Sciatica

This leaflet is for patients with sciatica, which is the commonly used term to describe pain in your leg(s). It is often caused by a disc protrusion irritating or compressing a nerve root, although this is not always the case.

How to manage your sciatic pain

The good news is that 90% of people with sciatica will be better within three months. The most important thing you can do to help manage your sciatic pain is to stop the nerve being irritated, thereby allowing your body to heal itself. You will know when the nerve is not being irritated as you will not feel your leg pain. You need to be guided by your symptoms.

The main things you can address to help your symptoms are:

1. Maintain good posture.
2. Pace your activities.
3. Use medication.
4. Use ice or heat packs.
5. Sleep well.
6. Look after your general health and wellbeing.
7. Seek medical advice.

As unpleasant as sciatica is, it is not a medical emergency. However, you should seek urgent medical advice should you experience any of the following:

• altered sensation around your genital area
• difficulty passing or controlling urine
• numbness, pins and needles or weakness in both legs
• unsteadiness on your feet

1. Maintain good posture

It is important to minimise the pressure on your lumbar spine which will decrease the amount your nerve is irritated. To do this maintain your natural lumbar curve, by sitting up tall, and avoid slouching as this puts 10 times more pressure through your back than lying. Often when your sciatica is severe you will find reaching forward, bending and sitting painful, and are better standing or lying.

2. Pace your activities

Changing what you are doing, and your position, will mean that your symptoms are not aggravated as much. Whilst your symptoms may feel better lying down it is important to get up and move regularly as this will:

• allow you to heal more quickly
• prevents you from stiffening up
• prevents your muscles wasting.

We generally recommend no more than three days in bed.

You may need time off work if you are unable to do any activity for more than a few minutes in the early stages of severe sciatica. If you find yourself in this situation we recommend that you discuss this with your GP and/or therapist. It is important to try and return to normal activities as quickly as possible. You may need to consider a fit for work certificate, which indicates what you can do, and also a phased return to work.

3. Use medication

The use of medication needs to be discussed with your GP and/or pharmacist. Sciatica literally means your sciatic nerve is inflamed. As a result if you are able to take anti-inflammatory medications such as Naproxen or Diclofenac these may be helpful. However, these can cause heartburn or stomach problems; if you experience these, please consult your GP.

There are also other medications that were not invented as painkillers, but have been found to be very useful to treat nerve pain such as Amitriptyline and/or Gabapentin. Amitriptyline in particular seems to promote good sleep and is often prescribed to take at night-time to help with sleep disturbance.

If you are suffering with significant muscle spasm there are medications that can be prescribed for a few days to help. It is important that if you are prescribed medication, you take it if needed as it will keep you moving.

These medications do not mask your symptoms but treat them.

4. Use ice or heat packs

Whilst it would seem that ice packs would be helpful to treat inflammation, some people find that heat is more effective for them as this can relieve muscle spasm. If you use either, please ensure the sensation in your back is normal. Wrapping a damp towel around a bag of frozen peas works as well as an ice pack. A hot water bottle is also an effective heat pack. Alternatively you can buy both from pharmacies.

5. Sleep well

It is extremely important to sleep well as your body releases its growth hormone ‘repair factor’ (when your body heals itself) during sleep. Poor sleep has even been found to cause back pain. Sleep is often disturbed by pain, and therefore ensuring that all factors that can affect sleep are addressed is important (caffeine, noise, light, anxieties, mattress, pillows, temperature and so on). Sometimes it is necessary to take medication to help you sleep whilst you have sciatica and people often find that the nerve medication helps with this.

6. Look after your general health and wellbeing

Looking after your general health gives your body the best chance to heal itself. The fitter you are, the stronger your body is, and, with a better blood supply, your body can focus on healing your sciatica. If you are very stressed and/or depressed this will impair your body’s ability to heal itself.

7. Seek appropriate medical advice

If you are suffering with sciatica we recommend that you consult your GP for appropriate advice, where pain medication can be prescribed as necessary. Your GP may also feel that you would benefit from physiotherapy. A physiotherapist can advise you on how to manage your condition, recommend exercises and use manual therapy techniques to help speed up your recovery.

If your symptoms fail to improve with medication, advice and physiotherapy, it may be appropriate to see a specialist for a further opinion. Your physiotherapist can advise you about this. You might benefit from an epidural which is a steroid injection into the space next to where your nerves are irritated. Occasionally, when there is an identifiable cause to your symptoms which have not responded to other treatments surgery might be required.