Sciatica is the term for symptoms of pain, tingling, and numbness which arise from nerve root compression or irritation in the lumbo-sacral spine.
Symptoms of sciatica typically extend to below the knee — from the buttocks, across the back of the thigh, to the outer calf, and often to the foot and toes.
Nerve root compression is typically caused by:
- A herniated intervertebral disc — in about 90% of cases.
- Spinal stenosis.
Risk factors which may increase the risk of developing sciatica include:
◦ Strenuous physical activity, for example heavy lifting or jogging.
◦ Whole body vibration, for example with driving.
Complications of sciatica include:
◦ Permanent nerve damage.
◦ Psychosocial problems.
◦ Loss of employment.
Management of sciatica involves:
◦ Checking for red flag symptoms and signs which may indicate a serious underlying cause such as cauda equina syndrome, spinal fracture, cancer, or infection. If present, admission or urgent referral should be arranged depending on clinical judgement.
◦ Providing adequate analgesia (paracetamol or ibuprofen first-line) for symptom relief. Additional and/or stronger analgesics can be considered if necessary.
◦ Providing information about its expected time course, self-help measures, and advice about staying active, resuming normal activities, and returning to work as soon as possible.