Sciatica – A Common Complaint and Ways to Manage It

What is sciatica?

Sciatica is a condition caused by the inflammation, compression or pinching of the sciatic nerve, which results in radiating leg pain. Sciatica can be severe and even limit daily activities. The pain is often worsened when one twists, bends, or coughs. It has an annual incidence of 1-5%, and a lifetime incidence of 10-40%. Older age (45-65 years), strenuous physical activity or certain occupations where workers are required to drive, operate machines, or be in physically awkward positions for prolonged periods can increase the risk of sciatica.

How do I know if I have sciatica?

Sciatica is mainly diagnosed based on the history of symptoms and findings upon physical examination. Some indicators for sciatica include:

• Pain or a sharp burning sensation deep in the buttocks
• Pain in one leg that is worse than lower back pain
• Pain radiating below the knee to the foot or toe
• Affected leg may “feel heavy”
• A straight-leg raise results in more leg pain

A straight-leg raise test is a physical examination that is performed by raising the leg and keeping it straight while laying down. The accompanying leg pain suggests that the disc in the lower back is herniated (bulging), which pinches or irritates the nearby sciatic nerve. Besides physical examination, diagnostic imaging may be used in patients with red flags such as severe or worsening symptoms, suspicion of underlying diseases (infections or cancer), or persistent pain despite conservative care.

How can I manage or treat sciatica?

Sciatica treatment and management focuses on controlling pain and managing function by staying as active as possible and avoiding prolonged bed rest. Some ways to manage and relieve the pain include:

• Avoiding sitting or standing for too long (set an alarm every hour to take a short walk)
• Maintaining a good posture
• Light exercises such as walking or swimming for short distances (consider the severity of pain and ability of movement)
• Gentle stretching of the back and legs
• Use of hot or cold packs on the painful area to relieve pain and decrease inflammation
• Short-term use of non-steroidal anti-inflammatory drugs (NSAIDs) to help manage the pain

Surgery should only be considered when the pain persists for more than 12 weeks and does not respond to treatment. If the pain continues to worsen and interferes with your work and daily life, please consult a medical professional for an in-depth checkup.

The Bottom Line

In this modern day and age, many of our jobs involve spending long hours of the day sitting at the desk or sitting in cars. This sedentary lifestyle puts many people at risk of sciatica, and some may already be struggling with it. As such, making appropriate lifestyle changes is important to help prevent sciatica from occurring and recurring. Let's get moving!

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References:

1. Jensen RK, Konsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019;367:16273.
2. Davis D, Maini K, Vasudevan A. Sciatica (Updated 6 May 2022). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2022. Available from https://www.ncbi.nlm.nih.gov/books/NBK507908/. Accessed on 4 August 2022.
3. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-1317.
4. Harvard Health Publishing. Taming the pain of sciatica: For most people, time heals and less is more. Available at https://www.health.harvard.edu/blog/taming-pain-sciatica-people-time-heals-less-2017071212048. Accessed on 4 August 2022.