Dr Mel: Back pain
Around a third of us will suffer with sciatica at some time in our lives
Back pain is common, and often spreads into the buttocks or thighs, but it isn’t sciatica unless you also have pain below the knee. The
sciatic nerves are formed by nerve roots that leave the spinal cord between bony vertebrae and their cushioning intervertebral
discs, in the lower (lumbar) spine. The nerves pass through the buttocks, down the backs of the legs (like stocking seams) and into the feet and toes, side-shoots control muscles and
sensation in these areas.
The causes
Pressure on the sciatic nerve can interrupt electrical signals running up and down to the brain. Space is tight, so a ‘slipped’ disc or damage to the spine (such as arthritis, ‘wear and tear’, narrowing, trauma, infection, and bone diseases such as osteoporosis or cancer) can cause sciatica, as well as low back pain.
Less commonly, the nerve can get trapped lower down by problems in the pelvis or leg.
The symptoms and tests
The pain is a neuralgia, and may be a constant stabbing, shooting, burning or tingling sensation, or triggered by moving, coughing or sneezing. You may also notice numbness in the same areas, or actual weakness in your leg muscles.
The good news is that most cases of sciatica settle in four to six weeks (although it can recur). If it persists, or you have other symptoms such as weight loss, night sweats, or relevant medical conditions, your GP may suggest blood tests for any
signs of inflammation, and/or refer you for an MR scan to look at the soft tissues in your spine. (X-rays are only helpful in certain circumstances.)
Symptoms that affect both
legs, the area around your
genitals/anus, or your bladder or bowel control may be a sign of serious damage to your spinal cord – seek same-day medical advice.
The treatment
As well as self-help, your GP may prescribe stronger painkillers, refer you for physiotherapy or suggest seeing a back specialist.
Steroid/painkilling injections occasionally help, but you may need treatment for the underlying cause, or curative decompression surgery for a slipped disc or bony narrowing. This can have risks – see nhs.uk.