Managing Sciatica with Physical Therapy

Physical Therapy (PT) is one of the leading forms of treatment for sciatica. But, before we can discuss how PT relieves pressure on the sciatic nerve, we need to define what sciatica is and why it can occur.

What is Sciatica?

Sciatica occurs when the sciatic nerve that supplies sensation to your lower body becomes pinched. The longest nerve in your body, your sciatic nerve runs from your lower back all the way down to your feet. For this reason, sciatica symptoms often involve radiating pain. If you have sciatica, then you may notice that your pain begins in your lower back and travels into your hips, buttocks, hamstrings, calves, or feet.

You may also notice defining symptoms of nerve root compression, such as tingling, numbness, burning, or muscle weakness. Although these symptoms occur with all forms of nerve compression, if they co-occur with leg pain, then sciatica is often the culprit.

In addition, patients with sciatica often describe their leg pain as searing, stabbing, burning, or electric. If you notice any of these symptoms, then seek the advice of your doctor. Sciatica is easy to treat once you address the underlying cause.

What Causes Sciatica?

This is where things get a little trickier. Many different conditions can lead to sciatica. In fact, sciatica is more of a symptom than it is an actual diagnosis. For this reason, your doctor will want to examine you for the following causes:

• Bulging or Herniated Discs: A bulging disc occurs when a spinal disc sustains an injury or suffers from wear and tear. If the damage is severe enough, then the disc can swell outward from its natural borders, intruding on nearby tissues. If the disc ruptures releasing its contents into the body, we say that the disc has “herniated.” Both herniated and bulging discs can cause sciatica if they pinch the sciatic nerve in the lumbar spine.
• Spinal Stenosis: Spinal stenosis refers to a tapering or constriction of the spinal canal. Because your spinal canal houses your spinal cord, this can cause symptoms that mimic a spinal cord injury. If your lumbar spinal stenosis pinches your sciatic nerve, then you can also develop sciatica.
• Piriformis Syndrome: Your piriformis muscle is a narrow, pencil-shaped muscle that overlays your sciatic nerve. If your piriformis becomes too tight or inflamed, it can clamp down on your sciatic nerve.
• Spondylolisthesis (aka Slipped Vertebra): A slipped L4 or L5 vertebra can cause sciatica if it applies pressure to the sciatic nerve. Many people sustain a small fracture on the back side of their spine as children–without even realizing it. In adulthood, this issue can cause the bones of the spine to slip out of alignment.

Worried that you might have any of the conditions described above? To receive a full diagnosis and the latest options in sciatica treatment, contact our team of spine experts in Morristown, NJ!

The Goals of Physical Therapy For Sciatica Pain Relief

Physical therapists usually treat sciatica by using a mix of active and passive treatments. Active treatments make use of physical activity. In contrast, passive treatments help the body to relax without relying on physical exertion. However, the best PT regimens use the best of both worlds.

When it comes to active treatments for sciatica, the goals often involve:

• Building Strong Back & Core Muscles: You’ve probably heard that a strong core is the key to injury prevention. This is true when it comes to muscle strains and sprains–and it’s also true when it comes to preventing future cases of sciatica. When your core and back muscles are strong, they can support your spine adequately. This means that you can rotate your spine and lift objects without knocking your spine out of alignment.
• Stretching Buttocks, Hip, & Hamstring Muscles: Because your sciatic nerve runs from your lower back all the way down to your toes, many lower body structures can be affected by (or even cause) sciatica. To prevent sciatica, your PT will prescribe stretching exercises that loosen up your piriformis muscles, hamstrings, and hip flexors.
• Enhancing Cardiac Fitness: While you are recovering from sciatica, it is important that you don’t neglect your cardiac fitness. Aerobic exercise can actually promote healing because it gets your blood pumping. And, blood is the major transport system for healing factors and nutrients. A comprehensive PT program for sciatica will recognize this crucial role of blood in the healing process and apply it as needed.

Although your treatment plan will vary according to the cause of your sciatica, you can expect most PT programs to follow those 3 central goals. However, before talking to a PT, don’t forget to receive a full workup from your doctor. Like PTs, orthopedists are trained in the principles of sports medicine and sciatica recovery.

Passive Treatments for Sciatica

In addition to strengthening exercises, your PT will also prescribe a course of passive treatments that can relax stiffened or sore muscles. Some of these passive techniques include:

• Hot & Cold Therapy: PTs apply ice to sore muscles and structures in the lower back to reduce the tenderness of sciatica. In contrast, applying heat serves to increase blood flow, drawing healing factors to the site of the injury.
• Massage Therapy: A deep tissue massage can help to loosen swollen tissues in your lower back and legs. Your PT may focus on relieving tension (or “knots”) from your piriformis muscles, hamstrings, calves, or lower back.
• Transcutaneous Electrical Nerve Stimulation (TENS): TENS involves passing a mild electrical current through the muscles to relieve back pain and spasms. Your PT will deliver this current through the use of sticky pads, which are placed on the lower back and legs.
• Ultrasound Therapy: Similar to TENS, ultrasound therapy uses sound waves to achieve muscle relaxation and pain relief.
• Hydrotherapy: If your PT has access to a whirlpool or water spa, then he or she may prescribe water therapy. Water therapy uses warm water to increase blood flow and massaging jets to relax the muscles.

A Final Word on PT for Sciatica Relief

PT is known to be one of the most effective forms of relief for sciatica. However, not every patient will qualify for PT or witness improvements in their condition. If you have been diagnosed with severe forms of the conditions above (like spinal stenosis), then you may need surgery to reverse your sciatica.

This is where a board-certified, fellowship-trained team of spine specialists can come in handy. At the Advanced Spine Center of Bridgewater, NJ, our sciatica experts specialize in minimally invasive treatment options for sciatica. To find out if you qualify for one of our procedures, contact the Advanced Spine Center today!