Sciatica

What is it?

Sciatica is the name given to any type of pain caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest nerve in the body. It starts in the back of the pelvis and runs all the way down both legs ending at the feet. There are two types of sciatica:

Acute sciatica, which lasts up to six weeks
Persistent (chronic) sciatica, which lasts longer than six weeks

The most common cause of sciatica is due to a herniated (or slipped) intra vertebral disc but there are other causes as well so sciatic pain should always be investigated.

How does it affect people?

People with sciatica normally experience pain in the lower back, the pain can continue through the buttocks and radiate down the legs. The pain can affect one or both legs and can reach only as far as the buttocks or in some cases travel all the way to the feet. Sciatic pain can range from being mild to very painful and can last for weeks or months. People with sciatica can also experience some or all of the following symptoms around their legs and feet:

Numbness
Tingling
Muscle weakness
Loss of tendon reflexes
Loss of bowel or bladder control

Commonly the pain reduces mobility, disrupts sleep and creates anxiety about longer term problems.

Longer term pain and disability can have an adverse effect on an individual’s mood. This can sometimes lead to the onset of other health conditions such as depression.

How is it treated?

Most cases of acute sciatica will pass without the need for treatment. A combination of self-help measures such as over-the-counter painkillers, exercise and hot or cold packs can usually relieve the symptoms.

For persistent sciatica, the employee may benefit from a structured exercise programme under the supervision of a physiotherapist. In very rare cases, surgery may be needed to control the symptoms.

How might it affect work?

Most employees with sciatica are able to continue working or return to work within a few days, even if they have some residual or recurrent symptoms, although the work may require short term modifications to allow this. Generally the advice for someone with sciatica is to remain as active as possible and this will include, where possible, a return back to normal work to help recovery. The level of symptoms experienced and the effect that these have on the ability to undertake particular activities varies from one individual to another which makes generalisation difficult. However employees may experience discomfort with some of the following tasks:

Lifting and handling
Bending and twisting
Sitting for prolonged periods (may affect driving)
Standing for long periods without movement
Walking long distances
Climbing up stairs

What do I need to do as the manager?

Discuss the problems your employee has in respect of the tasks above and how they relate to work activities. Identify what tasks they can and cannot perform and the length of time that they can perform them. Where changes can be reasonably accommodated, you should modify duties to enable the employee to return to or continue at work. It is likely that their capability will improve quite quickly so you should review work with the employee every 2-3 days. Make sure that they are able to cope and where possible increase their workload in stages to help facilitate their return to full duties.

Key points to consider when managing an employee with sciatica

Focus on support; helping them to remain at work or to return to work as soon as possible
Employees do not need to wait until they are pain free before they return to work
Evidence suggests that early return to work or continuing at work with symptoms does not increase the risk of ‘re-injury’ but actually reduces recurrences and sickness absence over the following year
Modified duties should be a temporary measure and not normally last for more than 4 weeks
In cases of an absence of more than 4 weeks, or difficulty in returning to normal duties after 4 weeks, refer to Occupational Health for advice

Points to remember

Fit notes

If an employee produces a fit note indicating that they require modified duties, discuss this with them and consider if the modification recommended can be reasonably accommodated.

Job tasks and risk assessments

Review the risk assessment for the employee’s job role and work tasks including the ability to drive safely where required. Take into consideration any temporary modification that may be required to accommodate their reduced ability to undertake certain tasks.

General guidance

If you require further information, refer to the general advice on managing attendance.