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Sciatica

Sciatica is a common condition which is characterised by pain that radiates from the spine down the leg.

Sciatica is a common condition which is characterised by pain that radiates from the spine down the leg. The pain can be extremely intrusive with patients often describing a persistent burning sensation and tightness down the back of the leg. Other symptoms include pins and needles, numbness, loss of sensation and occasionally weakness.

Using an analogy, sciatic pain can be like a toothache. It can be a nagging, constant pain with various levels of severity. Symptoms often get worse by prolonged periods of sitting down, such as longer car journeys, as this puts pressure on the lower back.

Sciatica is commonly caused by pressure or irritation from a disc problem in the spine, which causes the pain radiating down one or both legs. The original issue in the spine could be caused by a trauma such as a car accident, sports injury, or manual handling incident. However, it could also be linked to general wear and tear of the spine over time, which could be affected by poor posture and prolonged periods of sitting down throughout the day such as office work.

When you get an injury, you will often have inflammation as a result. In the case of sciatica, this inflammation is compressing the nerve root in the spine, causing the symptoms to occur.

To explain further, it’s helpful to think about the spinal anatomy when thinking about sciatica. Your lower back, or “lumbar” region, is made up of five vertebrae. These are labelled “L1” through to “L5” which sits at the bottom of your spine. In between these vertebrae are discs which act like shock absorbers to provide support and cushioning for your spine. It is usually the lowest vertebrae, L4 and L5, which are more likely to be overloaded and injured. Inflammation around these areas can cause compression to the nerve roots around the spine, which may lead to these sciatic symptoms.

Sciatica can be straightforward to diagnose through simple tests, however the condition can often be misunderstood. For instance, lower back pain by itself is not usually an indicator of sciatica.

As the main symptom is leg pain, a common part of the assessment will include a “straight leg lift”. The purpose is to compare one leg to the other, in terms of pain levels and the angle legs can be lifted in turn. The patient lies on their back and slowly lifts their unaffected leg into the air. There will be a point where this becomes uncomfortable, much like a typical hamstring stretch. This is then used as a benchmark to compare to the other side with the symptoms.

Part of the assessment may also include specific pressure on the sciatic nerve itself. For more severe cases, an MRI scan may be required to provide additional detail for the diagnosis.

Sciatic pain can be extremely painful and intrusive in everyday life. However, its severity will lie along a spectrum. In severe cases, patients may not be able to function normally and may even be struggling to simply sit down in a chair. In these cases, it is particularly important to see a spinal specialist quickly to get treatment under way. However, in other instances patients can function normally with their activities, so they are seeking help with rehabilitation to relieve all traces of their symptoms.

Sciatica itself will get better over time. For an injury such as a disc prolapse, it can typically take 6-12 weeks to recover. However, if sciatica is severe or persisting, a consultant spinal surgeon may discuss surgical options with you.

The first step in the treatment plan will be to address the current pain. If you are seeing a consultant spinal specialist, they may prescribe nerve related pain relief for you if needed. Alternatively, your local GP will be able to recommend and prescribe appropriate medication for your symptoms.

The next step is to assess the daily activities that could be underlying causes and contributing factors of the pain. For instance, there could be something in your job or at home which is putting pressure on the nerve. In these cases, a plan will be worked out for how these can be avoided to help reduce the symptoms.

Other treatments include postural advice along with manual therapy, such as massage or spinal mobilisations, to try to calm down the affected nerve root. There are also particular exercises which can help, although care should be taken to avoid stretching. Nerves do not react well to aggressive stretching or compression, so your physiotherapist or consultant will recommend gentle exercises you can do to mobilise the nerve, without irritating it further.

For more severe cases, a specialist spinal consultant may recommend targeted spinal injections. If other options are not viable, then a specialist may explore surgical options with you although this will be discussed in consultations you have.

Sciatica is a common condition but unfortunately, it is also difficult to predict, as it can be caused by age-related wear and tear. However, practicing good posture and back care techniques are always advisable. As the lower part of the spine is under strain, staying fit and strengthening your core can also help. Finally, practicing good manual handling techniques is also a fantastic way to reduce risk of injury, for sciatica and other back conditions more generally.

If you believe you are suffering with sciatica, then we have a team of experts with many years of experience who can help. Whether you would like to book a physiotherapy assessment, or a consultation with a spinal specialist, get in touch for a no-obligation discussion about your options.

We also have state-of-the-art equipment which we can use to help you with your recovery. For instance, the AlterG anti-gravity treadmill [1] creates a vacuum to effectively reduce your bodyweight on the treadmill, which in turn reduces the load on your spine. Similarly, the Hydro Physio aquatic treadmill [2] can also be used to complete exercises in a controlled environment, with warm water helping to relax muscles and reduce pain.

We also have Nordic Health spinal strengthening technology [3] which is specifically designed to help with your recovery from a spinal injury. The equipment is customisable and a member of the team will talk you through how to get the most from it.

[1] https://www.circlehealth.co.uk/rehabilitation/about-us/specialist-equipment/alter-g-weightless-rehabilitation [2] https://www.circlehealth.co.uk/rehabilitation/about-us/specialist-equipment/hydro-physio [3] https://www.circlehealth.co.uk/rehabilitation/about-us/specialist-equipment/david-machine

Specialists offering Sciatica

Mr Bhupal Chitnavis

Consultant Neurosurgeon

BSc (Hons) MBBS FRCS (Eng) FRCS (SN)

BMI Shirley Oaks Hospital

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Mr Robert Sneath

Consultant Orthopaedic Spinal Surgeon

MB, BS, MSc, FRCS

BMI The Meriden Hospital

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Mr Jonathan Walczak

Consultant Orthopaedic & Trauma Surgeon

MBBS Bsc FRCS(Eng) FRCS(Orth)

BMI Chelsfield Park Hospital 3 more BMI Shirley Oaks Hospital BMI The Sloane Hospital BMI The Blackheath Hospital

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Mr Ramez Ibrahim

Consultant Neurosurgeon & Spinal Surgeon

MBBCH (Hons), MSC, MD, MRCS, FEBNS, FRCS (SN

BMI Thornbury Hospital

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Mr James Walkden

Consultant Neurosurgeon

BMedSci, MBChB(Hons), FRCS(SN), FEBNS

BMI Albyn Hospital

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Mr Jeremy Holland

Consultant Neurosurgeon

BSc, MBBS, MS, FRCS(SN)

BMI The Alexandra Hospital

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