SCIATICA – i.e. attack of nerve roots, lumbago

All it takes is a sudden bend or a sudden movement while stooping to make it impossible to straighten up. It usually happens when you least expect it, and you can't prepare for it. The worst is when "radiculitis" forces you to bed and refuses to leave, and the back pain practically paralyzes you from the lower back, sometimes all the way down to your feet.

What can we do to help ourselves and what sciatica actually is, explains our specialist, Fabian Burakowski.

Sciatica is a very distressing set of pain symptoms, including sharp pain in the lumbar spine, radiating to the buttock, extending through the thigh and calf to the foot, decreased muscle strength, and decreased superficial sensation in the thigh or foot. Symptoms can last from several days to several weeks. The pain can be very disruptive to daily functioning, especially in the acute phase.

The sciatic nerve is the largest nerve in our body. It originates in the nerve roots located in the lumbar spine. This is one of the most common sites where compression or shaping can occur from other structures, such as a damaged intervertebral disc or degenerative changes. It then runs between the gluteal and hamstring muscles (back of the thigh), and at the level of the popliteal fossa, it divides into two smaller nerves: the tibial and the peroneal. Along its length, there are characteristic areas at risk of compression, such as the piriformis muscle. This nerve's fibers can be classified as sensory, motor, and autonomic.

Sciatica – symptoms

Paralyzing pain associated with radiculitis, radiating from the buttock to the lower limb with every movement, is a hallmark of this condition, but not the only one. Patients may also experience:

• difficulty moving and changing position,
• difficulty maintaining an upright position,
• numbness and burning sensation along the nerve,
• tingling, numbness in the fingers and feet,
• weakening of superficial sensation in the lower limb,
• decreased muscle strength in the affected leg.

The initial acute phase begins with severe, throbbing, stabbing back pain radiating from the lower back to the buttock. It most often extends through the thigh and calf to the foot.

The acute phase, or initial phase? How many phases can we expect?

– This condition is divided into two phases:

• acute – rest and drug therapy are recommended,
• chronic , in which physiotherapy will be helpful.

The acute phase , which usually lasts several days , is characterized by severe pain. Changing position in bed becomes difficult, and it's often impossible to maintain an upright position (patients report crawling to the bathroom on all fours). This is the phase in which pharmacotherapy (painkillers, anti-inflammatory medications) is generally necessary to relieve pain. Of course, such a condition should be consulted with a family doctor or neurologist to rule out conditions other than spinal problems. A physiotherapist may also be the primary contact, providing advice on appropriate positions and, if necessary, advising the patient to see a doctor. The doctor will prescribe pharmacological treatment, order imaging tests, or issue a sick leave certificate.

The chronic phase gradually follows the acute phase. This phase can last for two weeks or sometimes several months . The patient can move, but typically experiences discomfort/pain radiating down the leg in certain positions or after prolonged sitting or walking. Sometimes, there is a persistent reduction in superficial sensation or even mild muscle weakness. This is the time when it's necessary to consult a physiotherapist to plan treatment, which can help prevent recurrence and accelerate the return to full physical function.

Home remedies for roots

– I would avoid intense heat, as it can worsen inflammation. Gentle warmth, however, can be helpful, as it can reduce the muscle tension that develops during acute pain episodes.

To reduce pain, we can adopt pain-relieving positions, such as the fetal position or lying on our backs with our legs placed on a chair (with our hips and knees bent at a 90-degree angle) – the so-called chair position.

Movement is recommended as much as possible. Even simple exercises like hip lifts while lying down, moving your knees from left to right, and walking if possible. Immobility in bed plays to our detriment. 

When is it absolutely necessary to see a neurologist/neurosurgeon?

– We should definitely see a doctor when we notice:

• significantly reduced strength in the lower limb, e.g. foot drop, inability to stand on tiptoes when standing on one leg,

• paresis of the lower limb,
• disturbances in urination and defecation (may indicate significant pressure on the nerve structures),
• severe pain.

What are the causes of root problems?

There are many causes of root problems, here are the most important ones:

• pressure on the nerve roots, most often at the L5-S1 or L4-L5 level,
• blockage of the facet joint or sacroiliac joint – these are symptoms imitating pain of nervous origin – similar symptoms to pressure on the nervous structure,
• spine overload (physical work, pregnancy, overweight),
• sedentary work – contracted muscles, dehydrated intervertebral discs (susceptible to damage), long-term nerve compression,
• degeneration of intervertebral discs,
• spinal canal stenosis, i.e. its narrowing,
• spondylolisthesis,
• tumors in the spine area,
• obesity.

How to treat sciatica?

– In the acute phase, rest and pharmacotherapy are recommended to reduce severe pain. A good solution is a visit to a physiotherapist, who, after an interview and examination, will plan an individualized treatment plan for the patient. This typically includes manual therapy (mobilization), appropriate exercises, and supportive physical therapy (e.g., high-energy laser, electro-acoustic currents, etc.).

Sciatica is an extremely distressing condition for patients, often striking when we least expect it. It's important to know how to help ourselves before we consult a doctor or physiotherapist.