Sciatica can be an incredibly painful condition. There’s a 10-40% chance that a person will suffer from it in their lifetime. Even though it’s common, there’s still a lack of awareness about the best way to treat it.
Physiotherapy is the most effective way to get rid of sciatica and all its symptoms. How? That’s what we’ll cover in this post.
By the end of this post, you’ll know about the various techniques that physiotherapists use and the benefits of each.
How Can Physical Therapy Help Sciatica?
Physical therapy helps sciatica patients by reducing their pain, improving flexibility and safely returning them to performing functional activities.
Quick overview of Sciatica: It’s a painful condition that occurs due to the compression of the sciatic nerve either at the root level or somewhere along its path. You’ll feel the pain moving down from your lower back or buttocks into the leg. The more severe the compression or irritation of the nerve, the worse your pain will be.
Here are the four main ways physiotherapists use to treat sciatica: (Reference)
- Exercises
You’ll be prescribed various stretches and strengthening exercises from day one of PT rehab. The goal is to help your vertebrae move a bit and un-pinch the nerve that’s causing you pain. These exercises will change during the different phases of recovery.
- Manual Therapy
Physical therapists use their hands or tools to ease muscle tension in the lower back, decrease pain and help the vertebrae go back to their healthy position.
- Postural Readjustment
Your physiotherapist will teach you the optimal postures for lifting heavy objects, sitting for a long time, and other activities that might be contributing to your sciatica pain.
- Gradual Return To Full Activity Level
The in-clinic rehab ends with advice on long-term management of posture and muscle strength. Some patients experience muscle weakness in the lower back and buttock even after the resolution of sciatica pain. Hence knowing how to manage it is necessary to retrain to your full activity level.
Now, let’s dive deeper into how each component helps you get rid of sciatica pain for good:
Exercises for Sciatica
There isn’t a single type of exercise that works for all sciatica patients. The choice of exercises depends on the individual patient’s primary complaints.
If your symptoms are mild to moderate, you might not need a supervised exercise program.
Your physio will have a detailed chat with you about the activities you should continue and the ones you should avoid. Then s/he’ll advise you to stay moving and avoid complete bed rest at home.
Performing exercises under the supervision of a physiotherapist at home or in the clinic is for patients who have intense pain in their legs, who avoid exercises out of a fear of doing them wrong, who have a history of being sedentary, and who don’t understand the way exercises are to be performed.
You’ll find that physiotherapists often insist that their patients follow a structured exercise program and come into the clinic because treatment adherence is a serious problem. The advice to stay active, although great advice, isn’t practical in most cases. Patients fail to follow the physio’s instructors at home, then complain of persistent pain and wrongfully blame physiotherapy for not being effective. That’s why physios prefer that their patients continue the exercise program under their supervisor.
Generally, here are the categories of exercises that work best for sciatica patients:
● Static and Dynamic Lumbar Stabilization Exercises
This includes training your back muscles to maintain the spinal curvatures while sitting upright or performing activities of daily living.
Exercises for training low back stabilization include:
- Pelvic tilt exercise: stand comfortably and pull your belly button inwards towards the spine to tilt your hips forward. Then do the opposite to tilt it back without moving too much of your back or legs.
- Cat position with alternate arm reaches: on a couch or floor, get down on all fours and lift one arm in the air at a time. Try to maintain the curvatures of your back and balance.
- Hook lying March: lay flat on a floor with knees bent and feet on the ground. Pull your belly button towards your spine. Then lift one leg at a time.
● Increase Motor Control and Decrease Disc Bulge
These exercises are aimed to improve muscle activation and small muscle recruitment to increase control of the low back.
It includes directional preference exercises which are completely dependent on the symptoms of individual patients.
Directional preference exercises: when a vertebral disc bulges, it can be in any direction although it’s most commonly towards the posterior. The exercises your physio prescribes should be such that they help reduce the bulge by pushing the material back into the boundaries of the vertebral column. For a posterior disc bulge, extension exercises are ideal. For an anterior bulge, flexion exercises are best. Such exercises that depend on the direction of the bulge are called directional preference exercises in this article.
Some of these include:
- Back flexion/toe touching exercise
- Back extension: lay on your belly and lift your upper body on your elbows.
● Neural Mobility Exercises
Stretching tight muscles in the back and buttock can open space up for nerves to glide easily and it eases sciatica pain. (Reference)
This technique is called nerve flossing or nerve gliding.
