in your foot, which makes normal walking difficult or even impossible.

Sciatica can also potentially cause permanent nerve damage, resulting in a loss of feeling in the affected legs.

How is sciatica diagnosed?

A healthcare provider can diagnose sciatica using a combination of methods. They’ll review your medical history and ask about your symptoms. They’ll also do a physical examination. That exam will include:

• Walking. Sciatica often causes visible changes in how you walk. Your provider will watch for those changes as part of diagnosing sciatica.
• Straight leg raise test. This involves having you lie on an exam table with your legs straight out. They’ll slowly raise your legs one at a time toward the ceiling and ask when you start to feel pain or other symptoms. These can help pinpoint the cause of sciatica and how to manage it.
• Other flexibility and strength checks. These can help your provider determine if any other factors are causing or contributing to your sciatica.

What tests will be done to diagnose this condition?

Several tests can help with diagnosing sciatica and ruling out similar conditions. The most common or likely tests include, but aren’t limited to:

• Spine X-rays or computed tomography (CT) scans.
• Magnetic resonance imaging (MRI) scans.
• Nerve conduction velocity studies
• Electromyography.
• Myelogram.

How is sciatica treated, and is there a cure?

Treating sciatica usually involves trying to decrease pain and increase mobility. Many treatments are things you can do yourself.

There are several treatment options if you have sciatica that won’t go away or is more severe. Surgery might be an option if your case is severe or other treatments don’t help.

Self-treatment

Depending on the cause, milder cases of sciatica usually get better with self-treatment.

NOTE: Pain that’s moderate to severe, with numbness and tingling or muscle weakness are all symptoms that need professional medical care. You shouldn’t try to self-treat them.

Self-treatments can include:

• Ice. Cold or ice packs can help reduce pain and swelling during the first few days after sciatica pain starts. You can use an ice pack or a bag of frozen vegetables for this (but always wrap them in a towel to prevent cold-related injuries to your skin). Apply cold for 20 minutes at a time, several times a day.
• Heat. After the first several days of using cold or ice, switch to a heating pad or warm compress. Apply heat for 20 minutes at a time. If you’re still in pain, switch between hot and cold packs — whichever best relieves your discomfort.
• Over-the-counter medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first choice. They reduce pain, swelling and inflammation.
• Stretching and activity. Learning how to stretch properly from an instructor with experience with low back pain can be a major help. They may also be able to help you work your way up to other general strengthening, core muscle strengthening and aerobic exercises.

If the self-care treatment approach doesn’t help after a few weeks, you should talk to a healthcare provider.

Conservative treatments

Conservative treatments are a step up from self-treatment. Your healthcare provider can offer these as options if self-care wasn’t helpful or if your symptoms are severe enough to need more involved care.

Conservative treatments can involve similar treatments to self-care, but with your healthcare provider guiding you. They can also involve the following:

• Prescription medications. Painkillers, muscle relaxers and other medications may help with sciatica symptoms. Other medications, like tricyclic antidepressants and anti-seizure medications, may also help if you have chronic or nerve-based pain.
• Physical therapy. The goal of physical therapy is to find exercise movements that decrease sciatica by reducing pressure on the nerve. Options include stretching exercises or low-impact activities like walking, swimming or water aerobics.
• Spinal injections. Injections like corticosteroids may provide short-term relief (typically up to three months). These usually involve local anaesthesia, so there’s less discomfort. Your healthcare provider can tell you more about this process.
• Alternative therapies. These treatments are increasingly popular and offer options other than standard medical therapies or medications. They include seeing a chiropractor for spine adjustments, yoga, acupuncture and more. Massage therapy might also help muscle spasms that occur with sciatica. Biofeedback can also help you manage pain and relieve stress.

Surgery options for sciatica

Surgery may be the best option when sciatica is more severe. Usually, healthcare providers don’t recommend surgery unless you have symptoms that indicate nerve damage is happening or imminent. They may also recommend surgery if you have severe pain that prevents you from working or going about your usual routine, or if your symptoms don’t improve after six to eight weeks of conservative treatment.

Surgery options to relieve sciatica include:

• Diskectomy. This is a surgery that removes fragments or small sections of a herniated disk that are pressing on a nerve.
• Laminectomy. Each vertebra has a rear section called the lamina (it’s on the side of the vertebra just underneath the skin of your back). A laminectomy involves removing a section of the lamina that’s pressing on spinal nerves.

What are the possible complications or side effects of treatment?

The possible complications and side effects depend on many factors, especially the specific treatments used, the severity of your symptoms, what caused your sciatica and more. Your healthcare provider is the best person to tell you about the possible side effects and complications that are most likely. They can also advise you on managing, minimizing or avoiding them.

How soon after treatment will I feel better?

Recovery time from sciatica depends on the specific treatment, the severity of your symptoms, their cause and more. Many cases of sciatica go away within four to six weeks without needing professional medical treatment.

More severe cases may also take weeks or months to get better, especially if you have more severe symptoms. Waiting too long to get treatment for sciatica — generally more than six months — also makes a good outcome less likely, so it’s important not to wait too long to talk to a healthcare provider.

Is sciatica preventable?

