Sciatica
What is sciatica?
Sciatica is a set of symptoms that arise from dysfunction of the sciatic nerve. The sciatic nerve is the longest and largest nerve in the body, and it runs from the lower back, through the buttocks, and down the legs. When the sciatic nerve is compressed or irritated, it can cause pain, numbness, and/or tingling in the lower back, buttocks, and/or legs. The pain is often characterized as sharp or burning.
What causes sciatica?
1. Vertebral Dysfunction
Herniated disc: occurs when the inner part of the disc between the vertebrae bulge out and put pressure on the sciatic nerve.
Degenerative disc disease: the discs between vertebrae may lose their height and become thinner, which will decrease the space between vertebrae and put pressure on the sciatic nerve.
Spinal stenosis: occurs when the spinal canal becomes narrowed, which can put pressure on the spinal cord and the sciatic nerve.
Spondylolithesis: occurs when one of the vertebrae in the spine slips out of alignment, which can put pressure on the sciatic nerve.
2. Postural Imbalance
Scoliosis: a sideways curvature on the spine can lead to compression and irritation on the sciatic nerve.
Lordosis: an excessive low back arch can compress the sciatic nerve at the level of the spine.
3. Movement Imbalances
Movement preferences that are asymmetrical can contort the low back and pelvis, which can put pressure on the sciatic nerve.
4. Piriformis Syndrome
The piriformis muscle is a small muscle located deep in the buttocks. When this muscle becomes tight or spasms, it can put pressure on the sciatic nerve.
5. Previous Injury
Trauma: accidents or injuries that cause damage to the spine can lead to sciatica.
Compensations: long-lasting compensations from previous injuries can affect movement patterns which can irritate the sciatic nerve.
6. Pregnancy
The extra weight and strain on the lower back during pregnancy can cause sciatica.
How does physiotherapy Treat sciatica?
Resolves the root cause
During the assessment, your therapist will determine where your sciatic nerve is irritated or compressed. Your therapist will then provide treatments, prescribe exercises, and educate you on how to reverse your sciatica symptoms.
management Strategies
1. Manual Therapy
Myofascial release: to reduce pain, tightness, and inflammation of the muscles, joints, nerves, and fascia of the affected areas.
Joint mobilization: to promote smooth joint movement and mobility of the back, pelvis, hip, and other affected areas.
2. Biomechanical Optimization
Improves alignment and stability of the spine, pelvis, and legs to reduce pressure on the sciatic nerve via:
Postural conditioning: corrects poor posture and improves alignment of the spine and hips during sitting and standing.
Movement pattern conditioning: optimizing walking mechanics by recruiting the appropriate hip, knee, and foot muscles.
3. Exercise Therapy
Stretching: to improve flexibility and reduce muscle tension in the lower back and legs.
Strengthening: to improve the activation and stability of the muscles in the lower back, core, and lower extremities which can restore optimal sciatic nerve function and reduce the risk of future injuries.
Low-impact aerobic exercise: low-impact endurance activities such as walking, cycling, or swimming can improve blood flow and reduce muscle tension.
Home exercise program: individualized exercise prescription to restore optimal and balanced movement.
4. Modalities
Acupuncture: use of thin needles to improve local and systemic function, regulate the nervous system, and promote the body’s natural healing processes.
Heat and cold therapy: to manage reduce pain and tension or control inflammation.
Electrostimulation: use of electrical currents to stimulate muscles and reduce pain.
Ultrasound: use of high-frequency sound waves to produce deep tissue heating to reduce muscle tension, fascial tension, and inflammation.
Laser therapy: to improve blood flow, reduce pain and inflammation, and promote tissue healing.
5. Education
Recommendations regarding lifestyle and activity modifications, posture, sleeping position, and shoe wear to help reduce load, risk of recurrence, and further injury.