Pathophysiology
Sciatica refers to leg pain from the back down the back of the leg and to the ankle from an irritation of the sciatic nerve. Causes of Sciatica vary and can include problems with muscles, joints and discs. Sciatica can begin suddenly and symptoms may come and go or be constant.
Symptoms
- Often sudden onset
- Leg pain on one or both legs, tingling, pins and needles or numbness in the back of the leg
- May have weakness in the calf or muscles around the ankle
- May come and go or be constant
- Pain can be worse on coughing or sneezing
- Symptoms often worse with staying in one position too long or bending
Management
- Changing your activity levels
- Ice or heat
- Pain relief
- Physiotherapy including range of movement exercises and a gradual strengthening programme- symptoms generally resolve in 6 weeks
- Orthopaedic options often include injections as first line treatment or surgery if unresolving- these are likely to improve buttock and leg pain but may not improve low back pain
Investigations
- MRI may be appropriate if symptoms do not improve with conservative measures after 6 weeks
- X-Ray and Ultrasound imaging is not recommended
- Treatments that are not recommended
The best current evidence suggests that some treatments may not be useful in the management of back pain and sciatica. These include:
- Electrotherapy (Ultrasound, Interferential, Laser)
- Traction
- High velocity manipulations
- Homeopathy
