Sciatica, or sciatic pain, is a term used to describe symptoms of pain, pins and needles, or reduced muscular control due to sciatic nerve root irritation. When the sciatic nerve root is compressed in the lower lumbar spine, symptoms can be felt along the pathway of this nerve, starting at the lower back, and travelling through the hamstring, calf, and into the ankle and/or toes. Commonly, people who have reached their 40’s are most at risk, however that is not to say other age groups cannot be affected. Sciatica symptoms can vary in severity, and whilst some may experience only niggling pain, it can impact others ability to walk, run, work or sleep on a day to day basis.
As physiotherapists, just a few of many common terms we hear from patients include ‘I have a burning sensation down the back of my leg’, ‘I have a shooting referred pain from my low back down my leg’ ‘I have an intense pain in my buttock’ and ‘my pain increases after prolonged sitting for longer than 10 minutes’. Luckily, there is strong evidence for physiotherapy treatment to achieve long term results in those suffering from sciatic nerve pain and symptoms.
A typical physiotherapy session will see your physical therapist ask you a series of questions to help us determine what may be causing your sciatica. Following this, there are a range of neural and muscular assessments we can do to further enforce what we believe to be the primary cause. In this objective assessment, we will assess the neural pathway of the sciatic nerve to see where it may be compressed or irritated, in addition to muscle tightness and strength. We will then look at what action we must take to address the cause of this. This may be done through soft tissue release, stretching, neural movement, and exercises that promote healthy movement and muscle strengthening.
Causes of Sciatica
Sciatica is caused when there is irritation of the sciatic nerve root which originates from the lower back, and travels down the glutes, hamstring, calf, lateral ankle and small toes. True sciatica is most often caused by spinal conditions, such as degenerative disc changes, disc herniation, or spinal stenosis, which can compress and irritate the nerve. Whilst this is the cause of true sciatica, people may also experience sciatic like pain and symptoms without this spinal change. Often, tightness of the gluteal muscles, specifically the piriformis muscle, will cause compression of the sciatic nerve as it passes through these muscles. Whilst this is more factually known as piriformis, or deep gluteal syndrome, this is often mistaken for sciatica as symptoms are similar. No matter the cause of the symptoms however, there is a high chance of achieving long term results through physiotherapy treatment.
The treatment your physio will deem most suitable for your symptoms will be dependent on what they determine to be the primary cause! If the primary cause is of spinal compressions such as a disc herniation or spinal stenosis, your physical therapist may use a combination of manual therapies and exercise to help get you out of pain, and promote healing. This may look like soft tissue massage and other manual therapies to help desensitise an area, in addition to strengthening, stretching and movement exercises to restore pain free range of motion rarely, a physiotherapist may also use electrical stimulation therapy in order to assist with muscle activation. Another common exercise your physio will get you to perform are sciatic nerve sliders or tensioners. These exercises will see the patient slide, or floss, the sciatic nerve, through the entire body, and help free it from any location it may be getting compressed or irritated. If the cause of your sciatic pain is due to muscular compression of the nerve however, treatment may be more focused on releasing and desensitising the nerve through means of massage, stretching, and eccentric strengthening.
What are the risk factors for Sciatica?
- Age: Those in their 40’s are at higher risk, as this is when bony spurs or disc bulges that can irritate the sciatic nerve are most likely to occur
- Occupation: Jobs that involve awkward positions may create increase stress on the spine, which may cause overloading and increase the chance of sensitisation of the sciatic nerve
- Obesity: Obesity may also cause excessive loading on the spine that could lead to changes in the spine, leading to Sciatica
- Neurological Conditions: Other neurological conditions that can alter the nervous system can also increase the risk of irritation to the sciatic nerve.
- Other risk factors for sciatic symptoms are muscle weakness and/or length imbalances of the gluteal, hamstrings calf and abdominal muscles..
Why Physiotherapy is the best treatment?
