One of the main symptoms associated with sciatic nerve irritation is pain. In most cases, the discomfort will be felt either in the area of skin supplied by the nerve or along the path the nerve takes on its journey into the foot. Typically, what this means is that pain can be felt on the back or outer edge of the thigh and/or calf and possibly into the foot. As mentioned before, back pain can be a feature of sciatica but not for everyone. Although everyone is different, people with sciatica will often find when they put pressure on their buttock (sitting down) or stretching their leg straight (sitting with your feet up on the coffee table, driving or sitting up in bed) will make their pain worse.
Sciatica
This page has been designed to provide you with the right information about sciatica and the rehabilitation that may help you in your recovery.
What is sciatica?
The term sciatica generally relates to an irritation of the sciatic nerve.
Your sciatic nerve comes from the lower levels of your back, passes through your buttock, down the back of your leg on its way to the foot. It is most often characterised by leg pain, but some people may also experience tingling or numbness. Back pain can also sometimes be associated with sciatica.
That sounds really complicated. Can you explain it more simply?
The nerves that supply your legs with their ability to work and feel come from your lower back. Your nerve’s main job (amongst other things) is to pass information (nerve impulses) down to their target site (muscle or joint or skin) and transport messages back up again to your spinal cord and your brain. Your sciatic nerve (and some smaller nerves that branch off it) provide the muscles on the back of your leg, your calf/shin and foot with their ability to work. It also provides (indirectly) the skin on the calf/shin and foot with its ability to feel touch, temperature and pressure.
Your nerves pass out of your lower back via small holes called foramen on their way down to your leg and foot. They are very good at doing their job and are generally quite resilient (i.e. they can put up with a lot of work without complaining) however, they are sensitive (hitting your funny bone which is actually a nerve is a good example of this). On the nerve’s journey from the back into your leg it is occasionally irritated and sometimes this can cause it to become upset and start to cause you issues.
Is it the same as a trapped nerve?
The term ‘trapped nerve’ is quite misleading and not a useful or accurate way of describing the issue. Worst of all, it can potentially cause people to get the wrong impression of what is causing their symptoms and worry that something is ‘trapped’ and needs ‘un-trapping’ in their back.
Nerves don’t get trapped. Nerves are sensitive and they can get irritated, just like any other type of body tissue. Certain things such as disc or joint changes or an injury can sometimes cause nerve irritation, but sciatica itself is not a damage problem and is certainly not because something is trapped in your back.
Does it matter what you call it?
We really think it does. Words are incredibly important as they help us understand what might be going on in our body and what we are dealing with. If you have been told that you have leg/back pain and that it is something you need to be concerned about, it is only natural to find yourself worrying about it. If things are explained correctly and words, phrases and images are used appropriately, you are likely to understand the issue better and be in a better frame of mind to do something about it.
To that end, you might find that your leg pain might be called ‘radicular pain’, ‘neuropathic pain’ or a ‘lumbar radiculopathy’ by people in the healthcare setting. Although these words might sound concerning, they essentially mean the same thing i.e. an irritated nerve. Most people are familiar with the word sciatica and given that it means virtually the same as some of the medical names we’ve just mentioned, we will use the terms sciatica for the remainder of this information page.
What are the common symptoms with sciatica?
This is a really important question; it is useful for you to know what is normal with sciatica as it can sometimes be a worrying time when your leg is really sore. We’ve broken the answer down into things that are found most commonly:
What causes sciatica?
It is not always clear to determine the cause of sciatica. In the past, it used to be thought that a nerve has to be touched, pinched or pressed on to cause it to become upset, however recent research suggests that nerves can become irritated without being physically touched. Inflammation (the body’s way of dealing with insult and injury) of some of the structures near the nerve can cause a change in the environment around it and might be enough to irritate it. With this in mind, nerves can still become irritated if something is creating pressure on or around them, such as disc and joint changes (Barrett & Hilibrand, 2015).
Interestingly, it is worth acknowledging that other factors might play a part in you developing symptoms with sciatica. How you are feeling, how well you sleep, whether you are dealing with emotional hardship or stress at the time, your physical fitness and the support network you have around you can all play a part in whether you develop symptoms or not, or how severely you might feel them.
