Carola Felchner

Carola Felchner is a freelance author at lifelikeinc.com and a certified exercise and nutritionist. She worked at various trade magazines and online portals before becoming self-employed in 2015 as a journalist. Before her traineeship, she studied translating and interpreting in Kempten and Munich.

More about the lifelikeinc.com expertsWhen it painfully pulls from the back to the leg is usually the sciatica fault. This colloquial term summarizes various complaints that emanate from the sciatic nerve. Medically correct, the phenomenon is called sciatica. Cause can be for example a herniated disc or an inflammation. Read more about the causes, symptoms and treatment of sciatica and why sciatica does not like prolonged sitting and how to prevent it.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. M54M51ArtikelübersichtIschias

  • symptoms
  • treatment
  • Examinations and diagnosis
  • lumboischialgia
  • Causes and risk factors
  • Sciatica in pregnancy
  • Course and prognosis

Quick Overview

  • What is sciatica? Damage to the sciatic nerve with pain that usually radiates to the leg. Doctors speak of sciatica.
  • symptoms: Tingling, electric shock-like or drawing pains, numbness, paralysis
  • Treatment: depending on cause and severity. Therapeutic options include medication, surgery, physiotherapy, heat treatments, massages etc.
  • Causes: Herniated disc, vertebral injuries, articular rheumatism, inflammation, abscesses, bruising, tumors, infections etc.
  • Forecast: With timely, proper treatment, the chances are good that the symptoms heal completely.
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Sciatica: symptoms

Of the sciatic nerve (Sciatic nerve) is the thickest nerve of the human body. He pulls over the back of the thigh and branches at the level of the knee in his two lower leg branches, the peronaeus nerve (Nervus peronaeus) and the Tibial Nerve (Tibial nerve). It supplies the muscles in the leg and, with its sensory components, sends sensations from the lower extremities to the central nervous system.

The sciatica can cause painfully or suddenly. Doctors refer to the typical sciatic pain as neuropathic pain, Many patients express themselves more vividly: Sciatic symptoms should "feel like an electric shock" or "ants tingling in the leg". In addition, you can numbness and paralysis occur.

Very characteristic is also that the Pain radiates, One speaks then of radicular (nerve root-derived) pain, This distinguishes the sciatica, for example, from a lumbago. This can also occur by unfortunate turning or lifting and manifests itself in sudden back pain. This does not pull in the leg.

If the fibers of the fifth nerve root of the lumbar spine (L5) are particularly affected, the pain runs from the buttocks via the posterior outer thigh to the outer knee to the front outer lower leg. He can even move on to the ankle. If the first nerve root of the sacrum (S1) is damaged, the sciatic pain will move from the sacrum over the buttocks into the thigh back. The pain continues over the popliteal fossa into the foot.

Radiating sciaticaThe sciatic nerve runs in the back thigh and branches at the level of the knee in his two lower leg branches. Often disc damage is responsible for the radiating sciatic discomfort.

If the sciatica is trapped due to a herniated disc, the pain is often increased by coughing, sneezing or pressing (during bowel movements) as well as movement. Rarely, in addition, the urination and defecation are disturbed. If inflammation is the cause of sciatica, the pain often increases at night.

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Sciatic Treatment: What to do when in pain?

How sciatica pain is best treated depends on the cause, severity and duration of the condition. However, in the first place sciatica treatment stands - especially in new pains - their the fastest possible relief, This is to prevent the pain from becoming chronic and developing a so-called pain memory. This is understood by physicians, that the central nervous system through "learning effects" later also reports pain, if there is no cause for it.

Sometimes the body alone manages to heal itself or the affected nerve. Often the pain then lasts for a few days to six weeks.

Tip: For acute complaints, it may be helpful to keep your legs high. You can build a so-called step bed by lying on its back and pushing a pillow or mattress under your legs so that the lower legs are raised and both hip and knee joints are bent at approximately 90 degrees.

If the pain does not improve or is very severe right from the beginning, the sciatica can be treated in three ways: with medication, other conservative therapies (physiotherapy, etc.) and surgery.

Medicinal sciatica treatment

Sciatic pain can be alleviated with analgesics. The attending physician is usually guided by the World Health Organization (WHO) Pain Management Level Scheme. This scheme consists of the three stages:

  • Non-opioid analgesics such as paracetamol, ibuprofen or diclofenac
  • weak opioid analgesics (like tramadol) in combination with non-opioids
  • strong opioid analgesics (eg morphine, buprenorphine or fentanyl) in combination with non-opioids.

First, it is attempted to alleviate the sciatica pain with non-opioid analgesics. If they are not effective, the doctor may prescribe weak opioids. Strong opioids are used only in the most severe, difficult-to-treat pain.

Opioids are very effective painkillers. But they can have life-threatening side effects and make them dependent. Therefore, they should be used with caution and under medical supervision.

Sometimes the cause of sciatica can also be specifically treated with medication. Then one speaks of one specific sciatica therapy:

For example, if an infection triggers the pain, the doctor may antibiotics (against bacteria) or antivirals (against viruses) prescribe. Antibiotics may also be needed in case of complications, such as a collection of pus that presses on the sciatic nerve.

