I have a client whose main problem is sciatica and he will struggle to get enough points outside of the times when he has acute attacks. The acute attacks are very bad and he has been prescribed morphine during these spells but they are a minority of the time. I know that the advice on back pain is generally to remain active so as to keep the muscles that support the spine in good shape and prevent increased stiffness but wondered if anyone knows of any research / guidance concerning these periods of very acute sciatica. Is there any potential risk to the client if they were to try to be active during these times?

um... sciatica being due to disc problems, not muscle problems ... i think person would be likely to do more harm than good.

I don't want to be unhelpful but my knowledge of current medical thinking is that the only risk would be that he would get better sooner (or more likely learn to live with the pain or change the way he moves.)

Is there any mileage about risks as he'd be under the influence of morphine?

Just to be clear.

Sciatica is a symptom (and is said to be ancient terminology) as it is nerve irritation.

The only effect of sciatica I understand to be is pain.

A slipped disc could be the cause as it presses on the sciatic nerve.

There would not be any danger to the disc (I understand) but just more pain.

Physiotherapy is commonly prescribed for sciatica.

Sometimes I think I only use ancient terminology. I don’t know what was wrong with the term sciatica, it is after all the sciatic nerve which is irritated. Why change this and keep bonkers things like ‘non-inflammatory arthritis’? (not that I’m suggesting this should be changed, more trouble than its worth)

Don’t know how significant it is but it is prolapsed disc that causes the sciatica. He has been given the usual advice to keep as active as possible when he is not suffering an acute attack but was told to rest as much as he could during an acute attack. Given how bad they are he probably didn’t need this advice to induce him to lie down as much as possible. His GP has indicated in some imprecise terms that undertaking activity at these times could potentially be risky for him. I’ll try to get more off the GP but whilst I’ve been able to find lots of research and guidance saying that exercise in general and specifically exercises prescribed by a physiotherapist help with back pain I can’t find anything specifically referring to exercise during acute attacks of sciatica. This might be because it is no different.

if it's a prolapse, he should have been referred to a consultant, and therefore a letter to consultant might be a better plan..

The main disabling factor (and risk) must be the disc prolapse rather than the sciatica which is symptomatic?

Has he been warned that the mechanical issues with hi back may warrant surgery now or if it worsens?

I'd have thought it reasonable that he took the pain of the sciatica as a warning not to (ab)use his back any more to avoid worsening his condition?

P.S. It's just something I read about ten years ago that said Sciatica was an ancient and outdated term.