Through physiotherapy treatment, we are able to address the root cause of a patient’s sciatica to achieve not just a quick fix, but long term results. Not only are manual techniques used to help reduce the pain and symptoms you are feeling, but we can also teach you how to do a range of physio exercises for sciatica to self-manage and improve your condition outside of one on one sessions. We can also aim to reduce any risk factors for sciatica that you may be presenting with, to minimise the chances of your sciatic pain returning in the future! If however this nerve pain does return, you will have a strong management plan already in place, in order to get on top of it early!
How many physio sessions do I need to fix Sciatica?
The number of physiotherapy sessions will be dependent on the severity of symptoms, and whether it is true sciatica, or another condition such as piriformis syndrome. If the sciatica is caused by spinal compression of the sciatic nerve at the lower lumbar spine, a patient may require up to 8-12 sessions over a 3 month period. If however the sciatic pain is caused by other conditions as mentioned earlier such as piriformis syndrome, it may take only 2-4 sessions to help release the muscle, teach and complete strengthening exercises and free the nerve from entrapment.
Why do physiotherapists prescribe exercise?
Whilst manual therapies such as soft tissue massage will help to desensitise your nervous system and reduce your symptoms, physio exercises for sciatica are a key player to achieve long term and lasting results. A diverse range of exercise will help us to promote healing, and get your body back to being pain free, whether it be through moving or prolonged sitting. Your physiotherapist may ask you to complete these exercises daily at home which will help to stretch these muscles and improve any muscle weakness, to prevent further irritation of the sciatic nerve. Even after your symptoms are gone, these exercises can be added to a weekly exercise routine to keep your body functioning healthily, and help prevent the sciatica returning!
Whilst Sciatica can be a debilitating condition causing a range of symptoms including intense pain and altered muscle activation, your physiotherapist will be able to help you through this time. Working together with the patient, we are able to use a combination of manual therapies and exercise to help you recover, and prevent the further onset of your sciatica symptoms returning.
Frequently Asked Questions
Is physio or massage Better for sciatica?
Physiotherapy is a better option than massage for pain relief from sciatica. Massage may make up part of the treatment of sciatica, however the evidence tells us that exercise, neural gliding and mobilisations are also necessary to decrease pain.
Is there a pressure point to relieve sciatica?
No, there are no specific pressure points to relieve sciatica. There may be some pain relief from pressure on certain muscles around the sciatic nerve, however this will vary from individual to individual greatly according to the research.
Should I push through sciatic pain?
You should consult with your healthcare professional before deciding whether or not to push through sciatic pain. In some people who are fearful of pain and movement, we will encourage them to begin to push into some pain, whilst in others who are constantly pushing into pain, we will decrease the amount of pain they are pushing through.
Does walking help sciatica?
Walking is one of the best ways to decrease pain from sciatica, as are most gentle forms of exercise. Walking gets a person out of a flexed spine position, which can also decrease pressure on the sciatic nerve.
Is sitting bad for sciatica?
Sitting in most people will cause an increase in their sciatica symptoms, including pain, tingling and numbness. This is due to increased compression in your lower back when you sit, compared to when you are standing or laying down.
What exercise is bad for sciatica?
Exercise that will increase pressure and strain on your lower back will typically cause an increase in symptoms from sciatica. This may include lifting heavy weights, plyometric exercise and running. It’s important to note that whilst these may increase symptoms, in some people they will be okay in moderate amounts and you should seek advice from a healthcare professional.
Why isn’t my sciatica getting better?
Sciatica is nerve related pain and there are many reasons why it may not be improving. Most commonly the reason it isn’t getting better is that the nerve is being constantly aggravated by activities throughout the day, namely the movements or positions that cause your symptoms to increase.
How do I stop sciatic pain in the morning?
To stop sciatica pain in the morning you can focus on stretching your glutes and hamstrings before you get out of bed each morning, having a warm shower to start your day and avoiding sitting for prolonged periods of time.