How to Effectively Manage Sciatica with Physiotherapy?
Many people complain of a lower back pain that radiates through the hips, buttocks and down their legs- a kind of tingling sensation. If you are one of those suffering from these symptoms, then you could probably be suffering from sciatica.
What is Sciatica?
Sciatica refers to pain, weakness, numbness or tingling sensation along the path of the sciatic nerve. It is caused due to the compression of (or) injury to the sciatic nerve. It most often occurs when a herniated disc or a bone overgrowth puts pressure on a part of the nerve and causes the irritation.
The sciatic nerve is the longest and thickest nerve in the body and comprises the nerve roots from the lower back region (lumbar spine) and from the sacral region (tail end of the spine). It starts from the lower back and extends down each leg through the hips and buttocks.
What Are the Possible Causes of Sciatica?
- Slipped or herniated disc.
- Spinal stenosis (narrowing of the spaces in the spine, resulting in pressure on the spinal cord and nerve roots).
- Piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks).
- Pelvic injury or fracture.
- Tumors, cysts and other growths.
- Spondylolisthesis (occurs when the vertebra slips out of place onto the bone below it).
- Muscle tightness causes change in the curvatures of the spine.
What Are the Symptoms of Sciatica?
- Sciatica pain can range from a mild tingling or a dull ache to a sharp, burning pain. In severe cases, the pain is so intense that it debilitates the normal movements of the individual.
- Another typical symptom of sciatica is exacerbation of pain during coughing or sneezing or if sitting for a long time.
- Sciatica usually affects only one side of the body. In some cases, one leg may have pain and the other leg may have numbness. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.
- Sometimes, sciatica is associated with weakness on leg or legs and or bladder, this is likely due to compression of the cord, it is classed as a medical emergency and it requires immediate medical attention.
What Are the Treatment Options for Sciatica?
There is no one-size-fits-all treatment plan for sciatica. It varies from case-to-case, depending on the symptoms and underlying cause. Treatment options can range from oral medications and/or guided exercise programs to invasive options such as injections or surgery.
Most of the time, acute sciatica is usually treated with over-the-counter painkillers, light stretching, acupuncture, physiotherapeutic mobilisation and walking exercises and use of hot or cold compression packs to reduce pain. In case you are allergic to any painkiller, you should ask your healthcare provider for alternate medications.
Chronic sciatica can be treated with a combination of self-care measures, medications, exercises, acupuncture, physiotherapy and also by the use of CBT (Cognitive Behavioural Therapy). CBT is a treatment method which trains patients to change their perception of pain.
If the above treatments do not provide any relief, then the facet joint injection and spinal nerve root blocks can be considered. As a last resort, surgery that involves either lumbar laminectomy or discectomy is offered.
How Is Sciatica Diagnosed?
Sciatica is diagnosed based on the findings from your history and a thorough physical assessment by your physiotherapist. To determine the origin of your sciatic pain, your physiotherapist will carry out a number of physical tests such as muscle strength tests, nerve mobility tests and lumbar range of motion tests.
In order to arrive at a proper diagnosis, your health care provider may also check if you’ve had an injury, fever, problems controlling your bowels or bladder, previous cancers or any unintended weight loss and furthermore can recommend radiological imaging like MRI Scan.
How Does Physiotherapy Help in the Management of Sciatica?
Physiotherapy and exercise are the most preferred first lines of treatment for relieving sciatica symptoms as these help in strengthening and mobilising the tissues of the lower back, pelvis, abdomen, buttocks and thighs.
Physiotherapists are specifically trained to manage sciatica through manual therapy, devising exercise programs, acupuncture and providing rehabilitation for radiating lower back pain.
Goals of Physiotherapy in Sciatica Management
- To deal with the underlying cause and promote healing.
- To relieve lower back, buttocks, thigh and leg pain.
- To reduce muscle spasms for enabling pain reduction.
- Restore pain-free functional movements.
- Restore normal functioning of the lumbar spine and sacroiliac joint.
- Improve lower body mobility.
- To reduce the perception of pain. Pain can be diverse or non-specific and pain tolerance varies from person to person and in the same person too, it varies from one instance to another. The perception of pain is complex as it involves the nervous system and the pain transmission pathways are equally complex to understand.
- Prevent recurrences and exacerbation of symptoms or flare ups.
