You’ve had this on and off pain for a while now, but never as bad as recently. Something just as simple as bending over to pick something up triggered that pain in your back that feels like it might be going down your buttock or leg. Other times, there wasn’t any problem.
You wonder whether you’ll always have to live your life being careful of things like bending over or lifting items. Or if the exercise you’re doing is making it worse, but you don’t want to stop. You’ve searched on Google and saw this term called “Sciatica” and it seems like something you have, but Google isn’t very clear in giving you the clarity you need – Do you need to get it checked out? Can you leave it, and will it go away on it’s own? Is it really even sciatica?
A common explanation is that sciatica is used to describe pain that radiates downwards along the course of the lumbosacral nerve roots, which may be from your back to the buttocks and back of your thigh to the back of your calf and foot.
This sciatica has been around since the time of the Ancient Greeks in 370BC!
Hippocrates described ‘ischias’ – pain felt around the hip and thigh – affecting men around 40 to 60 years old, and that young men who felt it would often have pain lasting around 40 days before resolving spontaneously!
From the 17th century all the way till the 19th century, physicians knew of sciatica but were unsure about what caused it –
Until the 20th century.
In 1931, a neurosurgeon named Elsberg described that the removal of ‘cartilaginous tumours’ from the spinal canal improved sciatic symptoms; and 3 years later in 1934, a famous paper by the New England Journal of Medicine cemented the idea that the prolapsed intervertebral disc caused sciatica.
The most commonly blamed cause of sciatica is this:
We NOW know that imaging scans (like MRIs) show that disc pathology (disc bulges and herniations), and stenosis with neural compromise (when the lumbar spine degenerates and causes narrowing of the tunnel where the nerve comes out from) is actually a relatively common finding in people WITHOUT any symptoms of sciatica, or back pain! (Brinjikji et al., 2015; Boos et al., 2000).
Patients with pain AND a disc herniation seen on MRI may experience marked improvement in symptoms WITHOUT any changes in your spine or disc, whereas the removal of herniated disc material or other causes of nerve root compression DOES NOT ALWAYS relieve pain.
Evidence suggests that it is not so much just pressure on the nerve root that causes sciatica, but a COMBINATION of immunological responses in the body – inflamed, stretched, and/or compressed nerve roots causes sciatic pain.
This CAN be because of an injury causing a disc bulge and pressure on the nerves, a muscle spasm that causes temporary pinching of the nerve, and other lifestyle factors which increase inflammation in the body like excessive alcohol, smoking, poor diet, inadequate sleep, and mental stress.
That being said, having a “diagnosis” of “Sciatica” is JUST identifying a symptom.
There needs to be an assessment of your complete history, and a physical assessment to identify what activities may need to be modified for the time being to help your active recovery. Eventually, you should be getting back to what you were doing before, and more.
Check the box if you feel pain over the back when you
If you’ve ticked at least 2 of these boxes, it indicates a possible disc issue.
(a) Sit on the edge of your chair. Slouch all the way down, as much as you can, including the head and neck.
(b) Keeping this position, slowly attempt to straighten out the right knee and bring your foot towards you. Take note if you feel any pain or not.
(c) Keeping this position, raise the head and look up. Did the pain get better, or did it remain?
(d) Put the leg down and repeat steps (a) to (c) on the opposite leg.
If the pain gets better when you look up, this indicates a disc and nerve problem. If it doesn’t, this indicates a muscle issue.
McKenzie’s Repeated Test
(b) Now put your hands on your hips, and slowly bend backwards 10 times. Does your pain get better?
・Pain that gets better as you repeatedly bend backwards could indicate a disc issue.
Without the presence of red flags, treatment of sciatica in the first 6–8 weeks should be conservative.
In patients with severe symptoms who fail to respond following 6–8 weeks of non-surgical treatment, imaging might be useful to identify if a herniated disc with nerve root compression is present. Surgery may only be indicated if imaging findings correspond well with the clinical symptoms, there was no success with conservative care, and/or the patient develops red flags.
WITHOUT surgery, 80% of the patients recover within 8 weeks and 95% within 1 year. (Valat et al., 2010)
Red Flags indicates: