Sciatica 

Dr Rob Hicks explains the causes, symptoms and treatment for different types of sciatica (pain radiating from the lower back along the legs and calves).

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Transcript of Sciatica

Hello, I'm Dr Rob Hicks.

I'm a GP practising at the Randolph Surgery in London.

Sciatica is a pain caused by pressure or irritation or compression

of the sciatic nerve.

The sciatic nerve is the longest nerve in the body.

It starts at the back of the pelvis,

runs through the buttocks, down the legs and ends in the feet.

Sciatica is relatively common.

Obviously it's not as common as simple muscular back pain,

but it's nevertheless quite common.

The people who are more likely to develop sciatica

and suffer as a consequence

are those over the age of 40

and those people whose jobs mean

that they are very, very physically active,

so they risk damaging their back and triggering the symptoms of sciatica.

The symptoms of sciatica are pain in the lower back

that goes through the buttocks, down the legs

and may be felt in the calves and in the feet.

That pain can be very mild or it can be incredibly severe,

so it can be really incapacitating.

Some people also suffer numbness and muscle weakness

in the legs and in the feet

and some people often get tingling in the feet as well.

The two different types of sciatica,

there's acute sciatica,

and that's defined as sciatica pain that lasts less than six weeks,

and there's chronic sciatica,

that's the sciatica pain that goes on for longer than six weeks,

and often that will go on for months, sometimes years.

When it's acute sciatica,

and that's the sciatica that lasts less than six weeks,

generally speaking an individual with sciatica

is able to manage that, to look after, to treat that themselves,

so they use over-the-counter painkillers and anti-inflammatories

to relieve the symptoms.

Exercise and keeping active is actually encouraged nowadays

because that will help to speed up the recovery of the sciatica

and lessen the risk of longer problems.

So if somebody needs to go back to work

they should also be encouraged to return to work as soon as they can.

When treating chronic sciatica,

the doctor's more likely to recommend prescription painkillers.

They may recommend physiotherapy, chiropractic therapy.

They may recommend a form of therapy called cognitive behavioural therapy

because of the ongoing nature of this chronic sciatica pain.

It brings people down.

By having this form of therapy

it helps people deal with the pain more efficiently and more effectively,

but also have a more positive attitude to dealing with it,

and that can actually make the pain less

and help the pain to be kept under control.

Sometimes it is necessary to offer back surgery to overcome this problem,

so it might mean surgically removing part of a disc

if it's the disc that has slipped and is irritating the sciatic nerve.

It might mean actually making the spinal canal wider,

and that's called a laminectomy,

if damage to the vertebrae or changes in the vertebrae,

the bones that make up the spinal column,

are irritating the spinal canal.

Or it may necessarily mean actually fusing two vertebrae together,

in the case of where one vertebra, if you think about a column of blocks,

has moved forwards on the other one such that it's now irritating the nerve.

What you want to do is fix those in place so that can't move.

Surgery is an option for some people

and is actually necessary for some people

to treat the long-term chronic sciatica problem.

I would say to somebody,

if they're not sure of what the diagnosis is or what to do,

then certainly ask their GP for advice.

If their symptoms are not getting better despite the right treatment,

or indeed are getting worse, then seek advice.

But if their sciatica back pain is accompanied by other symptoms

like a loss of bowel control, a loss of bladder control,

then certainly don't wait,

seek urgent medical advice

to try and avoid more severe long-term problems in the future.

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