Published on
Feb 5, 2025
Sciatica and lower back pain
Introduction
Lumbosciatica refers to the combination of low back pain (pain in the lower back) and sciatica (pain radiating down a leg along the path of the sciatic nerve). It is most often caused by a herniated disc or lumbar osteoarthritis, which irritate or compress a nerve root. This is an extremely common reason for consultation: low back pain is the leading cause of sick leave worldwide. While the majority of episodes resolve within a few weeks, some cases of lumbosciatica can reveal a serious pathology requiring urgent medical attention.
If you have low back pain radiating down your leg, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a home doctor: call 021 845 45 45 or use our app available on the App Store and Google Play.
Who is at risk?
The risk factors are numerous: lifting heavy loads, poor professional postures, sedentary lifestyle, prolonged sitting or standing, being overweight, a history of low back pain, pregnancy, weak abdominal and back muscles, lumbar osteoarthritis, herniated disc, osteoporosis, poor physical condition, smoking (which impairs the nutrition of the intervertebral disc), and psychosocial factors (stress, depression, anxiety). Men and women are equally affected, with the peak incidence occurring between 30 and 50 years of age.
Symptoms of lumbosciatica
Symptoms combine low back pain and radicular pain of a specific distribution.
Main symptoms
Low back pain : pain in the lower back, sometimes mechanical (worsened by effort, relieved by rest) or inflammatory (waking up during the night, morning stiffness).
L5 Sciatica : pain radiating down the postero-lateral aspect of the thigh, leg, to the top of the foot and the big toe.
S1 Sciatica : pain radiating down the posterior aspect of the thigh and leg, to the heel and the little toe.
Cruralgia : pain radiating down the anterior aspect of the thigh, in case of involvement of the L3-L4 roots.
Paresthesias (tingling, numbness) in the territory of the affected root.
Muscle weakness, sometimes a motor deficit (extension of the big toe, walking on tip-toes or heels).
Worsening with coughing, sneezing or defecation (indicative of root compression).
Stiffness, limited movement of the lumbar spine.
When to seek urgent medical attention?
An emergency consultation is necessary in the following situations ("red flags"):
Cauda equina syndrome : sphincter disorders (incontinence or urinary or fecal retention), saddle anesthesia, motor deficit in both legs — call 144.
Rapid and significant motor deficit in one leg.
Low back pain associated with a fever (suspicion of a spinal infection).
Pain occurring after a major trauma.
Low back pain in a patient with a history of cancer, osteoporosis, or taking corticosteroids.
Intense night pain, weight loss, deterioration of general health.
Patient aged > 50 years with new-onset low back pain.
What to do before calling Docadom? Avoid strict bed rest (which makes the situation worse), move gently, and contact your primary care physician first. If they are unreachable or if you need a home doctor outside of opening hours, call Docadom on 021 845 45 45 or make your request directly from our smartphone app (App Store and Google Play). In case of neurological signs (loss of strength, sphincter disorders, saddle anesthesia), dial 144 without delay.
Causes of lumbosciatica
Mechanical causes (most frequent)
Herniated disc : this is the most common cause of sciatica in young adults.
Lumbar osteoarthritis and degenerative disc disease : more common after age 50.
Spinal stenosis : neurogenic claudication of the elderly.
Spondylolisthesis : slippage of one vertebra over another.
Traumatic muscle or ligament injuries.
Inflammatory, infectious, and tumor causes
Ankylosing spondylitis and other inflammatory rheumatisms.
Infectious spondylodiscitis (rare but serious).
Vertebral metastases of cancers (breast, prostate, lung, kidney).
Myeloma, primary tumors.
Vertebral compression fracture due to osteoporosis.
Diagnosis of lumbosciatica
The diagnosis is essentially clinical. Imaging is only indicated in case of red flags, persistent pain, or before an interventional procedure.
Diagnostic methods
Anamnesis : onset circumstances, pain characteristics, associated signs, history.
Clinical examination : looking for a Lasègue sign, neurological examination of the lower limbs (strength, sensitivity, reflexes), spine examination.
