What is Sciatica?

Sciatica is a nerve pain that originates in the gluteal area. It comes from an injury or when the sciatic nerve is irritated. It consists of five nerve roots: two located in the lower back (known as the lumbar spine) and three in the sacrum. These nerve roots form two sciatic nerves: one runs through the hips, glutes and down a leg below the knee and the other continues down the leg and into the foot and toes. When one feels lower back pain that radiates down the leg, it can come from this nerve. It is usually caused by irritation, inflammation, compression or pinching that is located in the lower back.

Sciatica pain can differ and can be described as either a burning, electric and stabbing pain or a sharp and shooting pain. This pain can be continuous or come and go. The pain can also get worse if you make a sudden body movement, such as a sneeze or if you are sitting or standing for long periods at a time. Sciatica can occur on both legs, but it is more common to only affect one leg at a time. It gradually or suddenly comes and are usually seen in individuals that lead an inactive lifestyle or have a weak core. It can also be from someone that has a physically demanding job or uses improper form while lifting during strength training exercises.

The most common cause of sciatica is a herniated or slipped disc that causes irritation and pressure on a nerve root. Discs are the cushion between the spine and when it is disrupted, it can cause the disc to herniate which presses on the sciatic nerve.

Symptoms of Sciatica Pain

• Moderate to severe pain in lower back, gluteal region or down the leg
• “Pins and needles” tingling feeling in legs, toes, or feet
• With movement, there is more pain
• Weakness or numbness while moving the leg
• Loss of bladder or bowel control

Physiotherapy treatment at Curezone Physiotherapy clinic In Heartland, Mississauga

Goals of Physiotherapy Treatments

• Restore pain-free functional movement patterns
• Relieve lower back, buttock, thigh, and leg pain
• Reduce muscle spasm
• Restore function of the lumbar spine and the sacroiliac joint
• Improve mobility of the lower body
• Foster a better healing environment in the lower back
• Promote neurologic adaptations to reduce the perception of pain

Physiotherapy Exercises and treatment (4 to 8 weeks for most people, but may require more time)

• Superman (“centralization”; helps to move the pain up from the leg and isolate it in the lower back)
• Glute bridge and glute dips (strengthening the abdominal muscles that support the spine)
• Back flexion (“forward bending”; increases the size of the passageway of the pinched nerve)
• Hip flexion (strengthening hip flexors can improve how one walks, climbs the stairs or overall posture)
• Knee extension (strengthening the quadriceps muscles make it easier to walk, squat, run)
• Bird Dog (core and lower back stability)

Modalities

• Ultrasound – Relieves muscles that are stiff by improving the circulation through sound waves while heating the muscles
• Massage – Soothe the cramped muscles, nerves and ligaments
• Transcutaneous Electrical Nerve Stimulation (TENS) – Decrease the number of muscle spasms and assist in releasing pain blocking endorphins by producing electricity through the area of pain
• Heat – Soothe sore muscles and provides a supply of more blood, oxygen and nutrients. This is done as the heat will increase blood flow and allow the tissues to heal faster
• Spinal Decompression Therapy

Physiotherapy Treatments for Sciatica pain 

The physiotherapist aims at physical, manual, soft tissue mobilization, and/or exercise therapies in treating sciatica. Specific exercises depend on the underlying cause of sciatica, as well as other factors, such as the patient’s level of pain, overall conditioning, and the physical therapist’s training and experience.

Extension and flexion back exercises help relieve pain by promoting movement of the spine. Often, individuals with lower back pain and sciatica feel relief with specific directional movement of the spine. A physical therapist typically evaluates an individual’s directional preference before prescribing specific directional exercises, as these are tailored to the individual patient and symptoms. These exercises include backward (extension) and forward (flexion) bending. This directional movement is an important component of the McKenzie Method, also known as mechanical diagnosis and therapy (MDT).

The McKenzie Method (mechanical diagnosis and therapy) is a technique that involves a series of active directional movements to identify and treat a pain source in the spine, muscles, and/or joints. The technique focusses on moving the radiating pain closer to the center of the body through exercise, for example, moving leg pain closer to the spine. The theory of this approach is that centralizing the pain indicates improvements in symptoms.

Strengthening exercises include bodyweight and resistance exercises to strengthen the muscles of the abdomen, low back, hips, and legs.

• Isometric exercises involve contracting muscles without moving the joints. These exercises can help strengthen muscles when symptoms are more acute.
• Isotonic exercises include the contraction of a muscle to resist a constant load, such as resistance bands and weight training, to help increase muscle strength through constant resistance to specific motions.
• Nerve glides (nerve mobilization) involves active or passive techniques on a symptomatic nerve when it is placed into and out of tension to facilitate movement and reduce symptoms.

• Joint mobilization is a manual therapy technique in which the therapist applies pressure to a joint to mobilize it and produce a therapeutic effect.
• Joint manipulation is a manual technique in which the therapist applies a quick, thrust force at the end range of motion of a joint to promote pain relief and restore normal movement.
• Muscle energy technique is a form of manual therapy that involves the patient performing gentle muscle contractions in conjunction with the therapist moving the painful joints through a specific range of motion. This technique may help reduce pain and restore function.
• Myofascial release and soft tissue mobilization include the therapist using their hands or an instrument to mobilize the tissues in the lower back, hips, or legs to treat fascial (underlying soft tissue) restrictions and decrease muscle tension or spasm.

Once pain becomes manageable, it is important to start walking short distances. The more you sit, it will increase the pressure on the sciatic nerve. It is also important to refresh your posture when you are working at your disk or relaxing at home to help take pressure off the spine and reduce any sciatica symptoms. Overall, the best thing to do when experiencing sciatica is to gently stretch every day. Stretching is a great way to increase your range of motion and spinal flexibility while also building core and spinal strength. These stretches should not be painful or strenuous. A healthy spine and core that is strong can protect one from the pain of sciatica.

Make sure you book your appointment today and get assessed by our physiotherapist now at 905 997 4333

Sheena John

Registered Physiotherapist