The truth on sciatica treatments; what your GP will offer and what they’ll fail to mention!

 With NHS resources at an all-time low and the average length of a GP appointment clocking in at under 10 minutes in the UK today, no matter how chronic the symptoms or intense the pain, it’s unlikely that your doctor has the time or resources to bring you anything beyond the cheapest of quick fixes for sciatic symptoms.

So, for one big blue skies moment, let’s set aside the notion of time and money (how refreshing would that be for the medical professional and their patients?) and consider the options that your GP might talk you through if he had the wherewithal to explore the full range of possible sciaticatreating solutions in depth.

Maybe have a quick read of this before your next trip to the surgery. That way, you can arrive informed ready to ask questions on the best steps for dealing with your own sciatica:

Option 1. Anti-inflammatory drugs

Affordablepain relief is often the go-to for doctors seeking to ease distress for their patients. Anti-inflammatory drugs like Ibuprofen are often suggested or prescribed to manage the pain involved in sciatica. Many of us wish to avoid the prolonged use of pain relief drugs as they can carry their own risks of complications and side effects.

Option 2. Steroid injections

Epidurals with steroids may be offered as a short-term solution for pain relief but they can be as painful as the sciatica itself.The long-term benefits remain unproven and the short-term side effects can include depigmentation around the area of injection as well as fat atrophy. This is a cosmetic depression in the skin which can bring with it soreness and tenderness as a result of the loss of padding from the fat.

Option 3. Heat

Although tempting to seek the relief of heat at the site of pain, use of hotwater bottles and heat pads carry their own risk of scalding the skin, especially if pain symptoms are causing numbness to the area. You won’t feel the burn.

Option 4. Ice

Similarly, ice packs may appear to offer the promise of reducing swelling to discs but often are impractical to apply to the key areas of pain, can burn your skin and be generally ineffective.

Option 5. Get physical

Working on strength and conditioning to build your core can be a highly effective route to pain relief. However, if you’re already experiencing extreme discomfort this can be hard to achieve and problematic if you don’t know the correct exercises to do.You could pay for private physiotherapy or a personal trainer with experience in working with sciatica sufferers but this has a cost attached and will rarely be offered.

Option 6. Go under the knife

For most medics referring you to surgery will be a last resort when it is necessary for the surgeon to work on what is pushing on the sciatic nerve and causing your painful symptoms. This can be to remove all or parts of a herniated disc and although compared to some surgery is relatively minimally invasive, it carries with it all the risk of surgery, the inconvenience of time off work and time spent in recovery. You may not be a suitable candidate for an operation.

6. Shockwave therapy (ESWT)

Sciaticalm is a small device which has been shown to relieve pain quickly and inexpensively. It offers extracorporteal shockwave therapy that you can control yourself and is safe and free from side effects. Small, flexible and easy to use at home or work, thousands of customers report how helpful it is for chronic pain relief.

So what next? Are there ways you can help yourself to support your recovery and ease your symptoms?

Next week: Stretch the possibilities – discover the top 3 best exercises for sciatica.

What is sciatica?

If you’re sitting at home suffering with pain in your back, hip and the outer side of your leg, you might be searching on those symptoms or talking to friends and relatives who may suggest you’re suffering from sciatica. But what actually is that and is it in itself a diagnosis?

The term sciatica (phonetically pronounced – with emphasis on the bold text as sci-at-ick-er) is named from the sciatic nerve which is the largest single nerve in the human body. It starts either side of the lower spine when smaller nerves exiting the spine form together into the bigger sciatic nerve, as wide as an adult thumb. It then runs right through the buttock, fairly deeply, into the back of the thigh and down behind the knee. There it separates into the tibial nerve and common peroneal nerve which continue down the leg all the way into the foot and down to the toes. As you might expect, such a dominant and large nerve, plays a critical role in movement connecting the spinal cord with muscles in the leg and foot.

A variety of conditions in the lower back can irritate the sciatic nerve and cause pain to radiate along that nerve. This can be hugely debilitating and unpleasant for the sufferer as it presents as pain in a variety of ways and with various levels of intensity.

Sciatica sufferers describe the following key symptoms:

  • a dull ache in the lower back and buttocks
  • stabbing, throbbing, shooting or burning pain
  • tingling, numbness, pins and needles
  • weakness in the legs and foot

In fact, a combination of all these painful sensations is often felt in the buttocks, back of the legs, feet and toes. The pain often starts in the lower back and radiates down the buttock, following the path of the sciatic nerve into just one leg rather than both.

