Updated 7 April 2022 | Approved By Dr. Umberto Russo
What is Sciatica?Sciatica is a common nerve condition that can occur in up to 40% of people throughout their lifetime . Medically, sciatica can be described as ‘pain in the distribution of the sciatic nerve due to the pathology of the nerve itself . Simply put, this is a common condition where any abnormalities to the sciatic nerve cause pain down to specific areas of the hip, leg and feet.
Sciatic Nerve Anatomy
Sciatic nerve functionThe sciatic nerve is the largest and longest nerve in the body. As with any nerve, its primary purpose is to help communicate information between the body and brain. Body movement, sensation, and pain are examples of information exchanged through the nerve fibres.
Sciatic nerve locationThe sciatic nerve branches off the lumbosacral plexus. The plexus comprises many connected nerves that start from the lower back region (e.g. lumbar and sacral spine) . Originating from the L4 to S3 regions of the spine, the sciatic nerve then travels down towards the leg. For most people, the sciatic nerve will exit the back from the pelvis and hips before making its way down the hamstring and part of the groin. It will then reach the back of the knee before splitting up into the tibial and peroneal nerves. These two newly formed nerves then extend down the leg towards the calf, ankle and foot. All of these areas of the body are influenced by the sciatic nerve .
Sciatica SymptomsAs noted in the introduction, sciatica is a broad term used to describe any discomfort or disability that can impact any sciatic nerve region that travels down. Areas, where sciatica may be felt include the following:
- Lower back
- Bottom, hips and glutes
- Back of the thigh (especially the hamstring and groin)
- Leg and calf
- Tingling and/or ‘pins and needles’
- Burning sensation
- Weakness and lack/loss of movement
- Dull aches and pains that can worsen with specific activities (see: sciatica causes)
- Loss of control when going to the toilet (i.e. unusual bowel and bladder movements)
Sciatica CausesConditions or abnormalities which compress the sciatic nerve is the usual cause of sciatica. Different structures can begin to press on the nerve if inflamed, out of alignment or abnormal. Given that the sciatic nerve spans over a large distance, multiple structures can affect it. Examples of conditions, which can lead to sciatica, includes:
- Bulging disc
- Disc herniation
- Piriformis syndrome
- Spinal stenosis
- Cauda equina (urgent referral to the Emergency Department at the hospital is required.
- Rare conditions (e.g. cancer, ankylosing spondylitis, etc.)
Tests and Diagnosis
Physical ExaminationA GP can perform a physical examination of the body to determine whether your symptoms are related to sciatica. However, further investigations may be required to confirm a diagnosis. In addition to the physical examination, your GP may also require additional information, such as the onset, location and nature of pain that you are experiencing.
Imaging TechniquesDepending on your circumstances, your GP may refer you for additional imaging investigations, such as X-rays, MRI and CT scans. These techniques help identify any structures which could be causing your sciatica symptoms. Sometimes imaging assessments are not necessary as most episodes will resolve over time. However, imaging investigations may be required if you are not responding to treatment or experiencing ongoing symptoms.
PhysiotherapyAs most episodes of this condition are mild and can be resolved through conservative treatment. Your GP may refer you to see a musculoskeletal health professional, such as a physiotherapist. They will help provide treatment, such as soft tissue massage, joint mobilisations, TENS and dry needling to ease your pain. Additionally, they will also be able to develop strategies, such as sciatica stretches, lifestyle changes and further advice about how to relieve sciatica. Your physiotherapist may require to see you over several sessions to assist you with your recovery.
Sciatica Pain ReliefYour GP may also help ease your symptoms and discomfort by prescribing pain medications. These may help with short-term relief as you begin to recover. Other pain relief strategies may also include hot/cold packs, hydrotherapy, postural changes and rest.
Spinal Specialist ReferralFor most people, only conservative treatment and pain relief are required to recover from sciatica. However, if symptoms are severe or persist, a referral to a spinal specialist may be made. Further tests may be needed to assist with a more comprehensive diagnosis. Depending on your circumstances, more specialised treatments may be offered, including injections and surgery.
RecoveryGenerally, the outlook for those with sciatica is positive. Most people with sciatica will be expected to recover within 4-6 weeks after the appearance of symptoms . Those with more severe or widespread neurological pain may require additional time and care. Underlying factors, such as heavy occupations, depression and psychological conditions, are more likely to experience chronic symptoms.
ComplicationsThose living with sciatica will mostly have positive outcomes. However, those who have persistent or severe symptoms that do not see a GP promptly can develop ongoing complications, such as:
- Chronic pain
- Ongoing weakness and tingling down the legs
- Nerve damage
- Loss of bladder and bowel movement - which needs urgent medical attention and/or a visit to the emergency department at a hospital
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- Stafford, M. A., Peng, P., & Hill, D. A. (2007). Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. British journal of anaesthesia, 99(4), 461-473.
- Merskey H, Bokduk N. , Classification of Chronic Pain, 1994 2nd Edn IASP Press(pg. 13,-15, 198)
- Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2021 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/