Sciatica

 Sciatica

Leg pain, numbness, tingling and weakness

 

Sciatica is a hugely common problem. It often starts as low back pain which then radiates through the buttock, back of the thigh and into the calf. The foot may become numb or tingle. Severe cases can lead to foot drop due to weakness in the muscles of the leg. Famous sufferers are as diverse as footballer Thierry Henry and playwright William Shakespeare

Causes

The vast majority of cases are mechanical in origin. In other words there is no disease process as such, but the nerve roots have become compressed by the surrounding tissues. Commonly a prolapsed (“slipped”) disc will do this, although the facet joints can also produce a similar effect if inflamed and spinal instability (spondylolisthesis) is another cause. Occasionally the same sort of symptoms can be caused by a muscle in the buttock (piriformis) tightening around the sciatic nerve itself-the so called “piriformis syndrome”. Men sometimes get sciatica if they habitually drive cars with firm seats with a thick wallet in their back pocket which squashes the nerve.

Diagnosis

In many cases a clinical diagnosis is all that is necessary i.e. no special tests are required. The tell tale signs are the history, a reduction of ability to lift the leg up straight and maybe a loss of muscle power or ankle reflex. Plain X-rays are relatively unhelpful but the MRI scan will often reveal the cause of the pressure on the nerve roots.

Treatment

As ever it is best to start with simple treatments first. Hands on massage, manipulation and acupuncture will be helpful in many cases. Where possible, mobility should be maintained and as pain subsides core stability exercises should be encouraged to reduce the risk of recurrence. Cases that don’t respond to this may go for spinal injection (nerve root block or epidural) and a very small percentage may require surgery to remove the offending disc or stabilize the spine.