If you’ve experienced a sharp, shooting pain down your leg or you’ve overheard an old relative exclaim about their back acting up again, you’re probably familiar with the term ‘sciatica’. Sciatica is a common condition, which can be very distressing and debilitating for those who suffer from it. This insight will give you an understanding of what causes sciatica, and what you should do to manage it effectively.
What is sciatica?
Sciatica, is the colloquial term for lumbar radiculopathy. It’s characterised by a sharp, shooting pain, typically down the leg, which is often described as ‘electric’. People can also experience numbness or feelings or pins and needles, or weakness in their leg muscles. There are many different causes for sciatica, but the most common causes and disk herniation and osteoarthritis (1). Figure 1 shows the anatomy of the sciatic nerve and the lumbar disk. When the lumbar disk bulges/protrudes, it can compress or irritate the sciatic nerve, causing symptoms.
Figure 1.
What is the best way to help it?
The best treatment to help sciatica will depend on what is causing the pain, and whether it is a recent injury, or an ongoing, chronic condition. Here we will focus on managing recent injuries, but for a more detailed discussion on managing chronic causes of sciatica, check out another of our insights here.
Sudden or acute onset of sciatica is most commonly due to disk herniation as shown above. It can occur due to activities such as awkward heavy lifting, but is also associated with other health factors such as smoking or depression which can increase the likelihood of it occurring (2).
It’s important to take a conservative approach to treating sciatica, to avoid unnecessary/expensive treatment. This means starting with simple, safe, and cost-effective strategies, then only progressing to other treatment options later on. As chiropractors, sciatica is something we see often in clinic, so here are our top recommendations:
Seek professional care early
It’s important to get a professional assessment and diagnosis to decide the best management for you. Doing this earlier rather than later can improve your recovery time. Chiropractic care that includes hands-on care such as spinal adjustments, massage and dry needling can help reduce pain and improve movement immediately. Chiropractors can also provide appropriate, personalised advice on what you can do at home.
Stay as active as you can, avoid bed rest
During acute pain, it’s normal to want to stop doing any painful movements or activities. But we know that complete rest is not helpful! Instead, you should avoid only the most aggravating activities (e.g. bending forward) in the short term, then once the pain has reduced, you can slowly reintroduce them. We recommend maintaining as much movement as possible within an acceptable pain range. This will help with keeping your mobility and strength. Gentle movement, walking, and stretching of the lower back and legs are a great way to do this.
Pain relief
In addition to hands-on care and gentle movement, there are other pain relief options that can be performed at home. Heat/cold packs can be used to reduce inflammation and reduce pain, which can be especially useful before sleep. Over the counter pain medication such as paracetamol or ibuprofen may be used, but the supporting evidence is not strong (3). Commonly prescribed medications such as pregablin have been shown to be ineffective and may cause side effects (4) and are not recommended for sciatica.
Injections and surgery
More invasive procedures such as steroid injections and surgeries are potential options for sciatica patients. Current evidence suggests that injections can reduce pain in the short term, but is not a long-term solution (5). Interestingly, surgical procedures such as discectomy can reduce pain in the short term compared to non-surgical procedures, but the benefit reduces over time (6). However, given the potential risks associated with surgery, it is not recommended immediately for most patients.
At DMC Health and Wellness, we provide safe, and effective solutions to help you out of pain. If you or someone you know is struggling with sciatica, get in touch with the team today.
About the authors
David McNaughton is a clinician, researcher and lecturer. He is the director and principal chiropractor at DMC Health & Wellness. He has an extensive background in the diagnosis and management of chronic pain. In addition to his clinical studies, David holds a Master’s of Research and PhD in Psychology. He regularly publishes his research in peer reviewed medical and psychology journals. David has taught both undergraduate and postgraduate studies in Chiropractic and Psychology.
Isaac Searant completed a Bachelor of Chiropractic Science, Master of Chiropractic and Master of Research at Macquarie University. His research aims integrate chiropractic and physiotherapy into general practice for the effective management of low back pain. His clinical interests include spinal pain (neck and back) and sporting injuries. Regardless of the condition, his goal as a chiropractor is to work collaboratively with patients.
References
1. Ropper AH, Zafonte RD. Sciatica. New England Journal of Medicine. 2015 Mar 26;372(13):1240-8.
2. Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. Risk factors for low back pain and sciatica: an umbrella review. The spine journal. 2018 Sep 1;18(9):1715-21.
3. Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW, Wertli MM. Nonsteroidal anti-inflammatory drugs for sciatica: an updated Cochrane review. Spine. 2017 Apr 15;42(8):586-94.
4. Mathieson S, Maher CG, McLachlan AJ, Latimer J, Koes BW, Hancock MJ, Harris I, Day RO, Billot L, Pik J, Jan S. Trial of pregabalin for acute and chronic sciatica. New England Journal of Medicine. 2017 Mar 23;376(12):1111-20.
5. Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, Koes B, Ferreira PH. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Annals of internal medicine. 2012 Dec 18;157(12):865-77.
6. Liu C, Ferreira GE, Shaheed CA, Chen Q, Harris IA, Bailey CS, Peul WC, Koes B, Lin CW. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. bmj. 2023 Apr 19;381.
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