Continuing our hugely popular medical column, Medical Matters, this week Dr Ciaran Roarty of Scally/McDaid Medical Practice explains the condition of Sciatica and how it can be treated.
What is Sciatica?
Sciatica is the name given to the pain that is caused by irritation or compression of the sciatic nerve. This is the longest nerve in the body and there is one on either side. It travels from the back of your pelvis, through your buttocks all the way down the leg until it ends at the feet. Interestingly sciatic type pain is usually felt in the buttocks and legs.
Symptoms of Sciatica
Compression or irritation of the sciatic nerve can cause a number of symptoms such as:
-Pain, which can vary from mild to quite severe. Sitting for long periods may worsen the pain as can coughing or sneezing.
-a “pins and needles” or tingling sensation that spreads from your lower back down one of your legs to your foot and toes.
-weakness in your calf muscles.
While patients with sciatica may also have more general back pain, sciatic pain usually affects the buttocks and legs more than the back.
You should see your doctor if your symptoms are severe, persistent or getting worse over time. Your doctor will usually confirm the diagnosis by taking a detailed history of your symptoms and carrying out an examination.
They will also ask about symptoms such as tingling or numbness between your legs and around the buttocks, the recent loss of control of the bladder, bowel or both as well as sciatic type pain in both of your legs, as these symptoms together are suggestive of more serious problems t and warrant more urgent attention.
What causes Sciatica?
We’ve often heard of a slipped (prolapsed) disc and this is by far the most common cause of sciatica. What happens is that part of the inner softer part of the disc – a type of shock absorber that sits between the small bones of the spine –bulges out through a weakness in the outer part of the disc and presses on the nerves coming out from the spinal cord. The cause of the damage may be unclear but often as we get older the discs become less flexible and the soft centre becomes more likely to rupture.
Less common causes of include:
Spinal stenosis – narrowing of the nerve passages in the spine.
A growth within the spine
Spondylolisthesis – where one of the small bones of the spine slips out of position.
Cauda Equina syndrome – a serious but thankfully rare condition where nerves in the spinal cord are compressed.
Treatment of Sciatica
Most cases resolve themselves in around 6 weeks. There are a number of things we can do at home to help ease the symptoms, such as taking anti-inflammatory painkillers, using hot and cold packs, staying as active as we can and gentle exercises.
Further treatment in certain cases may be needed: for example an exercise programme under the supervision of a physio, stronger pain relief, injections, manual therapy as carried out by physios, chiropractors or osteopaths and sometimes psychological therapy and support.
There are simple things we can do to help minimise the risk of further flare-ups such as having good posture at work and lifting correctly, stretching before and after exercise and of course exercising regularly. A firm mattress to support your body and keep your spine straight is also important.
The above information is intended as advice only and should you have any concerns contact your own Doctor.
Dr Ciaran Roarty MB BCh BAO MICGP DRCOG is a full-time GP at Scally McDaid Medical Practice, Scally Place, Letterkenny, Tel 0749164111