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Sciatica: symptoms, causes, online consultation

Sciatica causes pain that occurs along the sciatic nerves. The sciatic nerves start at the lower back and spine, before passing through the buttocks and running down towards the legs; they stop just below the knee. The causes of sciatica can also be numerous: complications from osteoarthritis, a herniated disc, or narrowing or damage to the spinal canal. The pain felt with sciatica is often intense. Generally, the pain follows the sciatic nerves, starting in the lower back, then moving down through the buttocks to the back of one leg. Treatment relies on taking medication to relieve the pain. More rarely, surgery may prove necessary.

Mechanisms and causes of sciatica

The human body has two sciatic nerves, which are also the longest and largest in the body. Each sciatic nerve is made up of several spinal nerve roots, which originate in the lower back and the spinal cord. In terms of width, a sciatic nerve is almost as thick as a finger. The two sciatic nerves run from the lower part of the spine, before passing towards the hip (behind its joint), through the buttock, the leg, and finally the back of the knee. From the knee, the sciatic nerves divide into several branches towards the feet. Sciatica therefore occurs when the spinal nerve roots that make up the sciatic nerve (or the sciatic nerve itself) are pinched, compressed or damaged. Sciatica is therefore the pain caused by damage to the spinal nerve roots or the sciatic nerve. This pain can extend all the way along the sciatic nerve, down to the foot. Sciatica affects around 5% of people who suffer from back pain (lower back pain). Sometimes no cause can be identified at its origin. Nevertheless, certain causes have been identified:
   • A herniated disc;
   • Complications from osteoarthritis;
   • Narrowing of the spinal canal (spinal stenosis);
   • Swelling caused by a ligament sprain;
   • More rarely: Paget's bone disease, nerve damage caused by diabetes (neuropathy), a spinal tumour, a build-up of pus (abscess) or blood (haematoma) putting pressure on one of the sciatic nerves.
Sciatica may also have a hereditary or genetic component: some people appear to be predisposed to it.

Symptoms of sciatica

Generally, sciatica affects only one of the two nerves. The pain starts in the lower back, then passes through the buttock, down to the back of one of the knees. Patients often describe the pain as sharp, burning, like a stab wound. When pain appears in one place and moves to another part of the body, most often along a nerve, this is known as radiating pain. Symptoms of sciatica may also include:
   • Weakness or numbness in the leg or foot;
   • Difficulty walking, climbing stairs, running, straightening the leg and sometimes even coughing; all these factors intensify the pain, which is often relieved by standing up or straightening the back.
When sciatica also affects the cauda equina (a bundle of nerves originating from the spinal cord, in the lower back), some patients lose control of their bladder, and bowel problems may also be observed. Urgent medical care is required if these symptoms are present.

Treatments for sciatica

Treatment for sciatica involves relieving pain with medication or specific measures; more rarely, surgery may be necessary in cases of severe pain. Generally, the pain disappears on its own and further tests are not necessary. When this is not the case, several pain-relief exercises can help:
   • Stretching the muscles at the back of the thigh after activity or a warm-up;
   • Rest: one or two days in bed. Staying in bed longer than that risks weakening the muscles and increasing their stiffness, thereby worsening the pain;
   • Sleeping on your side at night, with your knees bent and a cushion between them. People who sleep on their back can also place a cushion or pillow under their knees. Sleeping on your front is not contraindicated when this position is not painful;
   • Applying heat (a hot water bottle) or cold (ice packs);
   • Taking painkillers (analgesics): non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, or paracetamol, to relieve pain or muscle inflammation.
In cases of severe pain, doctors sometimes prescribe corticosteroids by injection or orally. Physiotherapy can also help stretch the thigh muscles, to relieve muscle spasms. Seeing an osteopath can also be a solution in some cases. Lastly, surgery may sometimes be necessary when a herniated disc triggers chronic or persistent sciatica. Surgical removal of the protruding part of the disc (discectomy) may be carried out, as may removal of part of the vertebra (laminectomy), in some cases. General anaesthesia is often required. Hospitalisation also lasts between one and two days. Between 6 weeks and 3 months of rest are required after this type of procedure.

Consult a general practitioner to treat your pain

Sciatica is generally caused by compression of the nerve roots. It can be linked to a herniated disc, complications from osteoarthritis, or narrowing of the spinal canal. The pain is often burning, throbbing, similar to a stab wound. This fairly severe pain radiates along the sciatic nerve, generally below the knee or in the buttock. In addition to the pain, symptoms may include weakness, loss of sensation and reflex problems. If you have these symptoms or lower back pain, do not hesitate to consult a general practitioner. Online consultation with Feeli offers the benefit of care within minutes. After receiving a medical diagnosis, the consultation leads to a prescription, if necessary. Take care of your health!