Sciatica is a term used to describe pain that radiates downwards from the buttock along the course of the sciatic nerve. In the UK is has been suggested that the healthcare costs are £500 million and £3.8 billion in indirect costs from musculoskeletal conditions.
The most common cause of sciatica is from a disc bulge or herniation in the lower back where the nerve root is compressed and becomes inflamed. Other causes include spondylolisthesis, lumbar stenosis, foraminal stenosis and malignancy. Another reason for sciatica is piriformis syndrome, where a muscle compresses the nerve leading to pain and disability.
The first line of care for patients with sciatica is conservative, including information and the role of imaging, and advice to stay active. Supervised exercise therapy has also shown to be beneficial, particularly when symptoms have persisted beyond 6-8 weeks. Spinal manual therapy, which may consist of mobilisation and manipulative techniques, may also offer benefit and should be used in collaboration with other interventions. Medication may also be considered as a tool to reduce pain so the patient can become more active, but should not be used in the long-term management of the injury.
Patients with sciatica should be fully informed and empowered in understanding their injury, offered options for management and given a realistic prognosis. The majority will improve from acute injury, and patients should have a positive outlook in knowing they will recover fully.
Should conservative management fail, then other options may include injection therapy or surgery.