Physiotherapy for Sciatica
Signs and Symptoms:
- Pain that starts in your lower back to your buttock and down the back of the leg.
- Pain can be an ache or a sharp burning sensation.
- Pain can worsen with coughing, or sneezing this can indicate a disc “slipping out”
- It is possible to feel numbness or tingling in the affected side.
- Severe symptoms include trouble walking due to pain.
- Sciatica happens when the sciatic nerve becomes pinched.
- There are discs between the bones of your spine (vertebrae) that act as shock absorbers. Sometimes they can slip or bulge out and can cause pressure on the nerve. This is the most common reason for sciatica.
- Bone outgrowths called “bone spurs” can press on nearby nerves.
- There is a muscle that lies deep within your buttocks called the piriformis muscle – sometimes this muscle can become tight or spasm which can put pressure on the sciatic nerve.
- Sometimes other medical conditions (like tumors) can injure nerves near the spine.
Risk Factors/Who it Impacts
- Most common changes in the spine are due to age, such as slipped disc, or arthritis. These conditions can increase risk of experiencing sciatica.
- Obesity: more stress, due to weight, on your spine can cause spinal changes
- Sedentary lifestyle: Sitting for long periods of time can contribute to development of sciatica
- Diabetes can lead to increase risk of nerve damage and contribute to development.
- Usually diagnosed based on the exam findings by your physician. One test used to diagnose sciatica is the “leg-raise test”. The physician slowly raises each leg until the pain is noted; usually about 30-60 degrees can produce the pain. When the physician raises the unaffected leg, and it causes pain in the affected leg, it is a positive sign and can indicate a “slipped disc”.
- Imaging isn’t needed unless the symptoms don’t go away with a month of treatment or if the patient has a past medical history of:
- Disabling symptoms, osteoporosis, steroid use, unexplained fever/weight loss, tumor history, trauma and IV drug use.
- If patient does not have an improvement in symptoms from rest, physical therapy and medication after 3 months then an MRI is needed.
Principles of Physiotherapy for Lumbar Disc Herniation Causing Sciatica:
Overall, there are four phases of physiotherapy for the management of lumbar disc herniation as defined by Hoogenboom and colleagues in a 2013 issue of the International Journal of Sports Physical Therapy.
- Phase I (Inflammatory Phase, days 0-6) – the focus is to minimize inflammation and eliminate mechanical stress on the spine in order to provide a safe healing environment. Utilizing the Mackenzie method in this phase is also important, wherein avoiding flexion and emphasizing extension is suggested.
- Phase II (Repair phase, days 3-20) – this phase introduces exercises that utilize isometric contractions to resist frontal and rotational movements.
- Phase III (Remodeling phase, days 9 to full resolution) – in this phase full integration of rotational movement can occur.
- Phase IV – full return to sport and/or daily activities. Sports specific rehabilitation, postural control and injury prevention training.
Additional passive modalities that may help include deep tissue massage, hydrotherapy, transcutaneous electrical nerve stimulation, and spinal traction.
If non-operative treatment fails and patients continue to experience radicular (leg dominant) symptoms, a nerve root injection and/or surgical intervention may be required.