Sciatica | Mate haiataka

Your spine is made up of bones which are called vertebrae, and intervertebral discs (discs for short) that act as cushions between the bones.

The most common cause of sciatica is a prolapsed or herniated disc (also known as a ‘slipped disc’). This is when a disc bulges into 1 or more spinal nerves, or when there is a tear in the outer layer of the disc and the gel-like filling oozes out and irritates a spinal nerve. 

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Spinal stenosis is another common cause of sciatica. This is related to getting older and slowly gets worse over time. The parts of your spine that the nerves pass through become narrower, which can irritate or compress 1 or more of your spinal nerves.  

Disc herniations and spinal stenosis don’t always cause symptoms. Many people have these conditions and don’t know about it. They’re only a problem if symptoms develop.  

Less common causes of sciatica are:  

• spondylolisthesis – this is when a vertebra slips out of position and irritates or compresses a nerve root 
• a spinal or back injury or infection 
• a growth within your spine, such as a tumour 
• cauda equina syndrome, a rare but serious condition caused by compressed and damaged nerves in your spinal cord.   

The most common symptoms of sciatica are:

• shooting, stabbing, electric shock pain which usually starts in your lower back and buttock and runs down one leg past your knee and sometimes into your calf and foot
• numbness, weakness or pins and needles in a part of your buttock, leg and foot
• lower back pain.

If you only have lower back pain, or if the pain in the leg is in a large area, then it's probably not sciatica.

The most common pattern of pain is down your buttocks and the back of your leg, and into your foot. The pain in your leg is normally worse than the pain in your back or you mightn’t have any back pain at all.  

The pain can be mild or severe, and it can start suddenly or gradually. Sneezing, coughing or sitting for a long period of time may make it worse.  

See your healthcare provider if you have any of the following: 

• severe, ongoing or worsening pain 
• weakness or difficulty lifting your foot when walking  
• bowel or bladder problems, eg, loss of control or incontinence 
• fever or other symptoms that are worrying you.  

Your healthcare provider will ask you questions about your symptoms and examine your back and parts of your nervous system. This may include looking at how you walk, how your back and leg move, testing the strength and reflexes in your legs and feet and testing for numbness, tingling or reduced feeling in your leg. 

Scans aren’t needed to diagnose sciatica. Most people will get better on their own. Having a scan doesn’t change your treatment and isn’t needed. 

Your healthcare provider may arrange an X-ray or an MRI scan if:

• your symptoms or examination suggest:
  • you have a different problem
  • a cause for your sciatica which needs different treatment.
• your symptoms are not getting better after 6 weeks.

It's common to find a bulging or prolapsed disc on an MRI scan, especially as you get older. They often don't cause any problems, so finding one on a scan doesn't necessarily mean it's causing your symptoms.

Sciatica can improve without specific treatment so your healthcare provider may suggest a watch and wait approach to give your body time to heal naturally. During this time there are things you can do yourself to manage your sciatica. 

Painkillers, such as anti-inflammatories (NSAIDs) and paracetamol can help. Read more about pain relief medicines for short term pain. Talk to your healthcare provider about nerve pain medications eg, nortriptyline or amitriptyline, which can also help. 

See your healthcare provider if the pain hasn’t improved after trying home treatment for a few weeks, or if it's getting worse or stopping you from doing your normal activities. 

You should try and stay as active as possible as this will help your recovery. If you’re worried that movement or activity will make your pain worse, or cause more damage, talk to your healthcare provider. They can help relieve any anxiety or fear you may have so you can continue with your daily activities.   

If your symptoms are severe, your healthcare provider may talk to you about seeing a specialist doctor to discuss the following options: 

• Steroid injection – these are done using a scanning machine to safely guide the needle into the problem area in your spine where the steroid medicine is injected to reduce swelling and inflammation. 

• Surgery – this might be considered if you have severe symptoms or if your symptoms continue for more than a few months. However, it’s uncommon to end up needing surgery for sciatica. 

Because the cause of sciatica is often in your back, the treatment is often similar. Read more about back pain treatment.

Sciatica can be a real pain in the backside … and leg, and foot. 

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There are things you can do yourself to help you manage your sciatica: 

• Carry on with your normal activities as much as possible. 
• Gentle exercise – regular, gentle exercise and stretching can help your sciatica get better faster. 
• Make sure your posture is good when sitting and standing to help speed up your recovery and to prevent problems developing in the future. 
• See a physiotherapist – a physiotherapist can help you with treatment and exercises to help your sciatica.  
• Heat/cold packs – some people find warm baths or heat/cold packs can help relieve their pain. 
• Reduce time spent sitting and lying – try to reduce the amount of time you spend sitting or lying down. Moving and changing positions regularly is the best thing you can do to help get better faster.  
• Avoid lifting anything heavy. 
• Use a cushion – when you’re lying on your side, put a small firm cushion between your knees to help relieve your pain. If you’re lying on your back, put several firm pillows under your knees. 
• Practise relaxation techniques such as yoga, meditation or mindfulness, and do things you enjoy to distract you from the pain. 

Because the cause of sciatica is often is your back, self-care is often the same. Read more about back pain self-care.

Apps reviewed by Healthify

You may find it useful to look at some pain management apps, physiotherapy and exercise apps, mediation and mindfulness apps or breathing apps.

There's no proven way to prevent sciatica. However, the following things may help reduce your chance of getting it: 

• Stay physically fit and keep a healthy body weight.
• Take regular breaks if you have a job that involves sitting for longer than 2 hours at a time.
• Do exercises to keep your back and tummy muscles strong and flexible.
• Practise good posture when you’re sitting, standing, exercising or lifting heavy things.
• Avoid lifting heavy loads if you don’t have the strength for it.
• Breathe with your stomach not your chest. You might find a breathing app useful. 
• Maintain a healthy lifestyle – stop smoking if you smoke, reduce alcohol intake, eat a healthy diet and exercise regularly. 

If your sciatica is caused by a disc herniation, there’s a 50% chance that your leg pain will be better after 4 weeks whether you have any treatment or not. However, the pain can last for several months or longer. Normally leg pain gets better faster than back pain.  

Mild sciatica can get better by itself over time. However, if you’re in a lot of pain, if your symptoms get worse, if you have weakness or difficulty lifting your foot when walking, or if your bowel or bladder isn’t working properly, contact your healthcare provider immediately.