Intro
Sciatica, or Lumbar Radiculopathy, is the experience of pain in the lower back that spreads down the distribution of the sciatic nerve, from the buttocks down the back side of the thigh into the calf. Sciatica can be caused by nerve compression or irritation along the path of the nerve, which can cause pain, numbness, and/or altered sensation down the nerve.
About 40% of Americans experience some form of sciatica during their lifetime, most often affecting those between 30 and 50 years old.
Sciatica pain can affect your daily life by making you not want to participate in movement. While this may seem like the best option, it can often lead to more pain. Keep reading to learn why physical therapy is a great treatment option for sciatica.
Common Causes of Sciatica
Although it is more common for sciatica to affect one leg, it can occur in both simultaneously. It is considered acute if someone has sciatica symptoms for two months or less, while chronic sciatica lasts three months or more.
When sciatic nerve pain lingers on for months to years, it is more challenging to treat and can result in permanent nerve damage, numbness, and weakness in the leg.
The leading cause of sciatica is believed to be disc herniation, where part of the disc between two spinal canals pushes onto the nerve. Other causes of sciatica include foraminal stenosis, degenerative disc disease (DDD), a piriformis muscle spasm, and spondylolisthesis.
- Foraminal stenosis creates a narrowing of the gap where the nerves leave the spine, putting pressure on the sciatic nerve.
- Degenerative disc disease (DDD) results in the spinal discs shrinking and causes compression on the root of the sciatic nerve. The piriformis muscle can compress the nerve as it travels directly under the muscle.
- A Piriformis muscle spasm can occur from a tight piriformis muscle located in the buttock’s region, causing pain in the buttocks.
- Spondylolisthesis occurs when a spinal segment is shifted forward relative to the vertebrae beneath it, which can also pinch the sciatic nerve.
How Can a Physical Therapist Help with Sciatica?
If severe pain, muscle weakness, or movement problems occur, surgery may be recommended, but in most cases, physical therapy does the trick. Your physical therapist can determine if you need to meet with a surgeon during your initial appointment and will work with you to prescribe a personalized treatment plan.
Physical therapy for sciatica involves exercises, education on safe movements, ways to modify activities that allow low back pain to improve, manual therapy, and strategies for preventing the return of sciatica. Between modifying your movements to stop your leg pain, completing specific exercises customized to you, and making progress with the mobility in your spine over time, your sciatica should go away. At the end of your treatment, you will have tools to use in the future if your pain does come back.
Exercises to Treat Sciatica
The goal of physical therapy for sciatica is to reduce pressure on the nerve and to eliminate pain and numbness in the legs. Your physical therapist will guide you in movements to create more blood flow, space, and mobility of neural structures, decreasing irritation in the spine.
These movements need to be repeated until you no longer feel numbness or pain in your leg. Over time, these movements will increase the space for the nerve, allowing the return of normal movement without causing symptoms in the legs.
Other physical therapy interventions and graded exercises focus on increasing abdominal and gluteal muscle strength and improving flexibility in tight muscles surrounding the lower back. The gluteal and abdominal muscles help to support the lower body during normal movement and tasks. Maintaining good flexibility of the hamstrings, piriformis, hip flexors, and calves can be very helpful in alleviating lower back and sciatic pain. A physical therapist might prescribe the exercises below for you to do at home to relieve pain:
Glute Bridge
- Lie on your back with your knees bent and feet flat on the floor, hip-width apart. Place your arms by your sides, palms facing down.
- Engage your core and squeeze your glutes as you lift your hips off the ground, forming a straight line from your shoulders to your knees.
- Hold the position for a few seconds, then slowly lower your hips back to the starting position. Repeat for the desired number of repetitions.
Lying Knee to Chest Stretch
- Lie flat on your back with your legs extended straight and arms at your sides.
- Bend one knee and bring it towards your chest, clasping your hands around your shin or behind your thigh.
- Gently pull your knee closer to your chest until you feel a stretch in your lower back and glutes; hold for 20-30 seconds, then switch legs.
Clamshell
- Lie on your side with your hips and knees bent at a 45-degree angle, keeping your feet together.
- Pause at the top of the movement, then slowly return your knee to the starting position. Repeat for the desired number of repetitions, then switch sides.
- Keeping your feet in contact, lift your top knee as high as possible without rotating your pelvis or lifting your lower leg off the floor.
Bird-Dog
- Start on your hands and knees in a tabletop position, with your wrists directly under your shoulders and knees under your hips.
- Simultaneously extend your right arm forward and left leg back, keeping your back flat and core engaged.
- Hold for a few seconds, then return to the starting position and repeat on the opposite side. Continue alternating for the desired number of repetitions.
Cobra Stretch
- Lie face down on the floor with your legs extended and the tops of your feet flat on the ground. Place your hands under your shoulders.
- Press through your hands to lift your chest off the ground, keeping your elbows slightly bent and close to your body.
- Lift your chest as high as comfortable, feeling a stretch in your abdomen and lower back. Then, hold for 15-30 seconds before lowering back down.
Child’s Pose
- Kneel on the floor with your big toes touching and knees spread apart, then sit back on your heels.
- Extend your arms forward and lower your torso between your thighs, resting your forehead on the floor.
- Relax in this position, feeling a stretch in your back, hips, and shoulders, and hold for 20-30 seconds or as long as comfortable.
Find a PT Near You
Whether you’re experiencing excruciating sciatica pain or mild discomfort, seeking treatment from a qualified physical therapist is essential for adequate recovery, and regular sessions with a physical therapist can significantly improve your mobility, reduce pain, and enhance your overall quality of life. Don’t let sciatica control your life; take the first step towards recovery by using our interactive map tool to find a physical therapist in your area. Remember, early intervention can lead to quicker and more effective relief, allowing you to return to normal activities and improve your quality of life.