Symptoms of sciatica

• Pain: This can be infrequent or constant, varying in intensity. It might worsen with movements like sneezing or coughing.

• Numbness and tingling: These sensations typically occur in the leg or foot on the affected side.

• Weakness: There might be a noticeable reduction in strength in the affected leg or foot.

Certain symptoms may indicate more serious nerve compression- these require immediate medical attention. This includes: if you experience severe pain following an injury/fall, if you have trouble controlling your bowels or bladder, if you have pins and needles or numbness around the genital region, progressive weakness in the legs, or if the pain persists/worsens and does not improve with rest and over-the-counter medications.

Diagnosis of sciatica

Diagnosing sciatica involves physical examination and may also necessitate imaging tests like MRI scan. Sometimes a diagnostic nerve block may be considered. A diagnostic nerve block is when a pain-killer/anaesthetic drug is injected into the affected area of the lower back, to help pinpoint more precisely the nerve that is affected. There is a small risk of bleeding, nerve damage, and spinal cord damage with diagnostic nerve block injections.

I have low back pain- should I be worried about serious causes?

• Serious illnesses can affect anybody. You should definitely see a doctor if you’re worried about your low back pain.
• If you have any of the following, you need to call an ambulance immediately:
  • Numbness around your anus (bumhole), your buttocks (bum) or the backs of your thighs.
  • Incontinence of faeces (poo) or urine.
  • Worsening weakness in your legs.
• Things that can indicate an increased likelihood of serious problems include:
  • Significant trauma (eg. Road accident).
  • Pain going higher up in the back.
  • Feeling unwell.
  • Weight-loss.
  • Numbness/tingling.
  • Weakness in your legs.
  • Worsening or unrelenting pain.
  • Night pain.
  • Night sweats.
  • Older people (over 50).
  • Younger people (under 20).

How long does back pain last?

• The outlook is normally positive.
  • 90% of cases resolve within 6 weeks.
  • Most people who go off work are back at work within 1 month.
  • Most people who go off work for more than 1 month are back at work within 6 months.

What is sciatica?

• Sciatica occurs when a nerve in your low back is squeezed (or “trapped”), usually by a “disc” or a muscle.
• Discs are the shock absorber system of the spine
  • They are the doughnut-shaped softer pads between the bones of the back (vertebrae).
  • The spinal cord travels down the middle of the vertebrae and discs.
  • Nerves come out of the spinal cord between the vertebrae and discs.
  • If a disc bulges outwards between vertebrae, it can press on a nerve.
  • This can cause feelings of pain, numbness or tingling where the nerve travels to.
• Sciatica is when the pain goes down the thigh, into the knee and below, sometimes into the foot.
• It’s often worse if you bend forward, cough or sneeze.

What is the treatment for low back pain?

In most cases the treatment of back pain is as follows:

• Painkillers, usually starting with over-the-counter medications first.
• Sometimes other medicines such as muscle relaxants can help.
• Avoidance of triggers such as lifting/twisting/bending.
• Avoid bed rest if possible.
• Referral to a Physiotherapist and/or an osteopath.
• Gently maintaining an active lifestyle.

• Depending on the situation, imaging of the back (eg. MRI) may be ordered.
  • This is usually only required if serious pathology is suspected or if surgery is being contemplated.
  • Imaging of the back isn’t routinely recommended for mechanical low back pain as it doesn’t usually alter the management.
• Stronger painkillers or other medications may be required if things don’t improve.

Further Patient Resources

www.betterhealth.vic.gov.au

Article Resources

(1) Koes BW et al. Diagnosis and treatment of low back pain. BMJ. 2006; 332(7555):1430–1434

(2) National Institute for Health and Clinical Excellence (NICE) 2009.

(3) European Guidelines for the management of acute non-specific low back pain in primary care