Physiotherapy Advice for the Treatment of Sciatica

The term sciatica refers to nerve pain that starts somewhere in the groin and travels downwards through the back of the lower limb. Other names for this condition include sciatic neuritis, sciatic neuralgia, or lumbar radiculopathy. It is caused by anything which presses upon or irritates the sciatic nerve, the main nerve to the lower limb.

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The symptoms are quite characteristic, and include pain in the lower back, the buttocks, and different parts of the foot or the leg. Any or all of these may be present in various combinations. Sensations of tingling or of prickling, such as pins and needles, may also occur in the leg or the foot. In a very few cases, the leg seems to burn or tickle as if a spider were running up it, usually only on a single side and below the knee.

Anatomy of sciatica

The sciatic nerve is a large nerve, in fact the largest and the longest of all, measuring about the breadth of a human adult thumb at its maximum. It is formed in the lower back by the union of five nerve roots (the last two lumbar and the first three sacral nerve roots) which emerge from the gaps between successive vertebrae in the lumbar spine. It then travels into the upper part of the leg and all the way down into the foot. As it goes, it produces branches which send and receive nerve impulses to supply motor function and relay sensory information to the higher centers, from all parts of the lower limb.

What causes sciatica?

One of the most common causes is the slipped disc or more correctly, intervertebral disc prolapse, in which the disc bulges backwards from between the two vertebrae it is sandwiched with. This bulge may come into contact with the nerve roots or with the sciatic nerve itself, causing pain impulses to arise in different parts of the lower limb depending upon the parts supplied by the compressed fibers.

Spondylolisthesis is another condition in which one vertebra slips forward (but occasionally, backward) on its neighbor, causing pressure and injury to the sciatic nerve or narrowing of the spinal canal itself within which the spinal cord passes down to its end.

Piriformis syndrome refers to the abnormal tautness of the muscle in the buttock called the piriformis, which crosses an opening through which the sciatic nerve emerges into the lower limb. The tight muscle may trap the sciatic nerve and cause pain.

A space-occupying lesion such as a tumor or a cyst may arise near the sciatic nerve and compress it, but this cause is less common.

Treatment of sciatica

Sciatica may be treated at home, but the cause should first be evaluated so that potentially dangerous conditions are ruled out.

In some patients the pain goes away by itself.

For others, a non-steroidal anti-inflammatory drug could be helpful. Ice and heat packs are also useful for many patients. The ice should be used for 5-10 minutes (after wrapping in a towel) at any single application, and this may be repeated 3-5 times a day for the first 2-3 days when the pain is acute. After this, hot fomentations (again, after wrapping in a towel) are advised. Burns should be avoided.

Physical activity is advised though at a lower level, with a gradual stepping up in intensity until the normal level is restored. However, any form of heavy lifting is completely contraindicated for at least 6 weeks from the date of the first episode of pain.

Bending forward should be avoided completely as should any kind of twisting movement.

Exercise workouts should be resumed only at about 12 weeks. The focus should be to build strength and flexibility into the abdominal and spinal muscles.

Pain relief and flexibility may be achieved by physical therapy, chiropractic or osteopathic manipulations. However, these may fail if there is severe compression of the nerve. In that case, an MRI of the spine is recommended to visualize the condition of the spine. This will guide the need for specialized injection of an analgesic and anti-inflammatory drug, or an epidural injection, into the spine to relieve the symptoms.  

Helpful information

Always get up and move around once in 20 minutes if your work involves a lot of sitting.

Forward bending is dangerous in a person with sciatica, including just bending over a sink to wash the face, picking up something from the floor, making the bed or reaching too far forward.

Relaxed and regular moderate movement is helpful.

Resuming a normal daily routine of chores and work is useful to restore normal function and lessen pain.

Swimming and cycling are excellent for back strengthening and pain relief but should be done under advice from the health professional on the case.

Heavy lifting, twisting and bending simultaneously, and running or jogging are not recommended as they usually worsen the condition. Running may cause the spine to press down on itself, aggravating the injury and the symptoms.

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Last updated: Mar 15, 2018 at 9:29 AM

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