Sciatica: causes and treatment

Sciatica is the medical term used to refer to debilitating pain experienced in the lower back, hips, buttocks, and all the way down each leg.

In our latest article, highly well-regarded and qualified London-based consultant neurosurgeon, Mr Dan Plev, walks us through in comprehensive detail what exactly sciatica is, what causes the condition, as well as outlining the various different treatment options available for patients suffering from the mobility-affecting condition.

What is sciatica?

Sciatica is a term used to describe a pain experienced in the nerves which leaves the lower back and passes through the buttocks and/or legs. It can be felt as a dull ache, shooting pain or numbness and can occasionally cause weakness in the legs.

Unlike some pain which comes and goes, sciatica is often constant. There is no escape from it and this is why it causes misery in most patients. Fortunately, in most cases, the pain will subside with a bit of time simply due to the fact that our body is more than capable of healing itself.

However, in cases where the pain does not subside, there exist a variety of different and effective treatment options.

What causes sciatica?

Our bodies are controlled by electrical signals sent through the nerves to all areas of our body. Nerves exit the spinal column at every level, branching out from our spinal cord. The sciatic nerve is formed by nerves exiting the lower part of the spinal column, which is referred to in medical terms as the lumbar spine.

The sciatic nerve branches out into smaller nerves which control the bottom half of our body. They run like electrical wires through our buttocks and legs. When something interrupts or irritates these nerves, they deliver a pain signal to the brain and that can be felt as sciatica.

There are a variety of causes which lead to patients suffering from sciatica, including sitting for long hours at an inappropriate desk while working from home, as many will have experienced over the numerous lockdowns recently. Usually, the origin is the lower back.

Our spine is made up of a stack of bones like cotton reels (vertebrae). Between the vertebrae, we have cushion-like discs or intervertebral discs which act as spongy shock absorbers as we move. The discs are also important as they create a gap between the solid vertebrae. The gaps create space for the nerves to pass through as they branch off from the spinal cord.

There are two main issues which can affect the nerves:

1) a problem with a disc

2) a narrowing of the space where the nerve travels

A sudden onset of sciatica can be caused by a small disc bulge pressing onto a nerve. In this circumstance, as the body moves, pressure changes may help to retract the bulge and relieve the pain. Our discs are designed to support our weight and allow us to move freely. They rely on movement to stay healthy and function as a unit with the muscles and ligaments.

Weakness and stiffness in the soft tissues can mean the disc and vertebrae are placed under increased load. When that is combined with exposure to load for long periods, most commonly from poor posture and lengthy periods of sitting, it can put more strain on the discs.

How is sciatica treated?

Manual therapy and exercise manual therapists will use a range of stretching and mobilisation techniques to increase the flexibility of the soft tissues and alleviate the stiffness in the joint. Pain creates a vicious cycle where we can’t move, but it is the movement which is so important for the cure.

The goal is to create some movement in the IDD Therapy – gentle and non-invasive IDD Therapy is the fastest growing non-surgical spinal treatment for intervertebral discs with more than 1,000 clinics worldwide and 34 clinics across the UK.

Safe, gentle and non-invasive IDD Therapy helps those who may require something more for their pain when manual therapy alone is insufficient to achieve lasting pain relief. As movement is restored and pain eventually begins to subside, certain exercises, which anyone can do at home, are important.

These are designed to help to move the joints of the spine and hips, in particular. Exercise keeps them active, strong and engaged so they can support their share of load as we move. Combined with gentle walking, these simple exercises help to keep our spines healthy and prevent further episodes of pain.

Patients lie on the Accu SPINA machine which delivers IDD Therapy. They are connected to the machine using ergonomic harnesses and pulling forces are applied at specific angles to treat the affected spinal level. A series of treatments are given and the forces used are gradually built up as the body adapts to the changes.

IDD Therapy is combined with some other modalities, such as heat, and is provided in combination with manual therapy and strengthening exercises as part of a care programme. There are also different types of injections available that can help treat sciatica. The most common is aimed at reducing inflammation. A steroid injection can be given which helps to neutralise the inflammation and relieve pain.

When should surgery be considered?

Surgery is the preferred treatment for sciatica when either the pain is intolerable and has not responded to other non-invasive treatments or the pressure on the nerve is so extreme that it is causing weakness, usually in the legs or, in very extreme cases, a loss of bladder or bowel control (cauda equina).

The most common surgery given is called a microdiscectomy, where a small incision is made in the lower back and, using surgical instruments, the piece of disc material is removed. This can be very effective in relieving leg pain.

If the space where the nerve lies is narrowed, other forms of decompression-focused surgery can be used where small pieces of bone are removed to create space for the nerve or to remove bone pressing.

When might urgent surgery be required?

In extreme cases, where a patient is experiencing weakness in their legs, surgery will be considered early. Weakness or a loss of leg power can be a sign that the nerve is at risk of damage and relieving the pressure quickly is very important.

Mr Dan Plev is an exceptionally experienced, trained and revered consultant neurosurgeon who can help treat mobility-affecting and nerve-damaging conditions. Check out his Top Doctors profile today to book an appointment with him.