Sciatica” is the term for pain that is sent directly from the so-called sciatic nerve, starting at the hip, and extending to the thigh and knee bends.

Causes for the paralysis of the sciatic nerve can be slipped discs, pelvic or femoral fractures as well as bulges of the disc. Here the disc slips forward and presses against the sciatic nerve in the lumbar spine.

Consequences are severe pain and even numbness in the leg.

Medically, sciatica is the term used to describe a group of complaints in which irritation of the sciatic nerve occurs. This usually happens at the place where it leaves the spinal canal and spinal cord. In colloquial speech, sciatic pain is equated with the term sciatica.

The sciatic nerve – the thickest nerve within the human body

Ischias Schmerzen sind sehr unangenehm

Sciatica: pain in the sciatic nerve is extremely unpleasant.
Picture: Picture-Factory / fotolia.com

The sciatic nerve, also called ischiatic nerve, is made up of the fourth and fifth nerve roots of the lumbar spine and the first and second nerve roots of the sacrum.

It runs along the back of the thigh and branches off at the knee into two lower leg branching’s: the peroneal nerve and the tibial nerve.

The sciatic nerve is the thickest nerve within the human body. It controls the movements of the leg muscles and transmits sensory signals from the lower extremities to the central nervous system. Nerve fibres converging in the sciatic nerve originate from special openings in the vertebral bodies and intertwine to form the so-called plexus.

If these muscle fibres get exposed to pressure or become inflamed, the typical sciatic pain is felt, which radiates down a leg and can reach as far as to the foot.

This radiating, radicular pain can also occur in the cervical vertebrae as a result of a slipped disc. When this happens, the neck usually stiffens, and pain appears on one side of the arm. It is a sign that you should consult the doctor.

Often, sciatic pain refers to pain in the intervertebral discs and is a precursor of corresponding incidents. One reason for this is that the intervertebral discs support our spine with the help of 24 vertebral bodies. Thus, they hold together the entire skeletal framework of the human body. As soon as pain occurs here, it passes directly to the brain through a tangle of nerve fibres and the spinal cord.

In total, about 120,000 Germans are estimated to be afflicted with the disease each year.

Preventing sciatica pain

The best prevention against back pain in general and sciatica in particular is regular exercise such as swimming, gymnastics and stretching.

Especially for people working in a monotonously sedentary or standing job, physical compensation is necessary to strengthen the back muscles and increase flexibility.

Avoid incorrect postures at (office) work

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Pain in the area of the lumbar vertebrae is often triggered by permanent bad postures and often affects occupational groups that do a lot of sedentary work.

Sedentary work in particular can quickly impact on back health. Bad postures that develop over years of office work can trigger sciatica. Therefore, ergonomic equipment is highly recommended when working in a monotonous sitting posture for more than 4 hours a day. Ergonomic office chairs and electrically height-adjustable desks offer the user more movement throughout the day, which relieves the strain on the back.

Massages and posture training exercises provide relief

Massages and heat treatments (red light) as well as compresses and packs can be used to reduce the muscle tension that often causes back pain. However, these methods are only recommended if the complaints are not caused by inflammation.

Posture training is intended to regain lost mobility as far as possible and to learn how to move in a way that is friendly to the back. It is also about strengthening the core muscles so that the spine becomes more stable, and the intervertebral discs are relieved.

Exercise

Sport treiben

You should exercise at least one hour a week.

Aquafit and -jogging is the best kind of exercise for problems with the spine, back and joints. The reason for this is that when the water is up to our necks, it carries even one tenth of our body weight.

Muscles, tendons, ligaments and bones are relieved in a way that we feel light as a feather when we are in the water. At the same time, all muscle groups are strengthened, and the spine is stabilised.

There is another benefit: the water pressure lowers the heart rate. So it is also a great exercise for people with high blood pressure. Additional utensils, which can usually be borrowed from the lifeguard, help to strengthen the body’s muscles.

However, if you are not a water enthusiast or prefer to exercise at home, that is no problem either. There are numerous exercises you can do wherever you are, even at work.


1. Strengthening the sciatic nerve while lying down

  • Starting position: Lie comfortably on the floor, pull your knees towards your upper body, and place your feet on the floor. Your chin is always pointing towards your chest.
  • For the first exercise, use both hands to pull the right knee to the right shoulder and stay in this position for 30 seconds. Remember to breathe in and out slowly and regularly. Repeat the movement three times and then switch knees.
  • Next exercise: pull both knees to your shoulder and also stay in this position for 30 seconds. Repeat this movement a few times.
  • Remain in the starting position for the third exercise. Raise and lower your legs alternately without resting them on the floor. Move very slowly and consciously, taking care not to form a hollow back by pressing both arms firmly to the floor.
  • Now clasp your hands behind your head and bend your knees. Roll with the bent legs to the left, then to the right side. Stay on each side until you feel a tension in the lower back and hold the position for a few seconds.

2. Sciatica nerve training while sitting

  • This exercise sounds easy at first, but you will not be able to do it successfully the first time. For this exercise, sit on a mat and stretch your legs out straight. Now try to touch your feet with both hands.
  • You won’t be able to do this right from the start, but if you repeat this exercise every day, you will notice progress from time to time. The lumbar region becomes more and more flexible, and at the same time the back muscles are stretched and relaxed.
  • Do the exercises above regularly, ideally every day, to relieve sciatic pain or prevent sciatica. You can also get further suggestions for strengthening the sciatic nerve from a professional physiotherapist.

