Sciatica: symptoms, treatment, prognosis
If it hurts from the back to the leg, it is usually due to sciatica. This colloquial term summarizes various complaints originating from the sciatic nerve. Medically correct, the phenomenon is called sciatica. The cause can be, for example, a herniated disc or an inflammation. Read more about the causes, symptoms and treatment of sciatica here and learn why sciatica does not like sitting for long periods of time and how you can prevent symptoms.
- What’s sciatica? A damage of the sciatic nerve with pain that usually radiates into the leg. Doctors speak of sciatica.
- Symptoms: tingling, electric shock-like or pulling pain, numbness, paralysis
- Treatment: depending on cause and severity. Therapy options include medication, operations, physiotherapy, heat treatments, massages, etc.
- Causes: Slipped disc, vertebral body injuries, rheumatism of the joints, inflammations, abscesses, bruises, tumours, infections etc.
- Prognosis: With timely, correct treatment, the chances are good that the symptoms will heal completely.
The sciatic nerve (nervus ischiadicus) is the thickest nerve in the human body. It extends over the back of the thigh and branches out at the level of the knee into its two lower leg branches, the peroneal nerve (nervus peronaeus) and the tibialis nerve (nervus tibialis). It supplies the muscles in the leg and its sensory components transmit sensory messages from the lower extremities to the central nervous system.
Sciatica can cause gradual or sudden discomfort. Doctors refer to the typical sciatica pain as neuropathic pain. Many patients express themselves more clearly: This is how sciatica symptoms should feel “like an electric shock” or “ants tickling in the leg”. In addition, feelings of numbness and paralysis can occur.
It is also very characteristic that the pain radiates. One then speaks of radicular pain (originating from the nerve root). This distinguishes sciatica from lumbago, for example. This can also occur through unfortunate twisting or lifting and manifests itself in sudden back pain. But this does not pull into the leg.
If the fibres of the fifth nerve root of the lumbar spine (L5) are mainly affected, the pain runs from the buttocks via the rear outer thigh via the outer knee to the front outer lower leg. It can even extend up to the ankle. If the first nerve root of the sacrum (S1) is damaged, the sciatic pain moves from the sacrum over the buttocks into the back of the thigh. The pain continues through the hollow of the knee and into the foot.
The sciatic nerve runs in the rear thigh and branches out into its two lower leg branches at the level of the knee. Damage to the intervertebral discs is often responsible for the radiating sciatica.
If the sciatica is pinched due to a herniated disc, the pain is often intensified by coughing, sneezing or pressing (when defecating) and movement. Less frequently, urination and defecation are also disturbed. If an inflammation is the cause of sciatica, the pain often increases at night.
Treatment of sciatica: What to do in case of pain?
How sciatic pain is best treated depends on the cause, severity and duration of the pain. However, the first priority in the treatment of sciatica is to relieve the pain as quickly as possible, especially in the case of newly occurring pain. This is to prevent the pain from becoming chronic and a so-called pain memory from developing. By this, doctors understand that the central nervous system later reports pain through “learning effects”, even when the cause no longer exists.
Sometimes the body alone manages to heal itself or the affected nerve. The pain often subsides after a few days up to six weeks.
Tip: For acute complaints, it can be helpful to position the legs high. You can build a so-called stepped bed yourself by lying on your back and sliding a pillow or mattress section under your legs in such a way that your lower legs are elevated and both hip and knee joints are bent at approximately a right angle (90 degrees).
In case of acute sciatic pain, put your legs up. The lower legs should be elevated and both hip and knee joints should be flexed at right angles.
If the pain does not improve or is very severe from the beginning, sciatica can basically be treated in three ways: with medication, other conservative therapies (physiotherapy etc.) and surgery.
Drug treatment of sciatica
Pain from sciatica can be relieved with painkillers. The attending physician usually follows the pain therapy level scheme of the World Health Organization (WHO). This scheme consists of three stages:
- Non-opioid painkillers such as paracetamol, ibuprofen or diclofenac
- weak opioid painkillers (such as tramadol) in combination with non-opioids
- strong opioid painkillers (e.g. morphine, buprenorphine or fentanyl) in combination with non-opioids.