Physiotherapy Management of Sciatica Using Different Therapies and Exercises
The primary aim of physiotherapy is to relieve sciatica pain by removing pressure from the sciatic nerve. For this, the physiotherapists use a combination of strategies. They may either prescribe a specific set of exercises or use a combination of various types of physical, manual, soft tissue mobilisation, and/or exercise therapies, depending on the underlying causes of sciatica and also on the patient’s pain level and overall conditioning.
Physiotherapy management of sciatica pain involves various therapies such as cryotherapy (use of cold packs), thermotherapy (use of heating pads), ultrasound therapy, TENS (transcutaneous electric nerve stimulation), IFT (interferential therapy), shockwave therapy and lumbar traction
Sciatica management also involves a specific set (or) combination of exercises.
- Extension and flexion back exercises
Most of the time, patients with lower back pain and sciatica find relief with specific directional movement of the spine. Extension (backward bending) and flexion (forward bending) exercises help relieve pain by promoting movement of the spine. The physiotherapist evaluates the patient’s directional preference based on the symptoms and accordingly prescribes specific directional exercises.
This is a technique that works on the theory that centralising pain leads to improvement of symptoms. It involves a series of active directional movements to identify the pain source in the spine, muscles and/or joints and treat it. The technique focuses on moving the radiating pain closer to the centre of the body through exercise. For example, moving the leg pain closer to the spine. The goal is to reduce radiating pain from the spine. This method is adopted only by a therapist who has specialised training in this.
This includes resistance exercises to strengthen the muscles of the abdomen, lower back, hips, and legs. These exercises cause contraction of muscles without moving the joints and help increase muscle strength through constant resistance to specific motions.
- Functional retraining includes reintroducing movements such as lifting, carrying, bending, squatting, etc. The use of proper techniques and healthy movement patterns are incorporated to reduce pain and prevent re-injury.
- Nerve Mobilisation (nerve glides)
Nerve mobilisation helps in locating the source of pain and restoring the balance of the nervous system. It consists of techniques such as neural flossing and glides. This works by moving the compressed nerve slightly by taking it through a motion repeatedly. This repeated motion takes the nerve from a slack position to a position of being in tension without stretching the nerve.
- Myofascial Release Therapy (MRT) and Soft Tissue Mobilization
Myofascial release therapy is a kind of gentle, constant massage either with hand or instruments that helps to release tightness and pain in the myofascial tissues in the lower back, hips or legs. Fascial tissue is the connective tissue that covers and supports the muscles throughout the body. Physiotherapists will first locate the trigger points or knots in your fascial tissue and gently apply pressure until they feel that the tension is released.
- Active Assisted Range of Motion
In this, the physiotherapist assists the movement of parts of the lower body such as the hip and legs. This technique facilitates the movement of specific joints or muscles that cause pain.
Acupuncture or dry needling is a technique used by physiotherapists in which a small needle is used to target a trigger point. This is done to release hyper-irritable or hyper-contracted muscle tissue to reduce pain. It is less painful and very effective in reducing pain.
- Lumbar Epidural Steroid Injection
For some patients, physical exercises and other therapies as stated above may not provide long-term relief from pain. In such cases, the physiotherapist may be able to refer you to a clinician trained to inject or may use epidural steroid injections.
This injection is given in the lower back area (lumbar region) near the spinal cord and nerve roots. The patients may experience significant pain relief if this procedure is done properly. In general, if the sciatica is of recent onset and if nerve root compression is minimal, lumbar epidural injections will have favourable outcomes.
Alternative Methods in Physiotherapy for Management of Sciatica
Extracorporeal Shock Wave Therapy (ESWT)
Another effective technique used in physiotherapy for the management of sciatica is the use of Extracorporeal Shock Wave Therapy (ESWT).
Extracorporeal shockwave therapy (ESWT) is relatively new technology in the field of musculoskeletal medicine. It is a non-invasive therapeutic approach which does not require anaesthesia or pain medication.
ESWT uses a series of low-energy acoustic waves that are transmitted to the patient’s skin via a transducer with a topical gel as a medium.
ESWT with a combination of focused and radial shockwaves yields excellent results in treating sciatic nerve pain. It is effective in relieving myofascial trigger points that are often a contributing factor for back pain.
In conclusion, sciatica can be best treated if the underlying cause is identified and managed with a team of expert healthcare professionals including skilled and experienced physiotherapists. A physiotherapy clinic like Physios ‘R’ Us that has well-trained and experienced physiotherapists and offers a wide range of physiotherapy services will be the right place for your sciatica treatment.