What is Sciatica?
Sciatica is an umbrella term referring to all conditions or injuries that cause irritation to the sciatic nerve. The sciatic nerve is the largest nerve in the body. This nerve originates between the vertebrae in the low back and travels down the backside of each buttock, hip and leg.
What are the Causes of Sciatica?
The sciatic nerve can be compromised in a variety of different ways. The nerve can be pinched or compressed by a herniated or prolapsed disc and/or by a bone spur or narrowing of the inter vertebral foramen (a boney canal where the nerve exits the spine). The nerve can also be compressed through the myofascial (muscles and its connective tissue) tunnels that it passes through as it travels down your leg, such as the piriformis muscle.
What are the Symptoms of Sciatica?
Since the nerve can become irritated in a variety of ways, the presentation can vary from person to person based on their unique presentation. In general, patients who have sciatic pain will complain of discomfort in their low back and leg. Also, patients may also describe feelings of shooting pain, tingling or numbness in their leg and foot as well as weakness of their leg muscles.
Symptoms that are more concerning is severe pain, tingling or numbness down both legs, increase frequency and urgency to urinate and constipation. If these symptoms are present it is urgent that you see a medical doctor that day.
How can a Physiotherapist or Chiropractor treat Sciatica?
Conservative management strategies such as physiotherapy or chiropractic care are treatment solutions that have been supported by the research and provide better outcomes over the long term. Your physiotherapist and/or chiropractor will complete a thorough evaluation of your back, pelvis, hips and lower extremity to determine the underlying cause of your sciatic symptoms.
Once your therapist determines where your sciatic nerve is being compressed they will use manual techniques to mobilize your restricted joints/tissues, use prescriptive exercise to improve your muscle imbalances and incorporate other modalities to facilitate recovery of the sciatic nerve. In addition, acupuncture and or dry needling/GunnIMS can be used to reduce your pain and facilitate nerve tissue healing.
One of the most important exercises to do to protect your low back spine is core strengthening and posture. If your physiotherapist recognizes that this would greatly benefit you they can refer you to our clinical pilates program with an individualized one on one program with an instructor to help you regain that strength.
They may also refer you to consult with a sports medicine doctor, have regular massage therapy intervention or to get custom orthotics to address lower extremity alignment issues.
What are the Best Exercises for Sciatica?
Lying on your back with your head resting on a pillow and your knees bent feet flat, grab just above the knee of the leg to be treated with both hands. With your knee now overtop your hip you will slowly begin to move your knee and ankle. As you straighten the knee (leg is stretching towards the ceiling) you are also going to point your toes to the ceiling so your ankle stretches. Once you have reached your limit (which is indicated when a pulling sensation is created down the back of the leg), you will then slowly bend the knee again but during this transition flex your ankle so that your toes are up towards your shin.
Disclaimer: do NOT push through tension or pain with this exercise or preform this exercise if you have worse pain after- nerves are highly sensitive.
The “figure 4” stretch- this stretch is performed by lying on your back with your knees bent and feet flat. Take the leg to be stretched and turn the heel inwards and place it across your thigh of the other leg, you should look like your legs are making the number “4”. Then grab behind the knee of the leg with the foot flat and pull it up towards your chest. You should feel a deep buttock stretch in the crossed leg.
Hold 30 seconds, repeat 3x, 3x/day.
How to Treat Sciatica at Home?
Applying heat to the muscles of your lower back, buttocks or back of your legs may help to relive the pain.
Please refer to the last section for an overview of rehab exercises. Try to do the exercises daily and at an appropriate level in the initial healing phase and maintain 3x/wk for longer term prevention. A good program should address strength of your core and pelvis stabilizers and flexibility of your hips and lower extremity.
Simple thing like sleeping with a pillow between your knees at night, using a lumbar support role in sitting, moving around often and avoid the things that aggravate your symptoms can be helpful.
Your nervous system is compromised and it is the largest oxygen consumer in the body, why not give it what it needs.
What to Avoid if you have Sciatica?
Avoid Prolonged Sitting
Try to get up and move around often. It is especially important that if you are sitting you are maintaining a good posture and have a lower back support. Sitting can place extra stress of the lumbar discs or tighten the muscles in your hips and back of the thigh.
Avoid Heavy Lifting
Bending forward and twisting of your spine- all these movements can place extra stress on the lower back and lumbar discs. If this is the cause of your sciatica you will be contributing to the aggravation. If you do need to bend down, do it slowly using a squat or lunge as opposed to your back, try to engage your core muscles and try not to do it repetitively.
Avoid Prolonged Rest
You do not want to spend too much time lying in bed or on the couch, although that may help not aggravated your symptoms it will decondition your muscles quickly (within 48 hours) and create more pain when you try to get back to your lifestyle. The best solution is to pace your day, do short periods of simple activity such as walking slowly every hour or two and increase duration and intensity as your symptoms improve.
How Long Does it Take to Recover from Sciatica?
This answer will be dependent on many variables like the cause of the sciatica, how long you have had symptoms, your treatment and lifestyle.
If you take a committed approach to treatment and lifestyle management and become more aware of your body you can see improvements in the first few weeks which should continue to full resolution in 2-3 months. If your injury is more complicated or continues to be aggravated with setbacks or lifestyle then you can take up to 6 months to improve and get back to things you enjoy.
Your Physiotherapist and Chiropractor will inform you if your recovery is delayed and will refer you to one of our Sports Medicine Physicians for further consultant and possibly investigation. In rare more severe cases surgery can be an option but that will only be considered, this is often dependent on length of time present and failed conservative management and also MRI results.
For more information, check out our blog on sciatica treatments and the benefits of conservative management over surgery.
To book in with one of our experienced physiotherapists or chiropractors please contact us today.
Heather Imrie, FCAMPT Physiotherapist
Heather Imrie is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.