What is the best physical therapy for sciatica?

As a seasoned physiotherapist with extensive experience managing sciatica, I’ve observed the profound impact this condition can have on an individual’s daily life. Sciatica, characterized by pain that radiates along the sciatic nerve from the lower back down through the hips, buttocks, and legs, often stems from nerve compression or irritation.

Through this article, I aim to align closely with the search intent for those seeking the most effective physical therapy approaches for sciatica, focusing mainly on the nuances of prolapsed discs and piriformis syndrome, which are frequent culprits behind this debilitating condition.

Understanding Sciatica: A Deeper Dive

The journey through sciatica pain begins with recognizing the complexity of this condition. When compressed or irritated, The sciatic nerve, the longest and widest nerve in the body, triggers symptoms ranging from mild aches to a sharp, burning sensation or even excruciating discomfort. This nerve compression is often the result of a few critical conditions:

• Lumbar Slip Disc: Between two vertebral bones lies a disc-shaped jelly-like structure called an intervertebral disc. It is a very soft structure that acts as a shock absorber. The disc ruptures bulges out and can press against the sciatic nerve in a prolapsed disc.
• Piriformis Syndrome: This occurs when the piriformis muscle, located in the buttocks near the top of the hip joint, spasms and irritates the sciatic nerve.
• Degeneration of the Spine: Aging can lead to changes in the spine’s structure, potentially impinging the sciatic nerve.
• Other Factors: This includes facet joint injuries, spinal stenosis, spondylolisthesis, and sacroiliac dysfunction.

Notably, a prolapsed disc is a leading cause of sciatica, where the disc’s core leaks out, pressing on the sciatic nerve.

Sciatica Symptoms: What to Look For

It all starts with a pinch on the lower back. You feel it when you have to bend forward slightly while brushing your teeth or trying to pick something from the ground. With time, the pain increases down the back of the leg.

It felt as if something was pulling at the back of the leg. You had trouble getting out of bed, and climbing stairs was painful. On a motorbike, you sit tilted on one side of the buttock while trying your leg to keep straight to avoid pain. Over time, you felt a tingling sensation and numbness in your leg.

The above-described points are common symptoms of sciatica. But, in severe sciatica cases, one can even go bedridden for weeks and months. Here’s a summary of the symptoms of sciatica:

1. Pain radiating from the lower back to the back of the leg
2. Difficulty in movements such as climbing stairs or walking
3. Increased discomfort after prolonged sitting
4. Numbness, tingling, or weakness in the affected leg or foot

Physical Therapy for Sciatica: A Phased Approach

Physical therapy intervention is effective in curing scaitica¹. Sciatica can be categorised into three phases depending on the severity of the pain. We will discuss each phase in detail and try to understand how to manage it. These three phases are phase I, phase II and phase III.

Pain management (Phase-I)

Phase- I is the period of severe pain and disability. Pain is so severe that the slightest movement is enough to elicit the pain, and often, the person is bedridden. So, managing the pain is of utmost priority at this phase. There are different modes of controlling pain. Let us discuss one by one.  

Rest

During severe pain, rest is essential. But rest in a proper pain-free position is also essential. Below are the 3 resting positions, which you can adapt according to your convenience. Your physiotherapist will guide you to the proper resting positions. These can be one of the above or a combination of all.

Hot therapy

Hot therapy is very beneficial for pain relief. They should be applied after pain balm is applied over the tender region. One can use a hot water bag or electric heating pads.

Support

When dealing with sciatica, it is essential to prioritize back protection and support. One way to achieve this is by using a back pain belt. However, selecting a well-fitting belt that can provide the appropriate level of support and compression to alleviate sciatic nerve pain effectively is crucial.

A good-fitting back pain belt can help stabilize the lower back, reduce inflammation, and relieve the pain and discomfort associated with sciatica.

Restoring normal flexibility (Phase II)

Once the acute pain diminishes, the focus shifts to restoring flexibility through:

Lumbar spine mobilisation

A technique performed by physiotherapists to gently realign the spine and relieve nerve compression.

Lumbar traction

At this phase, intermittent lumbar traction is started. A calculated amount of traction force is given. Two belts with hooks (a waist piece and a chest piece) are fastened to the patient: one around the waist and another around the chest.

The patient is then made to lie on the traction table. The lower belt hooks to the traction machine, which applies the pulling force. The chest piece belt holds the body in a static position to counter the pull.

Strengthening exercises

Specifically designed exercises to strengthen the back muscles, support the spine and reduce the burden on the discs.

Phase III: Restoring Full Functional and Dynamic Control

This is the period of rehabilitation. The final phase aims for full rehabilitation, emphasizing posture education and advanced strengthening exercises.

Posture Education:

One of the leading causes of sciatica is poor posture, which can lead to nerve impingement and inflammation. Therefore, teaching and reinforcing correct sitting posture on the computer is essential to preventing future episodes of sciatica.

Correct posture involves maintaining a neutral spine position, with the spine’s natural curves in alignment. This can be achieved by sitting up straight, keeping the shoulders relaxed, and the feet flat on the floor. It is also important to avoid sitting or standing for prolonged periods and to take breaks to stretch and move around.

Advanced Strengthening Exercises:

Advanced strengthening exercises for sciatica are designed to improve the strength of the back, abdominal, and leg muscles to support the spine and maintain proper alignment.

By doing so, the muscles are better able to support the spine and reduce the pressure on the sciatic nerve, which can help to alleviate pain and discomfort. In addition to this, it is highly beneficial to add stretching exercises for sciatica, which can give almost instant relief in radiating pain.

Final takeaway

Navigating through sciatica requires patience, perseverance, and the right therapeutic approach. As we understand the underlying causes, symptoms, and appropriate physical therapy interventions, we pave the way for effective management and recovery. Remember, the road to recovery may have ups and downs, but with proper care, guidance, and a tailored physical therapy program, overcoming sciatica is within reach. Let’s embark on this journey together, armed with knowledge and the determination to return to a pain-free life.

Keep Reading: Sciatica pain relief: Dummies home guide that works

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.