Physiotherapy treatment has been shown to help with pain from sciatica by reducing inflammation and relieving muscle tension. The aim is to relieve the symptoms of sciatica so that you can get back to the activities you enjoy without pain. Our physiotherapists will work with you one-on-one to find out what’s causing your sciatica and how best to treat it. Physiotherapy treatment consists of non-invasive techniques to relieve muscle tension and promote healing.
What is Sciatica?
Sciatica is an umbrella term used to describe pain that travels down the back of the buttock and leg, as low down as the feet and toes. Pain is usually caused by an irritation to the sciatic nerve (typically at the level of your buttock), or the nerve roots in your lower back which give rise to the sciatic nerve. There can also be symptoms such as altered sensation, tingling and muscle weakness.
Despite popular opinion, you don’t necessarily need to have lower back pain in order to have sciatica. You can have symptoms and leg pain in your lower limb without having any back pain at all.
How long does Sciatica last?
Most cases of sciatica resolve within 4-8 weeks with appropriate physiotherapy management. If symptoms are more severe and include numbness, tingling and associated muscle weakness, it may take longer.
Sciatica rarely requires surgery, however in rare circumstances where there is severe nerve compromise, for example altered sensation in the saddle region or altered bladder or bowel control, surgery may be indicated.
What are the causes of Sciatica?
Often, there is no moment of onset for sciatica and tends to develop over a period of time. A 2007 study found that a common cause of sciatica is having a physical job, such as manual labourers and truck drivers. Specifically, common causes include those who are required to bend their spine repeatedly which may expose them to a greater risk of developing sciatica.
The nerves that supply your leg originate from your spinal cord, which exit through little spaces in the side of your lower back. These small nerves (called nerve roots) join together and form the large nerve known as the sciatic nerve. This nerve then passes down through the pelvis into the buttock where it passes through the muscles in your bottom and finally travels down into your leg.
Sciatica common causes include:
1) Compression and irritation of the nerve roots close to your spine by issues like a herniated disc or inflammation causing increased pressure on the nerves. It can also be caused by other spine issues such as a spondlyolisthesis or spinal stenosis.
2) Compression and irritation of the sciatic nerve which passes through your buttocks and travels down your leg. This can be caused by a muscle irritating the sciatic nerve as passes through it.
Essentially, sciatica is an irritation of the nerves in your lower back, or in your buttock.
What are the symptoms of Sciatica?
The hallmark symptom of sciatica is pain, the type of pain can vary:
- It may be sharp, feel like electric shocks, discomfort or numbness.
- There can also be sensations like tingling and feeling of weakness in your leg, ankle and/or foot.
- The pain is typically situated in the buttock and lower back region but can extend down into your hamstring, calf and feet (leg pain).
- Symptoms are typically one sided rather than affecting both legs. In rare cases you can have leg pain in both legs.
- Can have lower back pain.
These can be aggravated by coughing or sneezing, moving from sitting to standing, prolonged sitting, standing or lying down.
How is Sciatica diagnosed?
Sciatica is diagnosed by a cluster of findings in your history and physical assessment by your physiotherapist. Your therapist will carry out a number of physical tests to determine the origin of your sciatic pain, such as muscle strength tests, nerve mobility tests and lumbar range of motion tests.
We will also want to know if you’ve had an injury, fever, problems controlling your bowels or bladder, previous cancers and whether you’ve been losing weight without trying. The answers to these questions are important because if these symptoms are present, the cause of sciatica could be a serious condition, such as a bone fracture, infection or cancer. These are rare however.
Do I need a scan?
The majority of cases do not require any sort of imaging, and resolves within a period of 4-8 weeks with targeted physiotherapy intervention. However if symptoms are not settling beyond 8 weeks of physiotherapy intervention it may require further medial investigation and management.
How can my Physiotherapy help me?
1) Sciatica treatment in the early stages involves a strong focus on reducing your pain with manual therapy, dry needling, gentle nerve stretching, and spinal mobility work to reduce the sensitivity of the irritated nerve. This usually yields great relief and a significant reduction in symptoms in 1-4 visits.
2) Ensuring long term results and minimising the chance of your symptoms returning by completing a personalised rehabilitation plan. There’s a structured approach to ensuring we address sciatica properly (see the early, mid and late stage exercises below). Getting you pain free is our first priority, but it’s our attention to detail in helping you rehabilitate through the entire journey that ensures our results are unrivalled and your symptoms don’t return.
This involves strengthening exercises that target the muscles that support your lower back and buttock. This is vitally important, as it will contribute to your body being able to cope with the demands placed on it day to day, as well as any recreational activities you love to do. A robust long term management plan also involves targeted nerve mobility exercises to improve the movement of your affected nerves, as well as spinal mobility exercises to improve the movement of your spine.
3) Ensuring you have no lingering weakness that will affect your function and quality of life moving forward. With moderate to severe sciatica symptoms, once your pain resolves sometimes there’s often some left over weakness that make your usual tasks harder than they’d normally be. To get back to your normal self, this needs to be addressed. A thorough Physiotherapy assessment can help identify what’s lacking, and give you the knowledge to fix it.
4) Advice and education on positioning, posturing and the level activity suitable for you to allow your symptoms to settle and keep you comfortable whilst our treatment is having the desired effect. We’ll also give you the advice you need to gradually build back up to the activity level you want in a safe and non-detrimental way.
A big part of your rehabilitation once your initial symptoms have settled is ensuring there’s no residual sensitivity of your nerve, whilst working on the strength of your lumbar spine, pelvis and leg muscles.
Early stage Sciatica relief exercises/stretches
These exercises are great starting point for acute sciatica. If any of the exercises make the pain worse after completing them, stop immediately.
Mid stage Sciatica relief exercises/stretches
Click here for MID STAGE exercises.
Following on from early stage sciatica exercises above, the exercise progressions start applying more tension to your nervous system to improve its mobility, reduce its sensitivity and further reduce your symptoms. In these exercises a ‘slump’ or rounded low back has been introduced, which places further tension on the nervous system than if just tall sitting.
These exercises are perfect if you are experiencing mild symptoms, or you pain is settling down well from an acute or severe episode of sciatica.
Late stage Sciatica relief exercises/stretches
Click here for LATE STAGE exercises.
These exercises are the most demanding on your nervous system and are sure to give you powerful stretch to aid in keeping your symptoms away.
In addition to this, a strength program that targets our lower back, glutes and core can be very effective in preventing sciatica from returning.
In summary, sciatica is a very common and very treatable condition with good quality Physiotherapy management. It rarely requires scans or more invasive interventions such as cortisone injections or surgery.
It’s important to keep in mind recovery from this type of thing can be gradual. If those suffering from sciatica do the right thing for long enough whilst avoiding your aggravating activities, relief will result for the vast majority of people.
You can take the first step to resolving your sciatica pain by booking online here to see one of our expert physiotherapists today!
Alternatively if you are unsure about what to do next, please don’t hesitate to give the clinic a call on 8490 0777 and have a chat to one of our friendly physiotherapists. We’d love to help you!