Sciatica is a chronic disorder in which the patient experiences sciatic nerve distribution or related lumbosacral nerve root pain and/or paresthesia. A common mistake is that any low back pain or radicular leg pain is referred to as sciatica. Sciatica is specific to the pain that is a direct consequence of the root pathology of the sciatic nerve or sciatic nerve. The sciatic nerve consists of the nerve roots of L4 through S2, which coalesce to form the sciatic nerve in the pelvis. At a diameter of up to 2 cm, the sciatic nerve is easily the largest nerve in the body.
Sciatica pain is often caused by lumbar spine flexion, twisting, stretching, or coughing. The sciatic nerve provides the hamstrings with direct motor function, the lower extremity adductors, and the calf muscles with indirect motor function, the anterior lower leg muscles, and some intrinsic foot muscles. The sciatic nerve provides stimulation to the posterior and lateral lower leg and plantar foot indirectly via its terminal branches. Most cases of sciatica are the result of an inflammatory disorder that leads to sciatic nerve pain.
Symptoms
Sciatica patients may experience neurological symptoms, such as; pain, numbness, gait dysfunction, reflex impairment, sensory impairment/disturbance, lumbosacral radicular leg pain, muscular weaknesses, hot and cold or tingling lower limb (legs) sensations, and Paresthesias or dysesthesias and oedema in the lower limb.
Depending on which nerve is affected, symptoms of Sciatica can also vary;
L4: The patient experiences discomfort, tingling and numbness in the thigh when the L4 nerve is squeezed or irritated. When straightening the leg, the patient still feels weak and may have a diminished knee jerk reflex.
L5: The patient experiences discomfort, tingling and numbness in the thigh when the L4 nerve is squeezed or irritated. When straightening the leg, the patient still feels weak and may have a diminished knee jerk reflex.
S1: The patient experiences discomfort, tingling and numbness in the outer part of the foot when the S1 nerve is squeezed or irritated. When elevating the foot off the ground and balancing on tiptoes, the patient often feels fatigue. The jerk reflex of the ankle may be decreased.
Physiotherapy management
Conservative therapy is preferred in most cases of sciatica. Proof does not demonstrate that one treatment is preferable to the other;
- Patient Education
- Usage of hot or cold packs to ensure relaxation and minimise inflammation
- Avoidance of incitation or extended sitting/standing practises
- Well practised, erect posture
- Engaging in workouts to boost core strength
- Gentle stretching of the hamstrings and lumbar spine
- Light activities such as walking, swimming, or aqua therapy are regular.
- Usage of proper methods of lifting
- Physical Therapy and Exercise Targets in Treating Sciatica
Physical therapy and exercise help the lower back, pelvis, belly, buttocks, and thighs strengthen and mobilise tissues.
In treating the signs and symptoms of sciatica, the purposes of physical therapy and exercise are to restore pain-free functional movement patterns, to relieve lower back, buttock, thigh, and leg pain, to reduce muscle spasm, to restore function of the lumbar spine and the sacroiliac joint, to improve mobility of the lower body, to foster a better healing environment in the lower trunk.
Commitment and frequency are important characteristics of a good result of treatment as sciatica is used for physical therapy and exercise. The use of pain-relieving therapies such as over-the-counter (OTC) or prescription medications or epidural steroid injections may or may not be combined with physical therapy.
Sciatica Treatment: Physiotherapy & Exercise Techniques
In the treatment of sciatica, a physical therapist can recommend a combination of different kinds of physical, manual, soft tissue mobilisation, and/or exercise therapies. Different exercises rely on the underlying cause of sciatica, as well as other variables, such as the pain level of the patient, general conditioning, and the training and expertise of the physical therapist.
The following list highlights common techniques:
Back exercises for extension and flexion help alleviate pain by encouraging spine movement. Often, with precise directional movement of the spine, people with lower back pain and sciatica feel relief. Until prescribing specific directional exercises, a physical therapist usually assesses the directional preference of a client, since these are personalised to the individual patient and symptoms. Such drills include bending backward (extension) and forward (flexion). A significant aspect of the McKenzie Approach, also known as mechanical diagnosis and therapy, is this directional movement (MDT).
The McKenzie Approach (mechanical diagnosis and therapy) is a method for recognising and treating a cause of pain in the spine, muscles, and/or joints that requires a series of active directional movements. Via exercise, for example, bringing leg pain closer to the spine, the technique focuses on moving the radiating pain closer to the middle of the body. This approach’s idea is that centralising the pain implies changes in symptoms. The aim is to reduce effects of radiation coming from the spine. In the McKenzie Approach, a therapist who practises this technique normally has special training.
Bodyweight and resistance exercises to strengthen the muscles of the belly, lower back, hips, and legs require strengthening exercises.
- Without rotating the joints, isometric exercises include contracting muscles. A plank or a bridge hold provides examples of isometric exercises. When symptoms are more severe, these exercises may help strengthen muscles.
- Isotonic exercises involve muscle contraction to endure a constant load, such as bands of resistance and weight training, to help improve muscle strength by continuously resisting specific movements.
Sciatica Prevention/Control: Posture and Lifestyle Modifications
In addition to physical therapy and exercise, in the treatment and prevention of sciatica, contributing to proper and ergonomically assisted posture while sitting, standing, and walking is necessary. It is also important to adopt regular routines, such as following ergonomically healthy lifting techniques and using good postures for sleep.
Avoid bed rest and stay active
Patients may find the pain hard to bear when sciatica is serious and may need to rest for a day or two. However, it is normally not recommended to rest for more than a few days, as prolonged rest or inactivity may increase pain and lead to deconditioning. To allow the flow of healing nutrients to the injured structures that cause pain, daily movement is necessary.
While physical therapy is typically elective, meaning that it is the choice of the person to participate or not, it is usually an integral component of overcoming the signs and symptoms and helping to avoid sciatica in the long term.
