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The Treatment of Sciatica by Physiotherapists

Sciatica is severe leg pain. It can be in the buttock, thigh, calf and foot or in any one of these areas. It is not common, with an estimated 3-5% of the population suffering at some time. Men and women get sciatica equally, with women more likely to do so in their fifties and men in their forties.

As the lower nerves come off the spinal cord in the lumbar area they pass through a bony canal to emerge into the body. At this point the nerve is called the lumbar nerve root. Each nerve root runs down the leg to supply specific areas of skin and specific muscles.

The exact cause of sciatica is still being debated but it is generally accepted to be due to compression and irritation of the lumbar nerve root at or close to where it exits through the bony canal known as the intervertebral foramen.

A disc prolapse of one of the lumbar discs is the most commonly occurring cause for sciatica but scans have shown that a larger prolapse is not necessarily more painful. Other factors such as chemical irritation from the disc material may cause inflammation and swelling of the nerve root, blocking the local circulation and the nerve’s function to a degree.

The compression and/or inflammation can be enough to cause neurological changes in the skin, reflexes and muscles supplied by the affected nerve. These include pain, loss of feeling and a reduction in reflexes. Up to a quarter of people have symptoms lasting more than six weeks and self-referral to physiotherapists in the early stages is common. 


Physiotherapy Assessment of Sciatica

Due to the severity of a typical sciatica, assessment has to be limited or the person will suffer badly afterwards.

The subjective (questioning part) assessment is very important. True sciatica includes:

  • Sudden onset of severe pain in one or several areas including the buttock, thigh, calf and foot
  • The person can indicate relatively precisely where the pain is
  • They may or may not have low back pain
  • Pain surges down the leg
  • Difficulty sitting or lying
  • Difficulty sleeping

The objective assessment will include observation of abnormal posture such as avoiding weight on the affected leg and a shift of the body away from the painful side. Gentle movements may be performed to see if there is a pattern of worsening or improving in specific directions. The physiotherapist will test the reflexes, skin sensation and muscle power and may lift the leg up to test if the nerve is sensitive to being stretched.

Treatment for Sciatica

A physio has a number of approaches they can use to help someone with sciatica:

  • Explanation about the condition and that it will likely start to settle within a few weeks and will resolve completely with time
  • Encouragement to take medication regularly as advised by their doctor
  • Deep tissue massage to the buttock as Piriformis Syndrome may contribute to sciatic pain
  • Trigger point therapy
  • Acupuncture
  • Positioning to allow reduced pain at rest
  • Mobilisation techniques to the lower lumbar spine
  • Relaxation techniques to reduce pain amplification by tension or anxiety
  • A paced approach to steadily increasing activity, avoiding a severe pain worsening
  • Core stability work

Most sciatica episodes begin to settle within six weeks although this time can be very challenging for the person to cope with. Around 10-25% of sufferers have symptoms that last over six weeks. It may take months to settle completely. If there is no significant improvement at six weeks then a referral to a spinal unit may be appropriate. Further treatments include epidural injection, nerve root injection and discectomy.

Physiotherapy is recommended for the treatment of sciatica by the Department of Health’s National Institute of Health and Care Excellence (NICE). 

By: Jonathan Blood Smyth

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