Sciatica is also usually experienced more intensely on sitting or standing and generally feels better by walking movement or lying down to relieve the pressure. Symptoms can be experienced more acutely through stepping up or down stairs, uneven surfaces and involuntary movements. A sneezing fit or bout of coughing can wrack the body with intense pain.

In fact, sciatica is actually a way of describing what is happening to the body in pain from an irritated sciatic nerve. In that sense, it is a symptom rather than a diagnosis in itself, as the cause of the pain may be unknown and frequently harder to diagnose. Most GPs may mention sciatica in response to the symptoms described and acknowledge that it is clearly caused by some form of pinching or compression to the sciatic nerve at the lumbar segment.

Left untreated sciatica is said to calm itself and can get better within 4 to 6 weeks, although anecdotal evidence doesn’t tend to support that recovery is permanent. Many sufferers tell of repeated flare-ups, finding their own ways to relieve pain and speed recovery which we will discuss in future articles here along with possible root causes of that sciatic pain. Do subscribe to find out more…

Next week: The truth on sciatica treatments; what your GP will offer and what they’ll fail to mention!

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Is sciatic nerve pain something I just have to put up with?

No, sciatic pain does not have to be a chronic condition. The medical condition called “sciatica” is a major cause of work absenteeism and a major financial burden to both employers and our health care system. Your sciatic nerve is the largest nerve in your body. It begins as a bundle of nerves in your lower back and passes through your pelvis and down the back of each thigh. In the back of the thigh, the sciatic nerve splits into two smaller nerves called the tibial nerve and the peroneal nerve. The sciatic nerve carries impulses from nerves in your lower back to the muscles and nerves in buttocks, thighs, and lower legs. Sciatic pain consists of leg pain, which feels like a ‘pinched nerve’ or cramp, that can shoot down your leg to your foot, making sitting or standing very painful. Sciatica can occur suddenly,or develop gradually. You might feel a numbness, or a burning or tingling (“pins and needles”) sensation in your legs or toes.

The term ‘sciatica’ has come to be used to describe any pain felt in the leg along the length of the sciatic nerve. The incidence of sciatica is related to age. It is rarely seen before the age of 20, and it peaks in the fifth decade and declines thereafter. Between 13% and 40% of people will have sciatica sometime in their life. Sciatica has been called a symptom, a pinched nerve affecting one or more of the lower spinal nerves. The nerve might be pinched inside or outside of the spinal canal as it passes into the leg. Sciatic pain seems to involve a complex interaction of inflammatory, immune, and pressure-related elements. Symptoms like paralysis or incontinence indicate a more serious problem like nerve damage or a disease, and should be reported immediately to your primary care doctor.

The exact nature of the relationship of sciatica to disc, nerve, and pain is not yet certain. A herniated or ‘slipped disc’ is the most common cause of sciatica, but there is no one basic cause. Not everyone’s spinal disks age at the same pace. Spinal disks lose their elasticity over time: they lose fluid and become brittle and cracked. These changes are a normal part of aging. Another cause can be a small muscle deep in the buttocks that becomes tight or spasms, which puts pressure on the sciatic nerve. Narrowing of the spinal column, or a vertebra that is out of line, can affect the sciatic nerve.

Fortunately, most cases of sciatica are short term, and the pain resolves within a matter of weeks or months. But some cases do not resolve quickly, and 10% to 40% of cases can require treatment for chronic pain. Most patients with sciatica can be treated by their primary care doctor without the need for further diagnostic testing. The goal is to reduce pain and increase mobility. Physical therapy, with customized stretching exercises to improve flexibility of tight muscles, are often where treatment will begin, along with the use of NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin or ibuprofen to temporarily relieve pain and inflammation. In other cases, tests like Magnetic resonance imaging (MRI) or computed tomography (CT) scan are used to obtain images of the structures of the back. Spinal injections of an anti-inflammatory medicine, or surgery is available for people who don’t respond to other treatment, and who have severe pain. Many people believe that massage, yoga or acupuncture can improve sciatica. You can take steps to protect your back and reduce your risk for getting sciatica pain:

Practice proper lifting techniques – Lift with your back straight, bringing yourself up with your hips and legs, and holding the object close to your chest. Use this technique for lifting everything, no matter how light.

Avoid/stop cigarette smoking, which promotes disc degeneration.

Exercise regularly to strengthen the muscles of your back and abdomen, which work to support your spine. Whether you are sitting or lying down, tighten your stomach
muscles often, hold them tight, then release.

Use good posture when you are sitting, standing, and sleeping. Good posture helps to relieve the pressure on your lower back. Wrap up a towel for lower back support in your car seat or desk chair.

Avoid sitting for long periods.