Risk Factors for Sciatica
- Age – most common at 45-64 years
- Increased risk with being tall
- Mental stress
- Driving, including vibration of whole body
- Occupation – strenuous physical activity. A job that requires you to twist and bend your back, carry heavy loads or drive a motor vehicle for long periods might play a role in sciatica, but there's no conclusive evidence of this link.
- Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
- Diabetes - affects the way your body uses blood sugar, increases your risk of nerve complications.
- Smoking – weakens the discs probably through decreased circulation and blood supply.
- Obesity. By increasing the stress on your spine, excess body weight can contribute to the spinal changes that trigger sciatica.
Medical Treatment for Sciatica
Within the medical profession there are four or five basic options:
Rest – This will be advised if the condition is Acute or recent. You may be advised to take painkillers or anti-inflammatory drugs
Physiotherapy – exercises are commonly now given.
If the pain continues with Sciatic symptoms, referral to a specialist physiotherapist
MRI scan may be given
Possible referral to spinal surgeon
Cortisone or nerve block injections
Spinal surgery if symptoms indicate it and there is clearly no improvement or pain is too severe
My own view is that Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and injections should only be used if absolutely necessary, as they do not actually help the body and disc heal faster, but may actually inhibit and weaken the healing process, as I write about in ligament injury and healing.
Will I need surgery for my sciatica or disc bulge?
Commonly not! The medical profession now has studies that show surgery for sciatica is mostly not required, that the majority of cases will settle. Research showed that people who do NOT have surgery improve after two years to a similar extent to those who have surgery.
Surgery is now performed on an individual clinical basis, for those patients with severe disc bulges or extrusions that are giving constant and relentless pressure and pain or damage to the nerve root and that any more conservative care that can be given is worthwhile, including spinal manipulation.
‘Red flag’ or Danger Signs – When to See a Doctor
Although most people recover fully from sciatica, often without treatment, sciatica can occasionally cause permanent nerve damage. It can be very common with sciatica that sitting on the toilet is painful, and twisting even more so, but usually the bowel and bladder movements are normal.
Cauda Equina Syndrome is a very rare condition where there is loss of function or control with bowels and bladder. This is an immediate referral for medical care. Symptoms may include:
- Sphincter or gait disturbance
- Numbness around the bottom area - saddle anaesthesia
- Difficulty in going to the toilet (either bowels or bladder).
- Lack of bowel or bladder control
- Severe back pain usually in both legs.
With Cauda Equina symptoms seek immediate medical attention.
Weakness in the foot and numbness or pins and needles. There are times when clear weakness to the foot and toe muscles and altered sensation (numbness, pins and needles) can indicate that referral to the spinal surgeon, neurosurgeon or specialist orthopaedic consultant is required. In the past it was considered more of an emergency. We now recognise that most of the time the muscle strength and altered sensation do occur with sciatica, but heal.
Spinal Stenosis is a condition where the central spinal cord can be compressed and can sometimes be alleviated by Chiropractic treatment, but can also require surgery.
Lateral Canal Stenosis is where the nerve can be compressed exiting the spine. Sometimes this can be treated with Chiropractic and sometimes, once again, may require surgery.
Spondylolisthesis - when one of your back bones slips forward and out of position, possibly due to trauma in early life, or accident.
Tumours, infections, Osteoporosis and Cyst – These can affect the disc and the nerve.