  • "Always have a sciatica cleared up by the doctor"

    Three questions

    Dr. med. Joachim Mallwitz,
    Specialist in Orthopaedics
  • 1

    How can I tell if my sciatica is causing problems?

    Dr. med. Joachim Mallwitz

    A sciatica is a pain in the leg originating from the sciatic nerve. The pain begins in the buttocks and pulls down to the foot - these are the regions that the nerve supplies. He wanders at the back of the thigh and the back and side of the lower leg to the toes. Sometimes there is also a sensory disturbance or muscle weakness. A sciatica can strike anyone, because there are so many different causes.

  • 2

    Are there any quick emergency aids to relieve the pain?

    Dr. med. Joachim Mallwitz

    Basically, let the pain first clarify the doctor! What you can do yourself depends on the cause. Is an inflammation behind it, help appropriate medication. Sometimes the nerves are also constricted, perhaps because an intervertebral disc presses on them. A physiotherapist can then show you relief positions for the nerve, which you can later take on your own. Also heat and painkillers can relieve.

  • 3

    As an expert, do you have any special advice for those affected?

    Dr. med. Joachim Mallwitz

    Depending on what caused the sciatica, you can prevent new ailments. For example, in the case of a dysfunction of the musculoskeletal system, the patient is given a home exercise program. Among other things, he learns to improve his coordination of movement.

  • Dr. med. Joachim Mallwitz,
    Specialist in Orthopaedics

    Dr. med. Joachim Mallwitz is founder of the back center in Hamburg, which interdisciplinary since 2001 cares for the treatment of disorders of the musculoskeletal system.

Further conservative sciatica treatment

In addition to medicines, there are other conservative (non-operative) treatment options for sciatica. So can physical therapy relieve sciatica pain and improve prognosis in the long term. Depending on the method, it can loosen strained muscles, stabilize and strengthen the spine and correct any false and protective posture. For example, exercise therapy (physiotherapy, back exercises), heat treatments or massages are used. The therapist will select appropriate treatments for each patient.

This helps with acute pain. Put your legs up in acute sciatica pain. The lower legs should be raised and both hip and knee joints bent at a right angle.

Another important approach of the so-called multimodal treatment is the behavior therapy, It should help the patient to cope better with the symptoms. In addition, it is intended to prevent the patient being overprotected and less agitated for fear of sciatica pain. That endangers long-term treatment success. In modern sciatica treatment, the behavioral approach therefore plays an important role.

Bed rest can be advised in case of acute pain. But to prevent future sciatica complaints, sufferers should move a lot. So it is advisable, for example, in desk work to get up every now and then and do light gymnastics (back exercises, etc.). This relieves and strengthens the back and the intervertebral discs.

Operative sciatica treatment

Rarely, sciatica requires surgery. This can be the case, for example, if a herniated disc causes serious discomfort (such as defecation, paralysis, or severe, difficult to treat pain). Sometimes the sciatica is also the result of a narrowing of the spinal canal in the lumbar region (lumbar spinal canal stenosis). Then an operation may also be useful.

Most such operations are performed minimally invasive today. The surgeon does not make a big cut to have a direct view of the area to be operated on. Instead, he makes several small cuts, through which he introduces fine optical and surgical instruments into the body.

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Sciatica: examinations and diagnosis

Sciatica can be very painful, but usually disappears by itself within days to weeks. In case of persistent or recurrent complaints you should go to the doctor.

In general: If back pain is accompanied by numbness or paralysis in the leg and / or disorders of the intestinal and bladder emptying, one should urgently consult a doctor!

The doctor first asks you in detail about yours medical history (Anamnese). He may ask the following questions:

  • Since when do you have the pain?
  • Have the symptoms occurred suddenly and in connection with certain strains?
  • How would you describe the pain (eg as shooting or electrifying)?
  • Where exactly is the pain? Do you radiate?
  • What gives you relief?
  • What is your profession?
  • Is your everyday life affected by sciatica pain?

At the following clinical examination Your doctor looks first at your back and legs. He looks for any malpositions and checks the mobility of the joints, the strength of the muscles and their reflexes. He also tests the touch sensitivity and feel of the legs by stroking the skin and letting you identify the point where he touched you.

With the so-called Lasègue test, your doctor will check whether the nerve roots of the lower spinal cord are irritated. You lie on your back and the doctor raises your stretched leg. If the sciatic nerve is trapped or otherwise irritated, pain in the back, which shoots into the leg, occurs halfway up.

In the search for the cause of the discomfort, the doctor may perform further examinations, for example one magnetic Resonance Imaging (MRI or magnetic resonance imaging) or Computed tomography (CT). Such imaging techniques are especially important when paralyzed or maladapted.

To determine the location and extent of the nerve damage, the physician can use electrodes to determine the muscle activity (electromyography = EMG) and the nerve conduction velocity (electroneurography = ENG).

If suspected of one Sciatic nerve inflammation The doctor will give you blood to determine the levels of inflammation and identify any pathogens (like Borrelia). It may also be necessary to remove and analyze cerebrospinal fluid (CSF). To do this, the physician pricks a needle through the skin of the lower back and gently pushes it into the spinal canal adjacent to the spinal cord to remove a small CSF sample (Liquorpunktion).