If you have been suffering from sciatic pain for a long time, you should see a doctor anyway who will prescribe physiotherapy.

Sciatica treatment

Bandscheiben

Surgery is only necessary in quite a few cases. This decision is only made if there is no sign of decreasing paralysis in the arm or leg. In this case, the surgeon removes the disc defect if it is caused by a pinched nerve.

Nowadays, however, the main treatment for sciatica is a combination of painkillers, physiotherapy, posture training and sometimes muscle training (back and abdomen). In quite a few cases, the pain can already be relieved with special medication. Most of these are anti-inflammatory drugs.

If the pain is too severe, anti-rheumatic drugs are also used.

One exercise to quickly relieve sciatic pain

For this exercise, lie flat on the floor with the legs at a maximum angle of 90 degrees. A hottie or a heated towel can be placed under the pelvis. In this position, inhale, and exhale deeply.

Repeat for as long as it is not strenuous. There should be a noticeable improvement after two days.

If not, the family doctor and afterwards the orthopaedic specialist should be consulted. The doctor can find out how to treat the persistent sciatic pain best. He or she will examine the pain pathways and locate the source of the pain.

What to do about sciatica – 10 tips

When sciatica symptoms appear, act immediately. Here are 10 tips on how to deal with sciatic pain:

  • In acute cases, first remain in the posture for a minute, breathing in and out very deeply.
  • As soon as you can, try to stretch and move very slowly. Be sure to avoid moving too quickly.
  • Do not press or rub the painful area, as this will irritate the tissue.
  • See a doctor as soon as possible. He or she can prescribe physiotherapy or a massage, and in the case of severe acute pain, the doctor will also administer painkillers. Painkillers are necessary so that you do not remain in the cramping and painful posture for a long time.
  • Excessive resting while lying down is counterproductive! Do not stay in bed for more than two days but rather try to move around as much as possible. It often helps to go for a walk for a few minutes every day.
  • Whether you prefer a heat patch, heat cream, hottie, heat lamp or cherry stone pillow, heat always helps with a pinched sciatic nerve.
  • Perform daily exercises to strengthen the spine and relax tense muscles.
  • If you work in an office, a height-adjustable desk allows you to work standing up, as sitting for too long puts more strain on the spine than protecting it. If you have a slipped disc or sciatica, sitting for too long can even cause severe pain.
  • Pay attention to the correct posture in everyday life, especially when lifting something from the floor. For that, bend your knees and keep your back as straight as possible. Then straighten up very slowly, always keeping your spine straight.

If the sciatica pain does not go away

Sciatica – how to defeat the pain 2

Pain is a warning signal sent by the body. If pain does not resolve within a short period of time, a doctor should always be consulted! / Picture: thodonal / fotolia.com

If the sciatic pain increases when you cough or sneeze, while at stool or when you move quickly, the cause is most likely a slipped disc.

If the doctor diagnoses an inflammation as the cause, the pain often increases at night. The origin of an infection can be Borrelia (Lyme borreliosis) or Herpesviruses (shingles). Likewise, the degeneration of the vertebral joints (spondylarthrosis), an accumulation of pus (abscess) or even a growth (tumour) can be the trigger of sciatica in the form of an inflammation.

In such cases, the doctor must use medical imaging methods such as MRI or CT (magnetic resonance imaging or computer tomography) to gain clarity in the diagnosis.

Last but not least, sciatica can also have a psychological background. Depressive moods, stress or loneliness often cause back pain or make it worse. In such cases, the pain can quickly become chronic. Later, a so-called pain memory may even develop. This means that the central nervous system reports pain from its “memory” for which there is no actual cause (anymore).


Medicinal pain management step-by-step

Pain management for reliably diagnosed sciatica is approved by the World Health Organisation (WHO) and is done in three steps. First, non-opioid drugs are administered, such as paracetamol, ibuprofen, or diclofenac. If necessary, these drugs are then combined with a weak opioid such as tramadol. Finally, the third stage involves the use of strong opioids (morphine, fentanyl), which are prescribed in addition to the simple means.


Modern surgical procedures are minimally invasive

In medical practice, the elimination of pain in form of drug therapy is calculated with a maximum period of six weeks. If this is not successful, surgery must be performed to treat the slipped disc. Otherwise, there is a risk of permanent damage to the affected nerve roots. Common, modern procedures are laminectomy and nucleotomy, which are both minimally invasive.

This means that a part of the affected vertebral arch of the intervertebral disc is removed during the laminectomy. Nucleotomy, on the other hand, is used to remove the nucleus that has broken out of the disc. Both procedures have the common goal of creating more space for the damaged nerve roots and relieving the pressure that has developed in the area of the spinal column.

Conclusion: Sciatic pain can be an early symptom

Sciatic pain is not something to be taken lightly. It is often the first sign that an unchanged behaviour may have more serious consequences. This means that as soon as pain in the 4th lumbar vertebrae appears, you should seek a flexible compensation more than ever.

Regular walks or other advice that you can easily integrate into your daily routine can be found easy. Massages are always a good idea. They loosen the muscles and strengthen them as well.

The post "Sciatica – how to defeat the pain" written by:

Sophie Voigtländer

Expertin für Bürogestaltung und Ergonomie

Sophie joined deskonia at the beginning of 2021. Since then, she is mainly responsible for translating all kinds of texts into English.

She studied International Communication and Translation.

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