Exercises for this include:
- Buttocks stretch: lay flat on a surface and pull your knee towards your chest as much as you can.
- Figure of four: lay flat on a surface and bend your knees. Place your left foot on top of the right knee and pull the right knee towards your chest to stretch the piriformis muscle and buttocks.
● Strengthening of Core (Back and Abdominals) And Buttock Muscles
This is done to maintain long-term improvement after sciatica resolves. The goal is to strengthen the muscles enough to allow posture correction and space for nerves to move freely. These exercises include:
- Straight Leg Raise: lay flat on a surface and lift one leg all the way up.
- Bridging: lay down on the floor with your knees bent and feet on the floor. Lift your buttock off the ground by pushing down on your feet. It builds buttock muscle strength.
- Prone leg raises: lay on your belly and lift one leg as high up as you can.
- Abdominal curls/ crunches
Manual Therapy to Find Relief From Sciatica
Manual therapy mostly involves spinal/joint mobilization and traction although some physiotherapists also use other techniques based on their expertise.
The goal is to increase spinal joint motion to allow ample space for nerves to exit the spinal cord.
The effects of spinal mobilisations are short-lived. There’s a lack of evidence to support its use in patients with any type of sciatica (meaning mild or moderate pain & with or without neurological symptoms).
The sciatica management guidelines of some countries recommended not providing spinal mobilization at all. But many physiotherapists still apply spinal mobilisations today because some patients claim that it helps them with managing pain. (Reference)
Traction while lying supine (lying on your back) is beneficial. It creates space between the vertebrae and makes room for the nerves to exit the spinal cord without irritation. (Reference)
Traction: This is a decompression activity that pulls two sections of your body in opposite directions to open up some space in the middle. It’s usually done on joints and the spine to relieve pressure.
Sometimes you’ll have a machine provide you traction. Other times, one physiotherapist will stabilize your lower body while the other one pulls your upper body in the opposite direction to provide traction.
Postural Adjustment for Long-Term Sciatica Treatment
Posture has a major role in causing sciatica but it’s not given the attention it deserves.
For example, repetitively sitting in a slouched posture over time causes changes in the curvatures of the back. That modifies the way your back distributes the load of the body and increases the chances of a disc bulge. (Reference)
All the muscle strengthening and stretching in the world isn’t going to keep sciatica at bay if you don’t address the root cause – which is the posture in a lot of cases.
That’s all the more important for people with physically demanding jobs that involve driving for hours, working with the back bent, and lifting heaving weights.
Physiotherapists teach you optimal posture for sitting, lifting objects, and walking with equal load distribution on both legs.
Education and demonstrations are generally enough to help patients with postural adjustments. But in advanced cases that require additional help, paraspinal muscle stimulation with hands or electric current is used, although it’s rare.
Gradual Return to Activity After Sciatica
A physiotherapist will educate you on the appropriate level of activity that you can perform while your sciatica treatment is underway.
The goal is to have your symptoms settle down first and then resolve the underlying issues through the techniques we’ve covered above.
It’s critical to gradually increase your activities because that way, it’s easier to tackle any flare-ups that might happen during this process and ensure long-term improvement.
Should Physical Therapy Be the Go-to Treatment for Sciatica?
Yes, studies show that physical therapy is the best treatment option for patients suffering from mild to moderate sciatica. (Reference)
For severe sciatica with a large bulge or some other lumbar vertebral complication, surgery might be a better option but it’s not the go-to treatment for sciatica.
To understand why that is, you need to understand the mechanism behind sciatica.
The pain you feel in this condition is caused by sciatic nerve irritation or compression at the root level or somewhere along its path. To fix it, you need to create more space wherever it’s being irritated.
Medication doesn’t have the power to do that and surgery comes with its own complications. Hence physical therapy exercises and postural correction techniques are the best approaches to treat sciatica. (Reference)
You might be prescribed painkillers by your primary care doctor to manage pain if it’s too intense. But it’s generally only for a while and not the long-term treatment for the issue.
The Takeaway
Sciatica isn’t a disease on its own. It’s a symptom of the actual problem which is usually a herniated lumbar disc or irritation of the nerve in its path.
Physiotherapy for sciatica is a long process and requires active participation from you. But it’s the best treatment option to resolve this condition for good.
Doing the exercises as prescribed and working on improving your posture can help you get rid of the pain and frustration caused by this condition.
Feel free to contact us if you have any questions about how physio can help sciatica.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.