X-rays of the lumbar spine: not very useful in common acute low back pain, useful in case of red flags.
Lumbar MRI : reference exam in case of persistent sciatica, neurological deficit, or before surgery.
CT scan in case of contraindication to MRI.
Blood tests (CBC, CRP, protein electrophoresis) in case of suspicion of an inflammatory, infectious, or tumor etiology.
Electromyogram (EMG) in case of doubt regarding nerve root involvement.
Alternative diagnoses
Coxarthrosis or hip pathology, which can sometimes be misleading.
Piriformis syndrome.
Peripheral neuropathies such as diabetic neuropathy or others.
Arteriopathy of the lower limbs (arterial claudication).
Abdominal aortic aneurysm in the elderly.
Pelvic pathologies (gynecological, urological).
Treatment of lumbosciatica
Management combines medical treatment, maintaining adapted activity, and rehabilitation.
Medical treatment
Paracetamol as first-line treatment.
NSAIDs (ibuprofen, ketoprofen, diclofenac): highly effective for inflammation, used for short durations.
Muscle relaxants (thiocolchicoside, tetrazepam to be avoided): useful if there are marked muscle spasms.
Step 2 analgesics (tramadol, codeine) if necessary.
Oral corticosteroids as a short course: sometimes used in hyperalgic sciatica.
Epidural or foraminal injections : in case of persistent sciatica.
Strong opioids should be avoided in the long term.
Non-pharmacological measures
Maintaining an adapted physical activity : strict bed rest is detrimental.
Physiotherapy : stretching, muscle strengthening, core training, back care education.
Application of heat or cold depending on preferences.
Ergonomic advice for work and daily life.
Regular physical activity (walking, swimming, cycling) once the acute phase has passed.
Addressing psychosocial factors.
Surgical treatment
Surgery is indicated in case of cauda equina syndrome (emergency), significant motor deficit, or persistent sciatica after 6 to 8 weeks of well-conducted medical treatment. Techniques include microdiscectomy, laminectomy, and sometimes spinal fusion.
Prevention of lumbosciatica
Regular muscle strengthening (abdominal, back, core training).
Regular physical activity : walking, swimming, cycling, yoga, pilates.
Good posture at work (workstation ergonomics, screen at eye level).
Learning to lift loads by bending the knees and keeping the back straight.
Avoiding a sedentary lifestyle, changing positions regularly.
Maintaining a healthy weight.
Smoking cessation (impairs disc nutrition).
Managing stress and sleep disorders.
Adjusting the mattress and pillow.
Possible complications
The majority of lumbosciatica cases resolve without sequelae. Some can evolve into chronic low back pain, which is a source of prolonged disability. The most serious complication is cauda equina syndrome, an absolute neurosurgical emergency. Other complications include recurrences, neurological sequelae (motor or sensory deficit), chronic neuropathic pain, and professional and psychosocial impact (prolonged sick leave, depression).
When to contact a doctor for lumbosciatica
Any new or persistent lumbosciatica warrants a medical opinion. Here is what to do:
As a first step : contact your primary care physician, who can evaluate the situation, prescribe an appropriate treatment, and refer you to a specialist if necessary.
If your primary care physician is unavailable (evening, weekend, holidays), Docadom offers an emergency consultation by a home doctor. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.
In case of warning signs (rapid motor deficit, sphincter disorders, saddle anesthesia, fever, history of cancer), call 144 without delay.
Conclusion: stay active, do not immobilize yourself
Lumbosciatica is a common condition, usually benign but sometimes disabling. It is characterized by low back pain associated with radiating pain in the leg along the territory of a nerve root, which can lead to complications such as cauda equina syndrome, a neurological deficit, or disabling chronicity. Treatment relies on painkillers, maintaining activity and physiotherapy, and sometimes on surgery. Prevention through muscle strengthening, ergonomics, and physical activity remains key.
In case of severe or persistent pain, first consult your primary care physician. If they are not available, Docadom provides you with an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.
