Sciatica

It passes through the deep buttock muscles and travels down the leg supplying the muscles at the back of the thigh and the skin, muscles and joints from the knee downwards.

Irritation of the nerve causing sciatica can originate from injury or inflammation where the nerve begins in the low back, as in disc prolapsed, or it can be damaged on the outside of the knee where it is quite superficial, e.g. blow to the knee or fracture.

The symptoms can include back pain, or unilateral problems in the leg and or foot, which can include numbness, weakness, pain, pins and needles or areas of peculiar sensation, sometimes burning sometimes cold.

Diagnosis is made taking the history details and relating it to the findings on X-ray, blood tests and physical examination. Usually a severely irritated knee will produce a change in the reflex associated with the nerve.

The reflex for the Sciatic nerve is the ankle reflex or ankle jerk and if this is absent on one side compared to its healthy partner, it is a reliable diagnostic tool. If both reflexes are absent without evidence of any other problems this can be normal in a small number of people who have naturally sluggish reflexes. Absent reflexes bilaterally, coupled with other signs such as back pain, loss of sensation and weakness, should warrant further investigation.

Treatment depends on the cause, but usually will involve a combination of drugs to reduce the inflammation, relieve the pain and possibly a muscle relaxant to make sleep and resting more comfortable. Keeping off of weight bearing i.e. don't stand or sit for too long, is important as is finding a comfortable position to rest in, often bending the knees can help (use a pillow under your knees to support them when lying on your back).

Once there are signs of some improvement, gentle exercise to stretch the lower spine and gently moving around should be encouraged, to allow a return to normal. Often it is necessary to continue with painkillers for some time and because of this it is important to drink plenty of water and eat small but regular amounts of fibre rich foods, as there is a tendency for many painkillers to cause constipation. Also by taking painkillers you must be sensible in knowing your limitations, as sometimes it is possible to overdo things with the painkillers masking any warning signs.

It is also equally as important to read all the instructions with your medication as it is not always advisable to drive or drink alcohol as they can react badly, and you may not realize the side effects.

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