Leg Pain or Sciatica

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Leg Pain
or Sciatica

Diagram to show where nerves in the lumbar spine and sacrum refer pain into the legs

Arm Pain

 

The nerves in your low back, or lumbar region and your sacral region at the base of the spine, will refer pain down the front or back of your legs if they are irritated or compressed. Usually the pain in your leg is worse than the pain (if you have any) in your back. The nerve can also give other symptoms such as pins and needles or numbness.

Your spinal cord normally ends in the upper part of your lumbar spine (low back). At this point where the cord ends it divides up into lots of nerve strands which continue down through the spinal canal, behind the lumbar vertebrae. They look a bit like a horses tail and are therefore called the cauda equina nerves. At each vertabral segment an individual nerve root exits from a bony hole at the side of the canal (foramen) to run down the leg. As the nerves also supply the muscle you can feel weakness in your leg if the nerve is compressed.

There are a number of reasons why you can develop leg pain from your back.

Leg Pain

 

There are a number of different structures that can refer pain from your low back down your leg. Please take a look here for a more detailed explanation.

Investigations in the early stages of sciatic leg pain are not usually helpful as most people will get better naturally and not require any invasive treatment. If symptoms persist however, despite medication and manual therapy, then a Magnetic Resonance Imaging (MRI) scan can help to confirm diagnosis and pinpoint an area for further treatment options. X-Rays are not useful to diagnose back pain or leg pain. They are sometimes helpful to show structural abnormality and are therefore occasionally requested for this reason.

It is unusual for there to be a more serious underlying reason for back or leg pain, such as a tumour, infection or fracture. GP’s Physiotherapists and Consultants are good at identifying these rarer presentations and will organise investigations if they feel they are needed.

There is a rare condition called Cauda Equina Syndrome. If you develop symptoms which affect your bowel, bladder and sensation around the genitals then you must seek an emergency medical opinion. If you have these symptoms you should go immediately to Accident and Emergency. Please click here to see the symptoms that you need to act upon.

At New Hall Hospital we have a static MRI Scanner with rapid access. It is always best practice to see a spinal specialist prior to considering whether an MRI would be useful. NHS patients are usually seen by a community triage service who can refer for a scan if they think it would aid diagnosis and decisions about treatment options, before referring to a spinal specialist centre like New Hall. At New Hall we see a large number of NHS.

If you have Private Insurance or wish to Self Pay, then New Hall offers rapid access Spinal Consultant appointments with fast access to MRI scan then review of these images to consider treatment options. A number of Consultants offer a One Stop service for assessment, MRI, review and treatment on the same day if appropriate.

Medication

Early pain relief is essential as sciatica can be very painful. It is common for function to be limited and for sleep to be restricted. Most pain medications reduce symptoms, but do not eliminate them entirely. If you have some pain relief the evidence suggests you move better, sleep better and therefore recover more quickly. Talk to your GP about a suitable prescription based on your other medical history. The National Institute for Clinical excellence (NICE) recommend anti-inflammatories initially. There are other pain relieving drugs that your GP can prescribe if anti-inflammatories are not suitable or do not give sufficient symptom control for you.

A group of medication called anti-neuropathic drugs can also help some people with nerve pain. Talk to your GP to see if you are a suitable candidate for these tablets.

Physiotherapy

Manual therapy has been shown to help people recover from sciatic leg pain. It’s advisable to avoid high velocity manipulation techniques, but gentle manual techniques, ergonomic advice and exercises can be helpful. At New Hall Hospital we have a PHYSIOTHERAPY LINK department and offer rapid access clinics. By knowing the right way to exercise and manage flare ups of pain you are more likely to be able to manage any episodes if they occur. If you are physically fit then you are less likely to suffer with recurrent episodes.

Spinal injections are a specialist procedure that need to be done as a day case in hospital. Your spinal specialist will assess you, take a detailed medical history and undertake a physical examination. They will request any Investigations that are necessary. For sciatic leg pain there are a number of different injection options to consider. Your specialist will advise you of the pros and cons of each option and will discuss with you which procedure is likely to present the best outcome for you, depending on your MRI scan and symptoms. Your Injection will be done under X-Ray guidance as a day case procedure by either a Spinal Orthopaedic Consultant or Consultant Anaesthetist.

The following Leaflets outline each procedure along with the risks and benefits.

Lumbar Formaminal / Nerve Root Block and Lumbar and Caudal Epidural (Injection)

Several of our Spinal Consultants offer a Private Clinic whereby you can have a fast track assessment and MRI. You can then be placed on a fast access injection list if required.

A number of our Spinal Consultants offer a Private One Stop Clinic whereby you can have your assessment, MRI, follow up consultation and then injection if required during one visit to the hospital.

Spinal surgery is a specialist procedure and should not be undertaken lightly. Spinal surgery has a very good chance of helping leg pain symptoms if a corresponding cause can be found on an MRI that links with your symptoms. It is less likely to resolve low back pain if you have it, but can sometimes help. Your spinal specialist will assess you and take a detailed medical history alongside a physical examination. They will discuss various treatment options and together with you, will agree on a plan.

More information on surgical options for the lumbar spine and link here

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