Some causes of sciatica are preventable, but others happen unpredictably or for unknown reasons. For the causes that aren’t preventable, it may still be possible to reduce your risk of developing them.

The following can help prevent sciatica or reduce the risk of it happening:

• Maintain good posture. Follow good posture techniques while you’re sitting, standing, lifting objects and sleeping.
• Quit (or don’t start) using tobacco products. Nicotine from any source (including vaping) reduces blood supply to your bones, which can weaken your spine and its various components.
• Reach and maintain a weight that’s healthy for you. Your primary care provider can guide you on how to eat and get physical activity. Make sure you get enough calcium and vitamin D for bone health, too.
• Stay active. Physical activity can include everything from stretching to strength training. Increasing core strength and flexibility can improve back pain. Other forms of activity, such as aerobic exercise, can also help you reach and maintain a weight that’s healthy for you.
• Protect yourself from falls. Wear shoes that fit and keep stairs and walkways free of clutter to reduce your chance of a fall. Make sure rooms are well-lit, and there are grab bars in bathrooms and rails on stairways.
• Take time to recover if needed. Don’t try to work through back pain. That can lead to even worse injuries. Back pain doesn’t have to keep you from being active, either. You can still participate in low-impact activities such as swimming, walking, yoga or tai chi.

What can I expect if I have sciatica?

Milder cases of sciatica generally go away on their own with time and self-treatment. Most people (between 80% to 90%) with sciatica get better without surgery.

If your sciatica pain doesn’t improve after a few weeks of self-treatment, or you have concerns that you aren’t recovering as quickly as hoped, you should talk to a healthcare provider.

How long does sciatica last?

Sciatica often doesn’t last longer than six weeks. When it does, your healthcare provider may recommend more involved treatments, including surgery.

When can I go back to work?

When you can return to work or other regular activities depends on several factors. Those include your symptoms, the treatments you receive and more. Your healthcare provider is the best person to tell you if you can return to work, and what precautions or changes you might need if you do.

What’s the outlook for this condition?

Overall, the outlook for sciatica tends to be very good. Long-term issues aren’t common unless you have more severe symptoms.

When should I see my healthcare provider, or when should I seek care?

You should talk to your healthcare provider if you have moderate or worse pain, or if you experience any tingling, pins-and-needles sensations or numbness.

When should I go to the emergency room?

You should get emergency medical attention if you experience the following:

• Any muscle weakness.
• Loss of bowel or bladder control.
• Severe pain that keeps you from your usual activities and lasts for more than a few hours.
• Sudden severe pain, numbness or any other sciatica symptoms immediately after a fall, car crash or any other injury-causing event.

Additional Common Questions

Can sciatica occur down both legs?

Sciatica usually affects only one leg at a time. However, sciatica can occur in both legs in rare cases.

Does sciatica occur suddenly, or does it take time to develop?

Sciatica can come on suddenly or gradually. It depends on the cause. A disk herniation or injury can cause sudden pain. Arthritis in your spine or other degenerative conditions develop slowly over time.

Can weight gain during pregnancy cause sciatica?

Sciatica is common in pregnancy but isn’t usually related to pregnancy weight changes. Two main factors better explain why it’s more likely to happen during pregnancy.

The first explanation has to do with pregnancy-related hormones. Those hormones can cause a loosening of ligaments and connective tissue in your spine. That loosening makes your spine more flexible, which can cause disk slippage, pinched nerves and sciatica.

The weight and position of the foetus can also press on the nerve.

The good news is there are ways to ease sciatic pain during pregnancy, and the pain should go away after birth. Physical therapy and massage therapy, warm showers, heat, medications and other measures can help. Practicing good posture techniques during pregnancy can also help.

How can I tell if pain in my hip is a hip issue or sciatica?

Hip problems, such as arthritis in your hip, usually cause pain in your groin, or pain when you put weight on your leg or move it around.

If your pain starts in your back and moves or radiates toward your hip or down your leg, or you have numbness, tingling or weakness, sciatica is the most likely cause.

Sciatica vs. radiculopathy — what’s the difference?

Radiculopathy is a broader term that describes the symptoms caused by a pinched nerve in your spine. Sciatica is the most common type of radiculopathy.

Should I rest if I have sciatica?

Rest is helpful during the first two days you have sciatica. But total rest isn’t likely to help, and physical inactivity can make your pain worse and slow healing. The goal is to find a balance so you’re active enough to stay flexible and maintain strength but not make sciatica worse or injure yourself. A healthcare provider can guide you on how to find this balance and help you recover.

Can sciatica cause my leg and/or ankle to swell?

Sciatica from a herniated disk, spinal stenosis or bone spurs can cause inflammation or swelling in the affected leg. Piriformis syndrome complications can also cause leg swelling.

A note from Cleveland Clinic

Sciatica pain in your back, butt or legs can disrupt your life in many ways. Fortunately, there’s a lot you can do to help yourself recover. You can often treat milder cases yourself. More intense symptoms are also often treatable. Surgery usually isn’t necessary, but it’s an option if your symptoms are severe. With treatment, you can put sciatica behind you and return to living on your terms.

https://my.clevelandclinic.org/health/diseases/12792-sciatica