Low Back Pain and Sciatica
1. Introduction
Sciatica is an umbrella term used to describe symptoms that characteristically present as lower back pain with associated radiating leg pain. Although sciatica may or may not always be associated with lower back pain, it is thought that 90% of true cases are caused by a herniated (prolapsed) lumbar disc with subsequent compression and irritation of the nerve (2). It is this nerve compression that causes the radiating leg pain which in most instances is the most troublesome symptom.
It is worth noting that a variety of other conditions can mimic sciatica and these conditions are not associated with herniations. For example, joints within the spine can cause lower back and radiating leg pain which can produce sciatic type symptoms but, in this instance, the pain would not be from a herniated disc.
Frequently Asked Questions
- Sciatica is pain and/or pins and needles down the back of the leg. This can occur anywhere from your bottom to your feet and is caused when the nerve is irritated or compressed.
- It is estimated that approximately 13%–40% of people will experience sciatica at some point during their life (1).
- It is also estimated that about 5%–10% of people with non-specific low back pain also have sciatica (2).
- No.
- Sciatica symptoms usually settle within 2–4 weeks but may persist for longer in some people (4).
- With the right rehabilitation approach, you should recover well.
- Sciatica is most common in those aged between 40-50 (2).
- Those who frequently perform incorrect heavy lifting have a higher risk of developing sciatica (3).
- Being a smoker and being an ex-smoker were both identified as risk factors for sciatica (9).
- Being overweight or obese (9).
- Lower back pain with associated radiating leg pain.
- Not everyone will have back pain, you might just experience leg pain.
- Pain is often described as sharp and shooting.
- Sometimes associated with altered sensations often described as pins and needles or tingling (2).
- In rarer cases, the weakness of certain leg muscles might occur (2).
- Remain active within your limitations.
- Resume normal activities inclusive of work as soon as possible.
- Using hot and/or cold (ensuring that the skin is protected) may help relieve pain.
- Use a cushion between the knees when sleeping on the side, or pillows propping up the knees when lying on the back.
- Advice by a qualified physiotherapist will be helpful in most cases (1).
- This will depend upon several factors including, but not limited to, other medical conditions, stage of injury, your ability to follow your rehabilitation plan, etc.
- Fortunately, most patients have a good outcome and usually improve within 2–4 weeks with or without treatment (4).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
- Lower back pain with associated radiating leg pain.
- Not everyone will have back pain; you might just experience leg pain.
- Pain is often described as sharp and shooting.
- Sometimes associated with altered sensations often described as pins and needles or tingling (2).
- In rarer cases, the weakness of certain leg muscles might occur (2).
- Cauda equina syndrome (CES) is a rare but serious condition that is deemed a medical emergency. If you experience a combination of any of the following symptoms in this link, seek help immediately.
3. Causes
As detailed, the term sciatica is used to describe symptoms. Within the general population and amongst some healthcare professionals, the term sciatica is often used to describe nerve-related pain, but it is important to remember that a variety of different structures which are not always related to nerves can cause sciatic related symptoms. If nerves are involved in someone’s sciatica, this will frequently be caused by compression which might be caused by the following:
- Herniated intervertebral disc sometimes referred to as a disc bulge.
- Spondylolisthesis – occurs when a spinal segment moves from its normal position.
- Spinal stenosis – occurs when the column that your spinal cord travels down narrows causing compression.
- Other more sinister and significantly rarer conditions which might cause compression include infection and tumours.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing sciatica. It does not mean everyone with these risk factors will develop symptoms.
- Sciatica is most common in those aged between 40-50 (2).
- Those who frequently perform incorrect heavy lifting have a higher risk of developing sciatica (3).
- Being a smoker and being an ex-smoker were both identified as risk factors for sciatica (9).
- Being overweight or obese (9).
5. Prevalence
Studies report varying estimates of the number of people that sciatica affects due to various factors including its definitions, i.e. some studies will define sciatica as any radiating leg pain whilst others will define it as pain originating from nerve compression (6). Lifetime occurrence which describes the proportion of people who experience sciatica at some point during their lifetime ranges from 13%–40%.
