Managing Sciatica Pain with Physiotherapy

Introduction:

Sciatica pain is a pain felt near the area of distribution of the sciatic nerve (that is, around the buttocks, the posterior thigh, the posterior lower leg, and also the feet) as a result of continuous irritation of the nerve. Sciatica pain is characterized by a shooting pain that starts from the lower back and extends down towards the back of each leg. Various conditions can cause this pain. The pain of sciatica is quite distressing, often making it difficult for people to sit, stand, or walk. It is not a specific condition. Various factors can cause pain around the region of the sciatic nerve.

What Causes Sciatica?

In youth, sciatica pain is commonly due to damage to the spinal disc leading to swelling around the sciatic nerve. Occasionally, it might be caused by pressure coming from a prolapsed or slipped disc. In older adults, sciatic nerve pain may be due to compression of the sciatic nerve by ligaments or bones. There are several other causes of sciatica pain, such as prolonged sitting at the desk, pregnancy, dehydration, spinal degeneration, and so on. More common causes of sciatica pain include herniated disc, lumbar spinal stenosis, and piriformis syndrome. Whenever you experience sciatica pain symptoms, your physician must evaluate them to determine the cause.

What Causes Sciatica During Pregnancy?

It is unlikely for a pregnancy to be the cause of sciatica. Pregnancy-related changes can give you pelvic aches and back discomfort, although not sciatica pain. Sciatica pain is not caused by your baby pressing on a nerve. A majority of women who believe they may have sciatica pain in pregnancy, in reality, have pelvic girdle pain (PGP).

How Is Sciatica Diagnosed?

Sciatica pain is diagnosed through imaging with a CT (computerized tomography) scan or MRI (magnetic resonance imaging). Another variation of MRI, known as MR neurography, may help diagnose piriformis syndrome, which is another cause of sciatica not involving disc herniation.

How Is Sciatica Treated?

The doctor may suggest you visit a physiotherapist who is experienced in pain-relief exercises. If your back is stiff, your physiotherapist may use manual therapy and, in some cases, manipulation. Specific postures of Yoga can provide beneficial results to patients with sciatica as well. The different poses help relieve the pain and maintain the shape of your body and the tone of your muscles. Sometimes, it may be accompanied by a tingling or a burning sensation passing down the leg. The pain may be constant or an intermittent one which varies in intensity from mild to severe. Exercise is an efficient way to overcome the agony caused by sciatica pain.

In treating sciatica, physical therapy may:

• Provide relief from symptoms.

• Promote healing of the underlying cause.

• Prevent recurrences and flare-ups.

Several health professionals will provide medical care and treatment for the radiating lower back pain, including physical therapists, chiropractors, physiatrists, and certified athletic trainers. Physical therapists are specially trained in providing manual therapy, exercise programs, and rehabilitation for radiating lower back pain.

Physical therapy and exercise will help to strengthen and mobilize the tissues in the lower back pelvis region, buttocks, abdomen, and thighs.

The primary goal of physiotherapy in the treatment of sciatica are to:

• Restore the pain-free functional movement patterns.

• Relieve the pain in the lower back, buttock, thigh, and legs.

• Reduce muscle spasms.

• Restore the function of the lumbar spine and the sacroiliac joint.

• Improve the mobility of the lower body.

• Foster a more desirable healing environment in the lower back.

• Promote neurologic changes to reduce the perception of pain.

• Prevent future pain flare ups and reduce the fear associated with movement.

Commitment and regularity are the essential attributes for a successful treatment outcome while using physical therapy and exercise for sciatica. Physical therapy can be combined with the use of pain-relieving medications, like over-the-counter (OTC), prescription medications, or epidural steroid injections.

What Are the Physical Therapy and Exercise Procedures for Treating Sciatica?

A physical therapist may suggest various physical, manual, and soft tissue mobilization therapies in sciatica treatment. Specific exercises always depend on sciatica's underlying etiology and other factors, such as the patient's pain level, overall conditioning, and the physical therapist's training and experience.

The standard techniques used in the treatment of sciatica are:

• Extension and Flexion Back Exercises: This will help relieve pain by promoting the movement of the spine. Usually, individuals with lower back pain and sciatica feel relieved with the specific directional movement of the spine. These exercises include the backward (extension) and forward (flexion) bending. This directional movement is an essential component of the McKenzie Method, also known as mechanical diagnosis and therapy (MDT).

• The McKenzie Method: This technique involves a set of active directional movements to recognize and treat the cause of the pain in the spine, muscles, and joints. The method focuses on transferring the radiating pain closer to the body's center through exercise, such as moving leg pain closer to the spine. The theory of this method is that centralizing the pain shows improvements in symptoms. The goal is to decrease the radiating pain originating from the spine. A therapist who follows this technique has specialized training in the McKenzie Method.

• Isometric Exercises: This includes contracting the muscles without moving the joints using a plank or a bridge hold. It can help strengthen muscles when symptoms are more severe.

• Strengthening Exercises: This includes bodyweight and resistance exercises to strengthen the abdomen, hips, low back, and legs muscles.

• Isotonic Exercises: It includes muscle contraction to maintain a constant load, such as resistance bands and weight training, to increase the strength of the muscles.

• Functional Retraining: It includes reintroducing movements, such as lifting, carrying, bending, or squatting.

• Nerve Glides (Nerve Mobilization): It involves active or passive techniques on the asymptomatic nerve to facilitate movement and reduce symptoms.

• Joint Mobilization: It is a manual therapy technique in which the therapist applies pressure over a joint to produce a therapeutic effect by mobilizing it.

• Joint Manipulation: It is a manual technique in which the therapist applies a quick thrust force at the joint's end range to promote pain relief and restore normal movement.

• Dry Needling: It is a technique in which a certified physiotherapist will use a small needle to focus on a trigger point in a muscle. This technique is performed to reduce pain in the hyper-irritable and hyper-contracted muscle tissue.

• Muscle Energy Technique: This is a manual therapy that involves the patient performing gentle muscle contractions in combination with the therapist moving the painful joints in a specific range of motion. This technique may help reduce pain and restore function.

• Gait Training: It includes interpretation of walking technique and retraining correct gait patterns, consisting of video analysis.

• Myofascial Release and Soft Tissue Mobilization: In this,the therapist will use their hands or an instrument to mobilize the muscles in the lower back region, hips, or legs to treat fascial (underlying soft tissue) constraints and decrease the muscle tension or spasm.

• Active Assisted Range of Motion: It includes therapist-guided movement of parts of the lower body, like the hip and legs. This technique helps promote movement of the specific joints or muscles that cause pain.

Conclusion:

Sciatica is a condition in which the pain radiates along the sciatic nerve that runs from the lower back down through the buttocks and legs. The pain can affect one's daily activities. Physiotherapy can be beneficial for those suffering from sciatica. Sciatica pain can be alleviated, and the function can be improved through a combination of physiotherapy exercises, education, and advice, and with the help of manual therapy techniques. The therapist might use one or more of the techniques to treat sciatica pain. If a particular exercise or therapy causes any pain or discomfort, it should be informed to the therapist immediately.