Sciatica: the causes and the best treatment

Dr Mark's reply

Hopefully it won’t happen again, but as you have learned, it has a habit of coming back. If you can get a free second opinion from a private specialist, I would jump at the chance.

Most cases of sciatica – pain in the buttock or leg due to pressure on the sciatic nerve – are caused by a bulge in the jelly-filled discs that sit between the bony vertebrae.

The term slipped disc is a misnomer as the disc itself doesn’t actually move. The problem is caused by a tear in its outer case allowing the softer contents to burst out and compress nearby nerves, an injury that is particularly common on lifting when bending or twisting.

Discs typically heal slowly, with recovery over six to eight weeks being the norm, but as many as one in four patients still has problems after 12 months. Some cases do require more active intervention, including surgery, but this is generally avoided if possible.

Further investigation, such as an MRI scan and/or referral to a specialist, is indicated if the pain is severe and isn’t settling (typically within six weeks, but earlier if hard to control), or if there is a history of trauma, such as a fall.

Other ‘red flags’ that should prompt urgent reappraisal include any unexplained change in your bladder or bowel function, worsening pins and needles, muscle weakness in either one or both legs, or accompanying symptoms of general ill health, such as a high temperature or unexplained weight loss.