I’ve been told that I’ve slipped a disc. Is that why I’ve got sciatica?
The term ‘slipped disc’ is another one of the misleading terms that seems to be used frequently when dealing with back and/or leg pain. The main reason that it is a misleading and unhelpful way of describing some normal disc changes, is that your disc cannot slip out of place. Your discs are part of your spine and are so firmly attached to the vertebrae (spinal bones) that they do not come in and out of place.
“A disc is so firmly attached to its vertebrae that it can never, ever slip”
Professor Lorimer Moseley
So why have I been told I’ve got a slipped disc then?
This is a good question and the answer is likely to be a little complicated and different for each person. Some words and phrases, good or bad, can stick and the term ‘slipped disc’, albeit misleading and not helpful, seems to have stuck over many years. It is likely that you have come across the phrase talking to friends, family, searching the internet or even talking to healthcare professionals. Although not dangerous itself, the term ‘slipped disc’ and more importantly the impression or image it might conjure up for people is the reason why it can be harmful.
A different and perhaps better way to think about discs is by thinking about the last time you had a big meal. After a large lunch, your stomach will be full and can feel bigger and change shape (making you need to loosen your trousers in some cases!). A disc is designed as a shock absorber for the spine and therefore is able to adapt and change to allow you to cope with everyday things like lifting, walking and carrying things. Your discs can change shape (often seen on MRIs and labelled as ‘disc bulges’ or ‘disc protrusions’) and just like your stomach, they can settle and ‘change back’ after a period of time. In a review conducted by Chiu et al (2014), it was found that approximately 41% of disc protrusions (when the disc can change shape) will heal by themselves within 3 to 12 months.
How is sciatica diagnosed?
In most cases, sciatica can be diagnosed through clinical features (what it looks like and how it behaves), your symptoms (what you tell us about your pain and how it is affecting your everyday life) and the clinical assessment (testing the movements etc.).
Shouldn’t I have a scan to help find out what is wrong?
Scans and X-rays are a very important part of healthcare, however, for most people they are not required to work out what might be causing your pain. A detailed assessment including asking some specific questions, or a physical assessment where you’re asked to show some movements etc. can often be enough to confirm that your symptoms are nothing nasty and that rehabilitation is the right thing to help you get better.
Interestingly, the National Institute for Health and Care Excellence (NICE) recently updated their guidelines for the management of low back pain and sciatica in over 16s to state that imaging (MRI/CT and X-rays) should not be routinely offered to people suffering with back pain (NICE, 2016).
Interestingly, there is a growing body of evidence (research/ clinical studies) that suggest that some things found in MRIs/ in X-rays and labelled as ‘abnormal’ are just as common in people with pain as they are in people without pain. To help demonstrate this, Brinjikji et al. (2015) completed a study of over 3000 people who had no back pain and found that 50% of 40-year-olds had disc bulges; 50% of 60-year-olds had age-related changes (otherwise known as osteoarthritis), and nearly 100% of people in their 80s had disc changes. In other words, some of these ‘abnormalities’ can be considered as normal signs of ageing, as they are there whether you are in pain or not. This doesn’t mean that X-ray or MRI findings don’t matter, but it means that they might only form part of an assessment and shouldn’t be relied upon alone.
If you have had a scan and are finding yourself worrying about the results, it’s very important to discuss these with your physio, as they may be able to explain the results in a way that makes them easier to understand. It is important to know that an MRI does not predict your future either. In other words, if you’ve had an MRI scan, the results don’t mean that you will be worse as you get older. Saakksjarvi et al. (2020) followed up 26 patients who had had an MRI of their lower back in 1987 and found that although the changes found on MRI were more obvious on the repeat scan in 2017 (30 years later), the changes were not associated with worsening of pain or disability. In simple terms, although some changes were found on MRI when these patients were younger, it didn’t mean that they were in more pain or had more difficulties as they got older.
Should I go to Accident and Emergency?
Sciatica can sometimes be very painful and as such, quite distressing and worrying. For most people, they are able to make a recovery without needing to seek more help than just a GP and their physiotherapist.
Is there anything that I need to look out for?
