SCIATICA – What is sciatica and does it necessarily mean surgery?

What causes sciatica and what are your options once you’ve been diagnosed?

1990 in London, I was attending a training class in the torrid pursuit of qualifying as a tax professional. Suddenly I sneezed and it sent my life in a different direction. My lower back seized up and I was unable to move, frozen by the fear of pain. I excused myself and struggled to get home amid a two-hour commute before taking the next week off. 

Although I recovered from that episode, it set me on a road that would have many turns and junctions. Years of football and running took their toll and before long. Having moved to Singapore in the interim, I started getting pain down the side of thigh, particularly in the upper area and then also just above my ankle. At times there was tingling, at other times pain and throughout there was numbness. 

In time I found out that it was caused by prolapsed discs in the lower back. Your vertebrae (the bones that make up your spine) are separated and cushioned by flat, flexible, round discs of connective tissue. As I envisaged this, I saw a disc, between the bones in the spine that was slipping out of place and pressing on the nerves that also run down the spine. I came to understand though that these discs are soft tissue constructs and when a disc gets worn down, the gel which forms a natural part, tends to seep out and it’s that which makes contact with the spine’s sciatic nerve. Specifically this was happening for me at position notated as L4 and L5, at the base of the back. 

Physiotherapy tends to be the medical profession’s advice and that seems a sensible option over surgery if it’s thought that the situation can be relieved. But I was young and desperate to play football, allowing the injury to fester over a period of months. Thinking back I now see how ridiculous it was that I would line up in my position at right back and be leaning from the waist over to one side, in compensation for the discomfort I was feeling in my back.

Eventually I had surgery to fuse L4 and L5 together and this provided some relief. Several years later however, some family events made me realise that the pain, which was now worse than before, meant I wasn’t functioning as a young adult should be able to and I was booked in for surgery again. This time it was the scar tissue from the first procedure which had formed and was now pressing on the nerve. This was cleaned up and after recuperation I was delighted to be pain free. 

I had put on plenty of weight in the interim and following doctor’s orders I limited my activities to low-impact exercise. Spin classes became my life, the weight fell away and I could do pretty much anything that a person in their late 30s would be expected to. One day I went out onto Singapore’s historic Padang and couldn’t resist the opportunity to have a little trot. I built in some side-to-side shuffles and even worked up to a 20 metre sprint. In time I realised that these enjoyable sessions were mimicking a football game and despite advice to the contrary from my surgeon, I started to play competitive football again. 

15 years later, I’m pain free, a little stiff from time-to-time if I sit in the wrong kind of chair, but still playing football. The only thing I have banned myself from doing is road running, convinced that the constant pounding of kilometre after kilometre will be a step too far, not only for my back, but for my knees too. 

I have friends who also have back problems and also realise that mine, although serious and challenged by its own complexities, was relatively straightforward. Others have confluent injuries in the hip, leg and spine which make things more difficult to treat.

I come away from the experience as a big supporter of surgery. In my mind it gets to the nub of the problem and seeks to correct it. 

WebMD says that most people with sciatica get better in a few weeks without surgery. Over-the-counter pain relievers can help relieve pain, although they should be only a short-term solution. Doctors might also recommend putting cold packs on your lower back for a couple of days and then switching to hot packs for a few days after that. There are also lots of good stretches for lower-back and sciatic pain relief.

Your first instinct might be to rest and take it easy when you have sciatica, but it’s actually more important to keep moving. If you sit still, the nerve will continue to be irritated in that spot. Staying in motion will reduce inflammation.

If home remedies don’t work, your doctor will probably prescribe stronger medication, like anti-inflammatories or muscle relaxants. You might also try steroid injections, acupuncture, physiotherapy and the specific chiropractic care that an expert can provide.

If your pain lasts for more than three months, it might be time for surgery. See your doctor immediately if your sciatica causes severe pain and weakness, numbness, and loss of bladder or bowel function.

There is a future for people with chronic back pain and a very satisfactory recovery and lifestyle can be found. I’ve found that tennis (essentially a shuffling sport), football (a walking, jogging and sprinting event) accommodate my back well. Jogging and things like jumping rope are a problem and I stay away from those. 

General practitioners, realising that low-impact sports are generally best for back related issues, will naturally recommend swimming. But experts in the field agree with what I’ve found in practice, that the breaststroke in particular will have you naturally flexing your lower back upwards from the waist, which tends to squeeze that area and irritate the L4/L5 position, compressing that element of the spine that causes the problem in the first place. 

See a specialist if your GP doesn’t provide relief within a few weeks.

Singapore-based Steve Dawson is a seasoned sports journalist and broadcaster who has covered thousands of sporting events at arenas, in studios and hunkered down in commentary booths.
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