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    Low Back Pain and Sciatica

    What is sciatica?

    • Sciatica is pain and/or pins and needles down the back of the leg. This can occur anywhere from your bottom to your feet and is caused when the nerve is irritated or compressed.

    How common is sciatica?

    • It is estimated that approximately 13%–40% of people will experience sciatica at some point during their life (1).
    • It is also estimated that about 5%–10% of people with non-specific low back pain also have sciatica (2).

    Should I worry?

    • No.
    • Sciatica symptoms usually settle within 2–4 weeks but may persist for longer in some people (4).
    • With the right rehabilitation approach, you should recover well.

    Who is most likely to suffer from sciatica?

    • Sciatica is most common in those aged between 40-50 (2).
    • Those who frequently perform incorrect heavy lifting have a higher risk of developing sciatica (3).
    • Being a smoker and being an ex-smoker were both identified as risk factors for sciatica (9).
    • Being overweight or obese (9).

    What are the common symptoms?

    • Lower back pain with associated radiating leg pain.
    • Not everyone will have back pain, you might just experience leg pain.
    • Pain is often described as sharp and shooting.
    • Sometimes associated with altered sensations often described as pins and needles or tingling (2).
    • In rarer cases, the weakness of certain leg muscles might occur (2).

    What can I do?

    • Remain active within your limitations.
    • Resume normal activities inclusive of work as soon as possible.
    • Using hot and/or cold (ensuring that the skin is protected) may help relieve pain.
    • Use a cushion between the knees when sleeping on the side, or pillows propping up the knees when lying on the back.
    • Advice by a qualified physiotherapist will be helpful in most cases (1).

    How long will it take to recover?

    • This will depend upon several factors including, but not limited to, other medical conditions, stage of injury, your ability to follow your rehabilitation plan, etc.
    • Fortunately, most patients have a good outcome and usually improve within 2–4 weeks with or without treatment (4).
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    1. Introduction

    Sciatica is an umbrella term used to describe symptoms that characteristically present as lower back pain with associated radiating leg pain. Although sciatica may or may not always be associated with lower back pain, it is thought that 90% of true cases are caused by a herniated (prolapsed) lumbar disc with subsequent compression and irritation of the nerve (2). It is this nerve compression that causes the radiating leg pain which in most instances is the most troublesome symptom.

    It is worth noting that a variety of other conditions can mimic sciatica and these conditions are not associated with herniations. For example, joints within the spine can cause lower back and radiating leg pain which can produce sciatic type symptoms but, in this instance, the pain would not be from a herniated disc.

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    2. Signs & Symptoms

    3. Causes

    As detailed, the term sciatica is used to describe symptoms. Within the general population and amongst some healthcare professionals, the term sciatica is often used to describe nerve-related pain, but it is important to remember that a variety of different structures which are not always related to nerves can cause sciatic related symptoms. If nerves are involved in someone’s sciatica, this will frequently be caused by compression which might be caused by the following:

    • Herniated intervertebral disc sometimes referred to as a disc bulge.
    • Spondylolisthesis – occurs when a spinal segment moves from its normal position.
    • Spinal stenosis – occurs when the column that your spinal cord travels down narrows causing compression.
    • Other more sinister and significantly rarer conditions which might cause compression include infection and tumours.
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    4. Risk Factors

    This is not an exhaustive list. These factors could increase the likelihood of someone developing sciatica. It does not mean everyone with these risk factors will develop symptoms.

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    5. Prevalence

    Studies report varying estimates of the number of people that sciatica affects due to various factors including its definitions, i.e. some studies will define sciatica as any radiating leg pain whilst others will define it as pain originating from nerve compression (6). Lifetime occurrence which describes the proportion of people who experience sciatica at some point during their lifetime ranges from 13%–40%.

    6. Assessment & Diagnosis

    Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

    Your treating clinician will want to know how your condition affects your day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like magnetic resonance imaging (MRI) or X-ray are not required to achieve a working diagnosis. However, in persistent cases that have not responded to a period of appropriate conservative management, they may be warranted.

    7. Self-Management

    As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your sciatica. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

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    8. Rehabilitation

    Research is very clear that prolonged bed rest is detrimental for sciatica and that active self-management is key for a timely recovery. This includes advice about remaining active within limitations and resuming normal activities inclusive of work as soon as possible.

    Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing sciatica. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.

    9. Low Back Pain and Sciatica Rehabilitation Plans

    Early Plan

    This programme focuses on maintaining a range of movement within the lower back and low-level exercises aimed at the affected sciatic nerve. It is important not to further irritate the nerve so always work to a point of mild self-perceived tension only. We suggest you carry these exercises out daily prior to progressing onto the next stage of rehabilitation when your pain and function allow. Pain should not exceed 3/10 on your self-perceived pain scale whilst completing this exercise programme.

    Early Plan - Rating

    Intermediate Plan

    This is the next progression. More focus is given to progressive loading of the lower back and core with further exercises aimed specifically at the sciatic nerve. It remains important not to further irritate the nerve so always work to a point of mild self-perceived tension only. Pain should not exceed 3/10 whilst completing this exercise programme.

    Intermediate Plan - Rating

    Advanced Plan

    This programme is a further progression with challenging progressive loading of the lower back and core, and continued exercises targeting the affected nerve. It is important not to further irritate the nerve so always work to a point of mild self-perceived tension only. Pain should not exceed 4/10 whilst completing this exercise programme.

    Advanced Plan - Rating
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    10. Return to Sport/Normal Life

    For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

    As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

    11. Other Treatment Options

    • Medication – you might benefit from specific medication options prescribed by an appropriately trained healthcare professional.
    • Surgery may be considered as a last resort if there is severe nerve compression, or where there are persistent symptoms that do not improve with conservative management (7, 8).

    12. Links for Further Reading

    https://www.nhs.uk/live-well/healthy-body/safe-lifting-tips/

    https://www.nhs.uk/live-well/exercise/common-posture-mistakes-and-fixes/

    https://www.nhs.uk/live-well/healthy-weight/start-losing-weight/

    https://www.nhs.uk/conditions/sciatica/

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    Book an Appointment

    Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

    We have Pure Physiotherapy clinics across the country including Norwich, Dereham, Bolton, Manchester, Rochdale, Sheffield and Barnsley. Please view our clinics to find the closest physiotherapy clinic for you.

    References

    1. NICE (2016) Low back pain and sciatica in over 16s: assessment and management. National Institute for Health and Care Excellence. http://www.nice.org.uk.
    2. Koes, B.W., van Tulder, M.W. and Peul, W.C. (2007) Diagnosis and treatment of sciatica. British Medical Journal 334, 1313-1317.
    3.  Miranda, H, Viikari-Juntura, E, Martikainen, R., et al. (2002) Individual factors, occupational loading, and physical exercise as predictors of sciatic pain. Spine 27, 1102-1109.
    4. Van Tulder, M., Peul, W. and Koes, B. (2010) Sciatica: what the rheumatologist needs to know. Nature Reviews. Rheumatology 6, 139-145.
    5.  Chou, R. (2012) Treating sciatica in the face of poor evidence (editorial). BMJ 344.
    6. Konstantinou, K. and Dunn, K.M. (2008) Sciatica: review of epidemiological studies and prevalence estimates. Spine 33, 2464-2472
    7.  NICE (2016) Percutaneous interlaminar endoscopic lumbar discectomy for sciatica; Interventional Procedure Guidance.
    8. NICE (2016) Percutaneous transforaminal endoscopic lumbar discectomy for sciatica; Interventional Procedure Guidance.
    9.  Cook, C.E., Taylor, J., Wright, A., Milosavljevic, S., Goode, A. Whitford, M. (2014). “Risk Factors for First Time Incidence Sciatica: A Systematic Review”, Physiotherapy research international: the journal for researchers and clinicians in physical therapy. 19, 65-78.
    Other Conditions in Lower Back, Hips & Pelvis, Upper Legs, Lower Legs, Neurological

    Mechanical Back Pain

    Lower back pain caused by structures in the back, such as joints, bones and soft tissues.

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    Lumbar Disc Injury

    Lumbar discs sit between each of the bones of the spine. Problems can occur when these discs become irritated.

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    Spondylolysis

    An injury due to a stress fracture through part of a vertebra known as the pars interarticularis of the lumbar vertebrae (lower back).

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    Sacroiliac Joint Dysfunction

    Pain originating from the sacroiliac joint at the base of your back where the spine joins the pelvis.

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