Sciatica | Mate haiataka

The most common cause of sciatica is a herniated disc (also known as a ‘slipped disc’). This is when one of your spinal discs bulges into one or more spinal nerves, or when the outer fibrous layer breaks open and the inner toothpaste-like material oozes out. 

Spinal stenosis is another common cause. This is an age-related condition that slowly gets worse over time. It causes a narrowing of the nerve passages in your spine, which irritates or compresses one or more spinal nerves. 

Disc herniations and spinal stenosis do not always cause symptoms. Many people have these conditions and don’t know about it. They are only a concern 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 that tends to start in your lower back and buttocks 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 is unlikely to be sciatica. Not all leg pain is sciatica.

Sciatica pain is usually felt within a 2cm wide line that runs down the back of your leg. Different areas of the leg are affected depending on which spinal nerve is irritated. 

The most common pattern is pain down your buttocks and the back of your leg, and down to your foot. The pain in your leg is normally worse than the pain in your back. There may be no back pain at all. 

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

See your doctor if your pain is severe, ongoing or getting worse, if you have weakness or difficulty lifting your foot when walking, if your bowel or bladder is not working right, or if you have a fever or other symptoms that are worrying you. 

Your doctor will ask you questions about your symptoms and examine your back and nerves. 

Scans are not normally required for diagnosis. This is because most people will get better on their own, and so the scan does not change the treatment and is therefore not needed.

In the uncommon situation where a scan is needed, the best scan is an MRI scan. X-rays only show bone, not discs and nerves. MRI scans can be requested by non-GP specialists under ACC or under private health insurance. Some hospital specialists can also order them.  

If your sciatica is caused by disc herniation, there is a 50% chance of being free of leg pain at 4 weeks – regardless of 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. 

Some treatment options to discuss with your GP or doctor include: 

• waiting it out, allowing your body to naturally heal
• certain types of painkillers, such as anti-inflammatories and nerve pain medications
• gentle exercises and stretches – you could consider gentle walking or swimming
• physiotherapy – a physiotherapist can recommend suitable exercises for you, but this is normally not required
• heat and cold – some people find heat or cold packs, or warm baths helpful
• activity modification – reduce the amount of driving and prolonged sitting, and carrying heavy loads.

You may find a particular position that is pain relieving. Pain-relieving positions vary between people. One position may help some people but make the pain worse in others. 

In many people there is a psychological aspect to the pain that drives up the pain intensity and worsens function. Your brain and body exist as a whole. Some people find it helpful to address things like anxiety, fear and catastrophising. Learning coping and pacing skills may be helpful. 

If your symptoms are severe, your doctor may discuss the following options (which require referral to a relevant non-GP specialist):

• Steroid injection – these are done using a scanning machine to safely guide the needle. The steroid is injected around the problem area in your spine to reduce swelling and inflammation.
• Surgery – it is very uncommon to end up needing surgery, especially in the first few months. 

There are no proven ways of preventing sciatica. The following may help:

• Take regular breaks if you have a job that involves sitting for longer than 2 hours a day.
• Do exercises to keep your back and core strong and flexible.
• Avoid lifting heavy loads if you don’t have the strength for it.
• Breathe with your stomach not your chest. 

Many people are surprised to hear that there is minimal or no evidence for the advice found in many lifting guidelines. Your spine is designed to bend, and there is no evidence that you should lift with a straight back. However, it is sensible to avoid lifting heavy loads if you don’t have the strength for it.

Take the following analogy. Clench your fist tightly and try to do something with it like bending it or lifting something. You will probably find that difficult and uncomfortable. Likewise, your back should be supple and loose when moving for most activities. 

For general health, which includes your back, the following lifestyle factors are important: maintaining a healthy body weight, stopping smoking if you smoke, reducing alcohol consumption, exercising regularly and eating a healthy diet. 

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

Here are some tips to help you manage sciatica.


Image credit: Canva

1. Gentle exercise

Regular, gentle exercise and stretching can help your sciatica get better faster. Also, make sure your posture is good when sitting and standing to help speed up your recovery and to prevent problems developing in the future.

2. Medication

Ask your GP or pharmacist about anti-inflammatories and nerve pain medications that are available to help you manage the pain. 

3. See a physiotherapist

A physiotherapist can help you with targeted treatment and exercises to help your sciatica. 

4. Heat/cold packs

Warm baths or heat/cold packs can be helpful for some people.

5. Reduce time spent sitting/lying

Try to reduce the amount of time you spend sitting or lying. Moving and changing positions regularly is the best thing you can do to help get better faster. Avoid lifting anything heavy.

6. Use a cushion

When you’re lying on your side, put a small firm cushion between your knees to help relieve the pain. If you’re lying on your back, put several firm pillows under your knees.

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

Apps reviewed by Healthify

You may find it useful to look at some Pain management apps, Joint and bone health apps, and Physiotherapy and exercise apps.