Physiotherapists in Chiswick treat many different conditions including the issues profiled below.

Sciatica - Physiotherapy Examination

Sciatica is also known as nerve root pain, nerve root irritation, nerve root entrapment and slipped disc pain in the leg. True sciatica occurs when one of the nerve roots exiting the spinal canal is compromised, usually by a disc protrusion. The pain is typically severe, radiates down the leg beyond the knee, is worse in the lower leg or foot, has a surging quality and is worse with sitting or bending and better lying down. Physiotherapy examination starts with a history of the pain location and aggravating or easing factors and what were the precipitating factors for the pain problem.

The physio will examine the patient carefully as it is easy to aggravate the pain. Muscle power (as able), sensibility and reflexes will be tested to check the conduction of the nerve root involved and this should fit in with the area of pain reported. With the patient lying supine the affected leg will be raised with the leg straight to stretch the nerve and evaluate any changes in the pain reported. This neural tension test must provoke the typical pain to be positive. Palpation of the patient's spine may be performed in prone to evaluate the mobility or stiffness of the spinal segments.

Spinal Posture

Spinal posture can mean two main things, one being the shape and orientation of the curves in the spine and two being the angle that the whole spine is aligned to the vertical. The minimum of muscle activity occurs when the trunk is balanced directly above the pelvis and any deviation from this requires muscle activity to increase to maintain position. As the main moving muscles of the spine are orientated lengthways like the spine itself, when they contract they generate significant compression forces through the spine. Contraction of these muscles in easy standing or sitting still generates forces through the lumbar spine that are twice the body weight above the area.

In sitting it makes little difference to the degree of muscle activity whether the lumbar spine is held arched to some degree (lumbar lordosis) or flexed (bent), the key point is whether the spine is vertically aligned or not. So leaning back with a lordosis or forwards with a flexed spine both generate high muscle forces, whilst sitting upright in either posture does not. Sitting positions all flex the lumbar spine, with the lower two lumbar levels being significantly flexed in these postures, even to the maximum of their movement.