If you are suffering from sciatica then please do not delay. Best outcomes can be achieved by attaining the treatment options without delay. Sciatica occurs due to the strain on the sciatic nerve, and treatment should be aimed to reduce the strain as it may also end up damaging the nerve if not treated timely. Physiotherapy is one such treatment technique that involves removing this strain. Physiotherapy treatment helps to accomplish this by decreasing nerve pressure to relieve muscle strain from the lower spine, buttock, and leg.
The most common cause of Sciatica is the compression of the lumbar nerve root due to spinal disc herniation, disc prolapse, bulging discs, slipped disc, wear or trauma of the lumbar disc or vertebrae. Other causes of Sciatica can be spondylolisthesis, spinal stenosis, and spinal degeneration, even during pregnancy, it is common for the sciatic nerve to be affected due to the rapid increase in weight. The pain can originate in the lumbar spine caused by the compressed nerve or in other areas such as the pelvis, hips, piriformis, and gluteus muscles not related to the nerve compression. Pain in the sciatic nerve can radiate from the spine to the leg. The patient might feel the pain in both the legs on the front and lateral sides of the thigh.
Physiotherapy Management of Sciatica
Physiotherapy is a conservative treatment for sciatica pain, physiotherapy aims to offer relief by removing the pressure from the nerve and uses a variety of techniques and exercises to reduce muscle spasms, and pain and increase back range of motion and core strength. Physiotherapy treatment for sciatica comprises of electrical modalities, exercises (strengthening, stretching, and aerobic conditioning), muscle energy methods, spinal stabilization, mobilizations, nerve slides/glides, etc.
Ice packs or other cold options are applied to ease the pain of sciatica. Ice can be applied for about 20 minutes every two hours, but do not allow an ice pack to directly touch the skin.
Heating pads or a warm bath can be taken for at least 15 minutes, but no longer than a couple of hours. Heat therapy increases blood circulation and causes a decrease in pain, increases relaxation, and increases flexibility.
Ultrasound therapy is used to reduce irritation and stress of the nerve.
Transcutaneous Electrical Nerve Stimulation is also used to relieve sciatic pain. Two electrode pads are placed on the skin of the sciatic nerve roots and a small current is passed to produce a tingling sensation.
Interferential Therapy (IFT):
Interferential therapy is used to relieve sciatic pain, the two electrodes are placed at the nerve roots and the other two electrodes are placed at the leg, IFT is found to be highly effective for sciatica.
Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment that helps to relieve the pain of peripheral nerve damage, promotes local arterial remodeling and cellular regeneration, and also decreases muscle tone.
Lumbar traction helps to relieve pressure on sciatic nerve roots, thus relieving pain, and is widely used by Physiotherapists for sciatica.
It is important to note that the less active the person is, the stiffer their muscles become. The physiotherapist can provide an appropriate exercise routine that suits a person's specific needs. The physiotherapist recommends supervised exercise therapy including spinal mobilization, motor control exercise, nerve mobilization. Mobilization and manipulations are therapies performed by Physiotherapists to increase range of motion and lumbar function in patients with sciatic pain.
Stretching exercises are recommended to target cells causing discomfort when they are rigid and tight. Most people don't stretch those muscles, which stretch from the pelvis to the knee at the back of the thigh, in their everyday pursuits. E g of stretching exercises are knee to chest stretch, supine piriformis stretch, back extensions, sitting spinal stretch, hamstring stretching exercise, and transversus abdominis.
Strengthening exercises help in building muscles to prevent sciatic pain. The back and the core muscles are important for maintaining proper posture and body alignment. When patients take part in regular mild exercises, they can recover faster from sciatica pain and, are not as likely to have future reoccurrence of pain. E.g Abdominal strengthening, iliotibial band strengthening, cat and camel exercise, bridging, etc.
Aerobic conditioning Exercises:
Aerobic exercises like swimming, walking or running encourage the flow of fluids and nourishment to help make a greater recovery environment. Aerobic conditioning also has the advantage of releasing endorphins, the body's natural pain killers, which will help decrease sciatic pain.
Massage therapy can release tension and tightness in muscles and tendons and can also decrease inflammation by promoting blood circulation, relieving pain, and promoting muscle and nerve relaxation. Massaging the buttocks and back of the legs can relieve tenderness and tension caused by the pain of a pinched sciatic nerve. There are many different forms of massage therapy, including deep tissue massage, Swedish massage, and neuromuscular massage.
The physiotherapist recommends pillows and supportive aids to relieve the pressure on the nerve, such as:
- Foam Rolling
- Leg Elevation Pillow
- Sleeping Pillow
- Sturdy Back Brace
- McKenzie Lumbar Roll
- Wearable Relief.
The physiotherapist advises the person to decrease weight because the extra weight in the core area adds more pressure to the spine, thus incorporating more vegetables and lean meats into the diet, and increasing exercise to lose the extra weight, which can help decrease sciatica pain.
The person is also advised to be active instead of remaining in the bed or relaxing in a chair, this can flare up sciatica pain. Though initially resting for the first few days after sciatica pain develops is fine, remaining sedentary does more harm than good. Moving around helps increase blood flow, strengthen the muscles, improve flexibility, and reduce the perception of pain.
Always consult your physiotherapist before doing the exercises, as some individuals with sciatica feel better with exercises of a back extension posture, whereas others may feel better by doing forward flexion.