What is Sciatica?
Sciatica is a sign of perturbation in the function of the longest nerve in the human body the sciatic nerve. Sciatica is characterized by radiating pain from the lower back down to one or both legs; typically sciatica is due to pressure on the nerve root, usually by a herniated disk. The pain can be very disabling and cause a lot of suffering, but there are effective treatments, as explained by Glauber Barduzzi.
The typical symptoms of sciatica include pain that radiates from the lower back down to the back of the legs, below the knee, shin, feet and toes, other symptoms include a tingling sensation, pins and needles, numbness, throbbing pain, when the nerve compression is very high other symptoms such as loss of power, loss of sensation, muscle weakness may be present.
Sciatica nerve pain, nerve leg pain, buttock and leg pain, pain in the buttock and lower back are common complaints of people with sciatica and lower back problems.
Causes of Sciatica?
The most common denominator of all these causes is the fact that the lumbar nerve root is compressed due to wear or trauma of the lumbar disc or vertebrae, which may result in the inflammation process.
Spinal disc herniation, disc prolapse, bulging discs, slipped-disc are all common terms for lumbar disc pathology causing compression of the sciatic nerve. Other causes of Sciatica are spondylolisthesis (when one vertebra moves forward or backwards in relation to the next vertebrae), Spinal stenosis (narrowing of the spaces within the spine), spinal degeneration.
During pregnancy, it is common for the sciatic nerve to be affected due to the rapid increase in weight, growth of the belly and alteration of the woman's center of gravity, which can lead to compression of this nerve. In fact, between 50 and 80 percent of women have back pain during their pregnancies.
The pain can originate in the lumbar spine caused by the compressed nerve or in other related areas such as pelvis, hips, gluteus and piriformis muscles not related to the nerve compression.
The most common location of Sciatica nerve compression is on the lumbosacral nerve roots (L4-S1) forming the sciatic nerve. Disc herniations affecting the L5 or S1 nerve root are more common and cause pain at the back or side of the leg and into the foot and toes. If L4 root is affected, pain is localized to the front and lateral side of the thigh.
Physiotherapy And Other Treatments for Sciatica?
The first line of care for patients with sciatica is conservative treatment. Physiotherapy is a first choice conservative treatment for sciatica pain. Physio for sciatica should focus on education about sciatica, the role of imaging exams, and advice to stay active.
The physiotherapist can use a variety of techniques and exercises to reduce muscle spasm, pain and increase back range of motion and core strength.
Recommendations regarding supervised exercise therapy include motor control exercise, nerve mobilization, muscle stretching and core strength exercises. The type of exercise should be aligned with the specific complaints, wishes and conditioning level of the patient and the specific training of the physiotherapist.
Mobilizations and manipulations are therapies performed by Physiotherapists to increase range of motion and lumbar function in patients with sciatica.
Medications such as nonsteroidal anti-inflammatory drugs, corticosteroids, antidepressants, anticonvulsants, muscle relaxants, and opioid analgesics are widely used for acute sciatica and lower back pain. However, the consensus is that medication only give short term relief and the negative side effects should be considerate while taking medication.
Surgical treatment for Sciatica pain should be the very last option. Patients must not be rushed into surgery and surgical intervention should not be performed before conservative treatment. The fact that patients should be carefully selected for surgery is also supported by a recently published systematic review (link) that assessed if surgery was more effective compared to non-surgical treatment, the results showed that the short term improvement after surgery did not last more than 12 months, for functional improvement there was no difference between the groups and the rate of reoperations was 10% in the surgery group. Clark R et al, 2019.
Which Are Best Physiotherapy Techniques For Sciatica Pain?
Exercise
A physiotherapist should prescribe exercise therapies in treating sciatica. Rest makes the pain worse, as well as staying in the same position for a long time, which is why exercises are welcome.
Specific exercises can be prescribed depending on the underlying cause of sciatica, as well as other factors, such as the patient’s level of pain, overall conditioning, and the physiotherapist training and experience. Extension and flexion back exercises help relieve pain by promoting movement of the spine. Often, individuals with lower back pain and sciatica feel relief with specific directional movement of the spine. Pourahmadi MR. Et al. BMJ. 2016
Dry needling
Dry needling is a common treatment technique for muscle knots and it can be effective for Sciatica problems. Dry needling can be used to release muscle knots and spasm causing the narrowed spacing or tightened muscles in the lower back which greatly reduce the sciatica pain. One session of dry needling can be effective to reduce sciatica pain. It’s important to recognize that the correct technique, needle size and needle location need to be precisely targeted for better results.
Shockwave Therapy
Extracorporeal shock wave therapy (ESWT), is a non-invasive treatment which in patients with Sciatica relieves the pain of peripheral nerve damage and promotes local arterial remodelling and cellular regeneration. It is also known as an effective treatment for decreasing muscle tone.
Exercise programs in conjunction with ESWT are effective in improving the function of the sciatic nerve and preventing the denervation atrophy. Lee, J. H. et al. 2013.
Another recent study from Abd El-Salam. et al. 2016. on ESWT for sciatica neuralgia showed that it is an effective method to decrease pain and inflammation and improve the balance in patients with sciatic pain and beneficial method in treating sciatic neuralgia more than therapeutic exercise alone.
If you are experiencing undiagnosed back pain or sciatica pain, use our website to book an appointment with Glauber Barduzzi. Book Now!
References:
1. Ostelo, R. W. Physiotherapy management of sciatica. Journal of Physiotherapy. 2020.
2- Clark R. et al. Surgical management of lumbar radiculopathy: a systematic review. J Gen Intern Med. 2019.
3. Lee, J. H. et al. Effect of Extracorporeal Shock Wave Therapy on Denervation Atrophy and Function Caused by Sciatic Nerve Injury. Journal of Physical Therapy Science. 2013.
4. H S Abd El-Salam. et al. Effect of Shock Wave in Treatment of Sciatic Neuralgia. Journal of Medical Science and Clinical Research. 2016.
5. Pourahmadi MR. et al. Motor control exercise for symptomatic lumbar disc herniation: protocol for a systematic review and meta-analysis. BMJ. 2016
6. Slater J. et al. The Influence of Exercise on Perceived Pain and Disability in Patients With Lumbar Spinal Stenosis: A Systematic Review of Randomized Controlled Trials. Am J Lifestyle Med. 2015.
7. Stochkendahl MJ. et al. National Clinical Guidelines for non-surgical treatment of patients with recent-onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60-75. doi:10.1007/s00586-017-5099-2