What is Sciatica?
Patients often describe that they have “sciatica” or say their “sciatica is playing up”. So what is sciatica and what does the evidence say is the best way to manage it?
Sciatica is radiating leg pain that can cause severe discomfort and dysfunction and is caused by inflammation or compression of the sciatic nerve which is the nerve that exits the spine from the L4, L5 and S1 vertebrae. There can also be low back pain present. Between 10-40% of people will suffer from it in their lifetime.
The patient will normally describe:
- Pain that radiates below the knee.
- Leg pain that is worse than back pain.
- Feeling of numbness or pins and needles in the leg.
Upon testing there will be pain when stretching the nerve, weakness of muscles and abnormal reflexes.
What causes sciatica?
- Nerve root compression from a herniated/bulged disc is the most common cause.
- Inflammation from herniated disc irritating nerve
- Inflammation from facet joint degeneration irritating nerve
- Lumbar spinal stenosis
- Piriformis muscle syndrome can entrap the sciatic nerve
Routine imaging is not advised and potentially harmful if not indicated.
An MRI may be considered if trauma was the reason for the onset of the sciatica, if a serious pathology is suspected or if there are progressive, worsening neurological symptoms such as weakness and worsening pain.