Most low back pain is caused by an irritation of certain structures around your lumbar spine region, however it is very important to be aware of certain symptoms that are less common with back pain and what you should do if you have any:
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New (within the last 2 weeks) altered bladder function (difficulty starting, stopping, maintaining a wee or even knowing that you need to go).
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New (within the last 2 weeks) altered bowel function (incontinence or leaking or not knowing when your bowel is full).
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New (within the last 2 weeks) altered sensation around your genitals, anus or inner thighs (a change in the feeling or ability to feel temperature around where you would sit on a bike or horse saddle).
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New (within the last 2 weeks) difficulty coordinating your legs/rapid loss of leg strength (‘jelly-legs’ or that your legs won’t go where you want them to)
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New (within the last 2 weeks) altered sexual function (men: unable to achieve an erection or ejaculate; women: altered feeling during penetrative or oral sex)
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New (within the last 2 weeks) pain going into both legs
If you suddenly develop any or a combination of the symptoms listed above, you may need urgent medical assessment and you should attend A&E as soon you can. |
This information can be accessed in a variety of different languages here.
A summary of this information can be found in this short animation:
Is there anything else I should be looking out for?
The list above are the things that are most important for you to be aware of if you are dealing with back pain. However, there are a few other things that you should be aware of that are not dangerous, damaging or worrying, but might just mean that a different type of treatment will suit you better.
Along with your back pain, if you have any of the following symptoms (or more than one), you should discuss them with your physiotherapist or GP:
- Having a temperature or fever alongside your lower back pain
- Inability to lie flat due to your back pain
- A history of cancer and/or loss of weight alongside your lower back pain
What can I do to help myself?
Reassuringly, there are lots of things that you can do to help get your rehabilitation going and start your recovery.
What can physiotherapy do for me?
Physiotherapy for sciatica and/or back pain can be very effective. We offer a range of options to help you manage your complaint with exercise, education and lifestyle advice/coaching forming the main part of what we can offer you. We are also able to offer other treatments including manual therapy (hands-on), however these would only likely be offered alongside the exercise, education and lifestyle advice and decided upon on a case-by-case basis.
Will it get better?
In a lot of cases, it is very much possible for you to improve the symptoms you have with your leg/back. Most cases of sciatica will get better over time, but this will vary between people, with some recovering within weeks and some taking several months. Obviously, it is impossible to predict the timescale or the path that your recovery will take but encouragingly, with normal confident movement, increased physical and emotional fitness and resilience (if needed), most people will find that their symptoms can change for the better.
How long will it take before I feel something?
This is a very difficult question, but it is best think about how much time and effort you are going to throw at the challenge and how confident and motivated you are to do something about it. If you work hard and are consistent with what you do, often people will notice signs of positive response within weeks to months. If you are not committed to the challenge, it will take longer or may not respond at all.
It is worth remembering that in a lot of cases, the first signs of your sciatica settling/getting better is that the symptoms (pain/tingling) don’t go quite as far down your leg. In other words, you might find the pain/symptoms in your foot/calf eases before your thigh or buttock.
What happens if I do all of this and it doesn’t get better?
It is worth reminding yourself that most people’s symptoms do improve over time. It might be difficult to believe this when your leg/back is really sore and you can’t see any progress, however progress will often come in small amounts and is most likely to take weeks rather than days.
If you have really committed yourself to your rehabilitation and things simply are not improving, do speak with your physiotherapist as they will be able to discuss what other options may be available to you.
If your symptoms at any stage get worse, you should speak to your GP or physiotherapist who will again be able to discuss what options might be suitable for you.
Frequently asked questions
Below are some of the common questions that are asked when talking about sciatica that haven’t been covered in the information above.
Q: Do I need to have an operation?
A: The vast majority of people do not need to have an operation to help them with sciatica. In some cases (e.g. with extreme pain that isn’t responding to treatment or when the nerve starts to struggle to work i.e. worsening muscle strength), you might be referred for a specialist opinion at the Pain Management clinic.
A: As with the previous question, most people are able to recover from sciatica without needing to resort to operations or injections. As with the previous answer, if you have been working on your rehabilitation and you and your physiotherapist feel that nothing is really working or your symptoms worsen, then you may be referred for a specialist opinion at the Pain Management clinic.
