Sciatica is the name given to a range of symptoms that is caused by compression or irritation of the sciatic nerve. As a term, it is often used to describe any leg pains thought to originate from the back. Sciatica is commonly associated with back pain and is a condition that is not uncommonly treated by back surgery although many other treatment options exist.
Sciatica symptoms can be quite variable and often vary significantly by the time of day or the day of the week. They range from mild be extremely severe and can be made worse or improved by certain movements and positions.
- Burning or Tingling pain in the leg – often in a specific, consistent area
- Sharp shooting pain down the leg
- Pain worse on sitting or bending down (especially when for long periods of time)
- Weakness of leg, foot or toe muscles
- Numbness of skin of legs
- Pain particularly on one side of the lower back or one leg
Is it permanent? What is the risk of sciatic nerve damage?
Although the symptoms of sciatica originate from irritation of the sciatic nerve, it is uncommon for any permanent damage to the nerve to occur – in other word, a delayed diagnosis or delay to treatment is unlikely to affect final outcome. Nevertheless, it makes sense to start treatment early and it is certainly important to seek a review by a qualified back doctor at the first possible opportunity.
What is the sciatic nerve?
The sciatic nerve is the largest nerve in the body. There is one on the left and one on the right and they runs from the vertebrae of the lower back, down the back of each leg and supply many of the big muscles of the leg and also the overlying skin.
The nerves starts from a smaller nerve ‘root’ at the level of the back known as lumbar 4 (L4) and from further nerve roots down to the sacral region, sacral 3 (S3). Compression can be worst at L4, L5, S1, S2 or S3. Each of these levels supplies a particular area of the skin or muscle and a qualified back doctor will be able to determine which level is most likely affected by examining you.
For example, an L5 level compression of the sciatic nerve tends to result in difficulty in lifting the big toe or ankle and there may be numbness of the top of the foot.
Nerve compression is generally due to a protruding vertebral disc but rarely it can be a result of a condition call piriformis syndrome.
What is the prognosis?
Sciatica is common and most people will find their symptoms improve with simple treatment measures within a few weeks to months. A few people will have severe symptoms that fail to fully respond and, for some, back surgery may be considered as a last resort.
Is sciatica ever an emergency?
If you develop numbness around the buttocks and groin, or difficulty in passing urine or stool, or weakness of the legs, then you must seek medical attention immediately as you may have developed ‘cauda equina syndrome’. This must be treated quickly to avoid lasting damage to the spinal cord and is considered an emergency.
Early surgery is also considered if your sciatica symptoms get continuously worse, particularly if this happens over a short period of time, as in this case nerve damage is a possibility.
Treatment options for sciatica?
A good back brace has been shown to help some people with sciatica. Some other helpful measures, as for almost all back pain, include back exercises, back stretches, or other alternatives to back surgery.