First, an attempt is made to relieve the sciatica pain with non-opioid painkillers. If these do not work sufficiently, the doctor may prescribe additional weak opioids. Strong opioids are only used for the most severe pain that is difficult to treat.
Opioids are very effective painkillers. However, they can have life-threatening side effects and can cause addiction. Therefore, they should only be used with caution and under medical supervision.
Sometimes the cause of sciatica can also be treated specifically with medication. Then one speaks of a specific ischialgia therapy:
If, for example, an infection is the cause of the pain, the doctor can prescribe antibiotics (against bacteria) or antivirals (against viruses). Antibiotics may also be necessary in the event of complications, for example, when pus accumulates and presses on the sciatic nerve.
Sciatica is a pain in the leg that originates from the sciatic nerve. The pain begins in the buttocks and extends down to the foot – these are the regions that the nerve supplies. It moves along the back of the thigh and the back and side of the lower leg up to the toes. Sometimes a sensitivity disorder or muscle weakness also occurs. Sciatica can affect anyone because there are so many different causes.
The basic rule is: first have the pain clarified by a doctor! What you can then do yourself depends on the cause. If there is an inflammation behind it, appropriate medication will help. Sometimes the nerves are also constricted, for example because an intervertebral disc is pressing on them. A physiotherapist can then show you relief positions for the nerve, which you can later take independently. Heat and painkillers can also relieve.
Depending on what has caused the sciatica, you can prevent further symptoms. In the case of a functional disorder of the musculoskeletal system, for example, the patient is given an exercise programme for home use. Among other things, he learns to improve his movement coordination.
Further conservative treatment of sciatica
Besides medication, there are other conservative (non-operative) treatment options for sciatica. Physiotherapy can thus relieve the pain of sciatica and improve the prognosis in the long term. Depending on the method used, it can loosen tense muscles, stabilize and strengthen the spine and correct any incorrect or sparing postures. For example, movement therapy (physiotherapy, back training), heat treatments or massages are used. The therapist will select appropriate treatments for each patient.
Another important approach of the so-called multimodal treatment is behavior therapy. It should help the patient to cope better with the complaints. In addition, it should be prevented that the patient is excessively spared and moves less for fear of the sciatic pain. This endangers the long-term success of the treatment. In modern sciatica treatment, the behavioural therapeutic approach therefore plays an important role.
Bed rest may be advisable for acute pain. In order to prevent future sciatica symptoms, however, those affected should move around a lot. For example, when working at a desk it is advisable to get up from time to time and do light gymnastics (back exercises etc.). This relieves and strengthens the back and the intervertebral discs.
Surgical treatment of sciatica
In rare cases of sciatica surgery is necessary. This can be the case, for example, if a herniated disc causes serious symptoms (such as difficulty defecating, paralysis or severe pain that is difficult to treat). Sometimes ischialgia is also the result of a narrowing of the spinal canal in the lumbar region (lumbar spinal canal stenosis). Then, under certain circumstances, an operation may also be advisable.
Today, such operations are usually performed in a minimally invasive manner. The surgeon therefore does not make a large incision in order to have a direct view of the area to be operated on. Instead, he makes several small incisions through which he introduces fine optical and surgical instruments into the body.
Sciatica: examinations and diagnosis
Sciatica can be very painful, but usually disappears on its own within days to weeks. However, if the symptoms persist or recur repeatedly, you should consult a doctor.
In general: If back pain is accompanied by numbness or paralysis in the leg and/or disturbances in the emptying of the bowels and bladder, one should urgently consult a doctor!
The doctor will first ask you in detail about your medical history (anamnesis). He may ask the following questions:
- How long have you had the pain?
- Did the complaints occur suddenly and in connection with certain stresses?
- How would you describe the pain (e.g. as shooting or electrifying)?
- Where exactly is the pain? Do you radiate?
- What gives you relief?
- What is your profession?
- Is your everyday life affected by the sciatic pain?