A: Acupuncture is not advised for the treatment of back pain with/without sciatica (NICE 2016).
Q: Why are the exercises aimed at moving my back?
A: As mentioned above, a very common place for your nerves to become irritated is on their path out of your lower back on their way to your leg and foot. Exercises targeting your lower back with gentle, confident movement can really help your leg symptoms.
Q: Are the exercises going to be sore?
A: If your leg is sore to begin with, it is normal to expect that starting some exercises might be a bit sore to start with. As you get better and start to tolerate the exercises better, you should find that they are more comfortable, however it is worth knowing that strengthening exercises are meant to be hard work (and a bit sore), so if they’ve become too easy perhaps you need to increase the challenge.
Q: I don’t have any weights at home, how am I supposed to do the exercises?
A: This doesn’t matter. Most, if not all, of the exercises below can be modified or adapted using heavy bags, bottles of water or even books.
A: The pain in your leg is not an indication of damage, therefore it is safe to do normal things. Making sensible changes to the things that are most sore to allow your leg to calm down is a very sensible approach. Try to think of it as working with your symptoms, not against them. If something is really sore, it makes sense not to force it and work within a range that is comfortable, but it is safe to be sore.
Q: Are exercises the only things I can do?
A: Quite simply, no! The exercises will help get you moving and hopefully help with your strength, which are both important for helping leg pain, however, often looking at the things that your leg doesn’t like such as standing for long periods/carrying shopping and making some changes/adaptations to those things will help the exercises be more effective.
Q: Should I change my mattress?
A: If you are not having issues with your sleep, changing your mattress wouldn’t be advised. If you are having issues, first think about what changes/effort you're putting into controlling your leg pain during the day, as this is likely to be most effective. If you want to change your mattress and think it will help, then choose the one that is most comfortable. There isn’t a ‘best’ mattress as we all have different needs and preferences.
Q: What happens if I do all of this and it just doesn’t get better?
A: As mentioned before, ask yourself if you have really done everything you can to try and move your leg issue forwards. If the answer is no, consider re-reading the information above and seeking some guidance from your physio.
If you have really committed to your rehabilitation and still don’t find any benefit, then please bring this up with your physio who will be able to discuss your options.
Exercise tip:
For positional exercises, consider this as a position that you can try to get into whenever you can, as often as you can.
For movement exercises, aim to complete the exercises little and often throughout the day within what is comfortable.
For ‘nerve’ exercises, try to complete these exercises little and often throughout the day. Try to complete the movements for 30 seconds and complete 2-3 times. Feel free to adapt or change the exercise if you need to.
Possible idea for comfortable resting position:
‘Nerve’ Exercises
References:
Chiu, C.C., Chuang, T.Y. and Chang, K.H. (2014). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation. doi.org/10.1177/0269215514540919. Accessed: 07/07/2021.
Belavy, D.L., Albracht, K., Bruggermann, G.P., Vergrosen, P.P.P and van Dieen, J. (2016). Can exercise positively influence the intervertebral disc? Sports Medicine. 46(4):473-85. doi: 10.1007/s40279-015-0444-2. Accessed: 07/07/2021.
Brinkjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., Deyo, R.A., Halabi,S. and Turner, J.A. et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 36(4):811-6. doi: 10.3174/ajnr.A4173. Accessed: 01/07/2021.
Greenhalgh, S., Finucane, L., Mercer, C. and Self, J. (2018). Assessment and management of cauda equina syndrome. Musculoskeletal Science and Practice. doi: 10.1016/j.msksp.2018.06.002. Accessed: 29/06/2021.
National Institute for Health and Care Excellence (2016. Updated 2020). Low back pain and sciatica in over 16s: assessment and management (NG59). Available at: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions/low-back-pain. Accessed 01/07/2021
Sääksjärvi, S., Kerttula, L., Luoma, K., Paajanen, H. and Waris, E. (2020). Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study. Spine. 45(19):1341-1347.doi: 10.1097/BRS.0000000000003548. Accessed: 01/07/2021.