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects your day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like magnetic resonance imaging (MRI) or X-ray are not required to achieve a working diagnosis. However, in persistent cases that have not responded to a period of appropriate conservative management, they may be warranted.
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your sciatica. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
8. Rehabilitation
Research is very clear that prolonged bed rest is detrimental for sciatica and that active self-management is key for a timely recovery. This includes advice about remaining active within limitations and resuming normal activities inclusive of work as soon as possible.
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing sciatica. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Low Back Pain and Sciatica
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme focuses on maintaining a range of movement within the lower back and low-level exercises aimed at the affected sciatic nerve. It is important not to further irritate the nerve so always work to a point of mild self-perceived tension only. We suggest you carry these exercises out daily prior to progressing onto the next stage of rehabilitation when your pain and function allow. Pain should not exceed 3/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
This is the next progression. More focus is given to progressive loading of the lower back and core with further exercises aimed specifically at the sciatic nerve. It remains important not to further irritate the nerve so always work to a point of mild self-perceived tension only. Pain should not exceed 3/10 whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
This programme is a further progression with challenging progressive loading of the lower back and core, and continued exercises targeting the affected nerve. It is important not to further irritate the nerve so always work to a point of mild self-perceived tension only. Pain should not exceed 4/10 whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
- Medication – you might benefit from specific medication options prescribed by an appropriately trained healthcare professional.
- Surgery may be considered as a last resort if there is severe nerve compression, or where there are persistent symptoms that do not improve with conservative management (7, 8).
References
- NICE (2016) Low back pain and sciatica in over 16s: assessment and management. National Institute for Health and Care Excellence. http://www.nice.org.uk.
- Koes, B.W., van Tulder, M.W. and Peul, W.C. (2007) Diagnosis and treatment of sciatica. British Medical Journal 334, 1313-1317.
- Miranda, H, Viikari-Juntura, E, Martikainen, R., et al. (2002) Individual factors, occupational loading, and physical exercise as predictors of sciatic pain. Spine 27, 1102-1109.
- Van Tulder, M., Peul, W. and Koes, B. (2010) Sciatica: what the rheumatologist needs to know. Nature Reviews. Rheumatology 6, 139-145.
- Chou, R. (2012) Treating sciatica in the face of poor evidence (editorial). BMJ 344.
- Konstantinou, K. and Dunn, K.M. (2008) Sciatica: review of epidemiological studies and prevalence estimates. Spine 33, 2464-2472
- NICE (2016) Percutaneous interlaminar endoscopic lumbar discectomy for sciatica; Interventional Procedure Guidance.
- NICE (2016) Percutaneous transforaminal endoscopic lumbar discectomy for sciatica; Interventional Procedure Guidance.
- Cook, C.E., Taylor, J., Wright, A., Milosavljevic, S., Goode, A. Whitford, M. (2014). “Risk Factors for First Time Incidence Sciatica: A Systematic Review”, Physiotherapy research international: the journal for researchers and clinicians in physical therapy. 19, 65-78.
Other Conditions in
Lower Back, Hips & Pelvis, Upper Legs, Lower Legs, Neurological
Spondylolysis
An injury due to a stress fracture through part of a vertebra known as the pars interarticularis of the lumbar vertebrae (lower back).
Spondylolisthesis
A term to describe a slight change in position (usually further forward) of one vertebra relative to the vertebrae below.
Sacroiliac Joint Dysfunction
Pain originating from the sacroiliac joint at the base of your back where the spine joins the pelvis.
Mechanical Back Pain
Lower back pain caused by structures in the back, such as joints, bones and soft tissues.
Lumbar Spinal Stenosis
Narrowing of the spaces though which lower back spinal nerves travel which can result in weakness, pain and reduced function.
Lumbar Disc Injury
Lumbar discs sit between each of the bones of the spine. Problems can occur when these discs become irritated.
Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Deep Gluteal/Piriformis Syndrome
A presentation where the sciatic nerve is irritated in the buttock and can cause sciatica symptoms in the leg.
Cauda Equina Syndrome
A rare but serious condition as a result of compression of the nerves at the base of your spine.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Ankylosing Spondylitis
A rare condition that can cause joint stiffness and pain, often worse at night and when resting.