Sciatica: A Pain in the Bum
Sciatica can vary from mild and infrequent pain to constant and incapacitating, both affecting your daily life. Sitting is difficult, sneezing and coughing is dangerous, putting on socks and shoes can be increasingly problematic, getting in the car becomes an event, even picking up the smallest piece of paper can send a lightening bolt of pain down your leg without warning. Life begins to feel like a struggle with the light at the end of the tunnel diminishing the longer time goes on as the frustration and depression sets in.
Often referred to as ‘back pain’ or ‘pain in the buttocks’, sciatica is not an injury but a condition. What’s the difference I hear you ask? An injury is a description in which possible damaged structures or problems are described whereas a condition, such as sciatica describes a collection of symptoms. While people with sciatica can also have general back pain, the pain associated with sciatica usually affects the buttocks and legs much more than the back. Due to this the symptoms of Sciatica can vary from patient to patient but is often characterised by one or more of the following symptoms:
Quick do’s and don’ts before you start
DON’T sit down for long periods
DO use heat after 48 hours
DON’T put up with the pain
DO fight the symptoms
DO seek treatment if persistent
Step 1 Understand the Cause
Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve. The type, severity and location of sciatic pain can vary as a number of issues can cause this irritation to the nerve. Some of the most common causes are: misaligned vertebra, herniated disc, compressed disc, fractured vertebra, damaged nerve, swollen ligament or tendon or even a pulled or tight muscle. Often, a particular event or injury does not cause sciatica, but rather sciatic nerve pain tends to develop over time. The key to alleviating sciatica is to first understand what structures are causing the irritation to the nerve, by understanding this you can take direct steps to reducing your pain and feel like you’re getting your life back.
Are you suffering from?
- Constant pain in only one side of the buttock or leg (sciatica rarely occurs in both legs)
- Burning or tingling down the leg
- Pain that is worse when sitting
- Weakness, numbness or difficulty moving the leg or foot
- A sharp pain that may make it difficult to stand up or to walk
Step 2 Fight the symptoms
Like with most back pain conditions, one of the worst things you can do is stay still, or even worse with sciatica; sit. Sitting can cause more compression or irritation of the sciatic nerve resulting in your pain and symptoms increasing. It helps to stay active and mobile but reduce your activity overall, this includes no twisting or heavy lifting. Although I do not like the use of medication due the negative side effects on the body, sometimes it is necessary in order to keep active preventing the muscles from tightening. Non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen or naproxen will help to reduce pain and prevent further inflammation by blocking COX-2 mostly in the central nervous system. These medications are available over the counter in chemist’s in most countries. It is important to consult your chemist or GP prior to taking any medication as each have side effects that may affect you.
Fighting the symptoms – The top 5 ways to ease sciatica immediately.
Applying heat to the lower back and painful areas after 48 hours of symptoms can help to reduce sciatic pain by increasing circulation and reducing muscle spasms which can cause restriction to the sciatic nerve. Apply heat (a hot water bottle or microwavable heat pack) on the area for 20 to 30 minutes every 2 hours for as many days as necessary. Do not apply heat directly onto your skin as you can burn yourself.
Try to avoid sitting, particularly for periods longer than 1 hour, it is much better to stay standing or lying down on your front if possible. Self-stretching regularly will help to reduce muscle spasms that may be around the sciatic nerve and causing restriction and irritation. The Piriformis muscle in particular can be a prevalent cause of sciatic nerve compression commonly referred to as ‘Piriformis syndrome’ and can easily be stretched. Psoas Major and Iliacus muscles are also important to stretch as they can cause more rounding of the lower back. For guidance of the best stretches for lower back pain and sciatica please see:
Stretch it out: The top 10 stretches to ease your back pain.
As the sciatic nerve is compressed or irritated, not all signals to the muscle are being communicated effectively resulting in weakness in the leg. In severe cases of sciatica, you may need to use assistive devices such as walking sticks or crutches to help you get around. These devices can provide support for your leg to prevent you falling if your leg gives way. Knowing your leg can give way at the most unexpected times, it’s important to take precautions in your daily activities. You are already in pain, falling down the stairs at home as your leg has given way unexpectedly would not be a good thing. A back brace can help provide stability to your back giving you piece of mind though most likely will not change your symptoms significantly.
Step 3 Know if you need help
Although prolonged compression of a nerve can result in nerve degeneration, it’s rare that permeant sciatic nerve damage will result from sciatica. Many cases of sciatica will ease in around six weeks and with treatment the majority of people who experience sciatica get better within a few weeks or months finding pain relief with non-surgical treatment. For others, however, sciatic pain from a pinched sciatic nerve can be severe and debilitating with long term pain.
If after fighting the symptoms for two weeks, your pain has not subsided and is effecting your daily life, it is best to seek treatment. Although treatment methods can vary between each profession, rehabilitators, physiotherapists, chiropractors and physical therapists can all help with sciatica. In our experience after treating thousands of patients with back pain and sciatica, we have found a specialised combination of treatments to be the most effective for patients. As sitting can make your condition worse, a mobile service which come to you can be more beneficial as your sciatica is not aggravated from driving (sitting position) to a clinic.
When your pain and condition has subsided we also recommend specific lower back exercises and stretches to increase movement and reduce and help to prevent sciatica returning. Your rehabilitation program should include the strengthening of the lower back and pelvic stabilising muscles to improve function and core strength. Posture retraining can also prove beneficial in reducing the contributing factors to sciatica and other back pain conditions. For a guide on improving your posture see:
Stand up tall: 5 of the best posture exercise to ease back pain, improve concentration and become more motivated.
If you are experiencing any of the following symptoms it is increasingly important to get help immediately:
Do you have?
- You have pain in your lower back at night or when resting
- You have back pain with numbness below the knee
- You have weakness in one leg only
- You are unsure or have concerns about your condition
The Cauda Equina is a group of nerves at the very bottom of your spine which control many important functions for your body. It is even more important to get yourself to A&E department immediately if you are experiencing:
- Trouble holding back your urine or bowel movements
- Weakness in both legs
- Numbness in your groin or buttocks
For Cauda Equina nerve entrapment immediate neurological consultation is needed as urgent surgical spinal decompression to prevent permanent neurological damage may be required.
While every effort been made to ensure this article’s accuracy and evidence based, it doesn’t constitute legal advice tailored to your individual circumstances. If you act on it, you acknowledge that you do so at your own risk. We can’t assume responsibility and don’t accept liability for any damage or loss which may arise as a result of your reliance upon it.