In the following clinical examination, your doctor will first look at your back and legs. He pays attention to possible malpositions and checks the mobility of the joints, the strength of the muscles and your reflexes. He also tests touch sensitivity and leg feeling by stroking the skin and letting you identify the spot where he touched you.
With the so-called Lasègue test, your doctor checks whether the nerve roots of the lower spinal cord are irritated. You lie on your back and the doctor lifts your stretched leg. If the sciatic nerve is pinched or otherwise irritated, pain in the back already occurs at half height, which shoots into the leg.
In the search for the cause of the symptoms, the doctor can carry out further examinations, for example magnetic resonance imaging (MRI or magnetic resonance imaging) or computer tomography (CT). Such imaging procedures are particularly important in cases of paralysis or paresthesia.
To determine the location and extent of nerve damage, the doctor can use electrodes to measure muscle activity (electromyography = EMG) and nerve conduction velocity (electroneurography = ENG).
If sciatica nerve inflammation is suspected, the doctor will draw blood to determine the inflammation levels and identify possible pathogens (such as Borrelia bacteria). It may also be necessary to collect and analyse cerebral fluid (liquor). To do this, the doctor inserts a needle through the skin of the lower back and carefully pushes it forward into the spinal canal next to the spinal cord to take a small cerebrospinal fluid sample (cerebrospinal fluid puncture).
Lumboischialgia manifests itself in a similar way to “classic sciatica” (sciatica): those affected report, for example, pulling pain, tingling and numbness in the leg. Muscle weakness is also possible.
In contrast to ischialgia, in lumboischalgia not only the sciatic nerve is irritated, but also the nerves that leave the spinal cord at the level of the lumbar spine. Accordingly, the pain originates less from the buttocks than from the lower back.
You can read more about symptoms, diagnosis and treatment in the article Lumboischialgia!
Sciatica: causes and risk factors
The main cause of sciatica problems is a herniated disc or its precursor, the disc protrusion. However, other diseases can also be behind it if they press on the nerve roots and fibres of the sciatica. These include, for example:
- Vertebral body injuries
- Articular rheumatism
- Inflammation of a disc and the adjacent vertebral bodies (spondylodiscitis)
- Pus accumulations (abscesses)
- Bruises (haematomas)
Another cause of sciatica irritation can be an infection, such as Lyme disease. The bacterial pathogens of this infection (Borrelia) are transmitted by ticks. Herpes viruses in shingles (herpes zoster) can also cause sciatica problems.
Sciatica in pregnancy
Back pain is not unusual during pregnancy. But it is rarely the sciatic nerve behind it. Instead, the pain is usually due to pregnancy-related factors such as the growing weight in the abdomen and the hormone-induced loosening of the ligament structures.
This does not mean, however, that sciatica (similar) complaints should be taken lightly during pregnancy. Since, for example, a herniated disc or other serious causes are also possible, affected women should definitely see a doctor.
If the latter actually detects sciatica, it is usually treated with physiotherapy. Painkillers are not or only to a limited extent used during pregnancy for the benefit of the unborn child.
You can read everything important about sciatica in expectant mothers in the article Sciatica in pregnancy.
Sciatica: course of disease and prognosis
The trigger is decisive for the course of symptoms in sciatica. If therapy is started early, the prognosis for sciatic nerve pain is good. If no surgery is required, good pain therapy in combination with physiotherapy started in time can usually shorten the course of the disease considerably.
It is important to strengthen back and abdominal muscles with regular exercises and sports. A strong muscle corset relieves and stabilizes the spine. This can relieve or prevent back problems.
Patients should also learn back-friendly behaviour (for example, when working at a desk or lifting heavy loads). This can relieve existing complaints and prevent new sciatica problems.
In addition, social and psychological factors also influence the course and prognosis of back problems including sciatica. For example, loneliness, depressive mood and stress can cause or aggravate the symptoms. They can also contribute to back pain becoming chronic and reduce the effectiveness of painkillers. That is to say:
An intact social life, the support of relatives and friends, good conditions at work, a trusting relationship with the attending physician and a positive basic mood can significantly improve the prognosis of sciatica pain.