Physiotherapy for sciatica
Medically Reviewed By : Dr Sravya, MBBS, MS
Introduction
Sciatica is a common condition, sciatica is named after the sciatic nerve, sciatic
nerve runs from buttocks to the back portion of both the legs. Sciatica is
characterised by pain along the sciatic nerve, from the lower back to one or both
legs. Pain is the result of compression or irritation of the sciatic nerve. Pain can
range from mild to severe. Pain is accompanied by tingling numbness along the
course of the nerve.
What causes sciatica:
Sciatic nerve is the largest nerve of the body, when it is compressed or irritated it causes pain and discomfort along the course of the nerve resulting in sciatica. Some common causes of sciatica include:
- Herniated Disc: spinal disc is a rubbery cushion-like structure situated in the spinal canal. If it bulges out of spinal canal it is called herniated disc which compress sciatic nerve causing sciatica
- Spinal Stenosis: spinal canal is narrowed in spinal stenosis and puts undue pressure on the nerves
- Degenerative Disc Disease: Age-related changes in the spine can lead to disc wear and tear, causing pressure on the nerve.
- Spondylolisthesis: When one vertebra slips over another, it can irritate the nerve.
- Piriformis Syndrome: The piriformis muscle which is present in the buttocks, compresses sciatic nerve while passing through it.
- Injury or Trauma: Accidents or falls can damage the spine or nerve.
- Tumours or Infections: Rarely, tumours or infections can affect the sciatic nerve
- Pregnancy: Pressure on the nerve due to the growing uterus can cause sciatica during pregnancy.
- Obesity: Excess body weight can increase pressure on the spine and aggravate sciatica.
- Lifestyle Factors: Prolonged sitting, improper lifting, and a sedentary lifestyle can contribute to sciatica.
Symptoms of sciatica:
- Pain: The most prominent symptom is usually a sharp, shooting, or burning pain that radiates from the lower back or buttock down the back of one leg. This pain can vary in intensity and may be constant or intermittent.
- Numbness: You may experience numbness or tingling sensations along the path of the sciatic nerve, which can extend into the foot and toes.
- Muscle Weakness: Weakness in the leg or foot on the affected side may occur, making it difficult to walk or move the affected limb.
- Difficulty Sitting or Standing: You might find it uncomfortable to sit or stand for prolonged periods, as these positions can exacerbate the pain.
- Certain Activities: Activities like coughing, sneezing, or straining can intensify the pain due to increased pressure on the sciatic nerve.
- Lower Back Pain: Some individuals may experience lower back pain in addition to leg pain.
- If you can relate your pain to the above symptoms then you must take professional help or consult a physiotherapist
Diagnosis of sciatica:
Diagnosis of Sciatica involves a series of evaluations which come under the supervision of either a neurologist or orthopaedic surgeon.
Lets go into a detailed description of the diagnosis of sciatica
- Medical history: Medical history is the foremost essential part of diagnosis in which the doctor takes a detailed history of any injury to the back or legs when symptoms started, severity, recurrence, duration, aggravating and ameliorating factors.
- Physical examination: In this examination, reflexes are seen, such as motor movements, muscle strength, and altered sensation. The test is conducted by making the patient lie down with the leg raised at 45 degrees to see if it triggers pain.
- Neurological examination: It involves examination of reflexes, and loss of any movements to rule out nerve damage or compression.
- Imaging tests: X-rays: They are performed to look for any degenerative changes in the spine, fractures or injuries.
- MRI: To rule out the causes of sciatica MRI is a choice of experts, as it visualises structures nerve roots and the spine.
- CT scan: If MRI is not possible or contraindicated then a CT scan provides images of the spine quite clearly so it's a choice in many patients.
- Electromyography: To see for any nerve damage, injury or nerve function, electromyography means nerve conduction studies are carried out.
- Blood tests: They are less commonly conducted. But may be taken into consideration if any infection or inflammation is suspected.
- This extensive series of evaluations is done to rule out other diseases like hip joint problems or muscle strains. Once the diagnosis is confirmed, it's easy to develop a treatment plan and symptoms management.
Treatment of Sciatica:
Treatment of Sciatica aims to reduce intense pain, and to treat the underlying cause so that patients can lead normal lives without pain.
- Heat and cold therapy: Heat and cold packs are applied primarily to reduce pain temporarily. It helps in reducing inflammation also.
- Over-the-counter medications: Non-steroidal anti-inflammatory drugs are recommended to reduce inflammation.
- Prescribed medications: These medicines are prescribed by healthcare professionals to reduce intense pain with the help of painkillers, and muscle relaxants.
- Physiotherapy: It is the most effective treatment for sciatica. It focuses on personalised training of exercises which can strengthen the back and abdominal muscles and improve flexibility. It also helps to reduce pressure on the sciatic nerve. Physiotherapy is a choice of treatment in the first place and without it, treatment may be prolonged.
- Epidural steroid injections: It is used to reduce inflammation and relieve pain but it is a temporary solution.
- Surgery: It is the last option Surgery is when all the treatments fail or if there's an underlying structural issue like a herniated disc or spinal stenosis compressing the nerve. Surgical options include discectomy, laminectomy, or spinal fusion, depending on the specific cause of sciatica.
- Lifestyle modifications: Making changes in daily activities and habits can help prevent future episodes of sciatica. This includes maintaining good posture, taking precautions when lifting heavy objects, and avoiding prolonged sitting or standing.
- Maintaining weight: Maintaining a healthy weight can reduce the pressure on the lower back and decrease the risk of sciatica.
Importance of Physiotherapy in sciatica:
As sciatica is a painful condition it has serious effects on physical and mental health. So needs proper guidance for the treatment and physiotherapy sessions for sciatica Physiotherapy may take some time to gain muscle strength but its effective enough to alleviate pain permanently and it has benefited patients in recent years in a way that it has been a popular treatment for sciatica
Benefits of physiotherapy over other treatments:
- Relieves pain
- Improved muscle function
- Correction of posture
- Reduces nerve compression
- Helps in avoiding surgery
- Self-management of exercise at home after getting trained by a physiotherapist
- Reduces intake of painkillers
- Improves quality of life.
- Consulting with a physiotherapist and following their guidance is essential for a treatment plan that maximises the benefits of physiotherapy in managing sciatica.
Conclusion:
Ultimately, physiotherapy aims to manage the pain of sciatica and enhance the overall quality of life for individuals with sciatica by improving mobility, and restoring functionality, allowin g them to return to their daily activities.