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Sciatica

Overview

Sciatica is a term that commonly refers to pain that radiates along the path of the sciatic nerve, initially starting from your lower back and traveling through to your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.

Sciatica most commonly occurs when one of your discs in your lower back rubs and irritates part of your nerve. Sometimes however, it can be caused by bony spurs or narrowing of the channel that your nerve runs through.  This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be rather severe, most people's sciatic pain will resolve with physiotherapy treatment in a few weeks. People who have severe sciatic pain associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.

Symptoms

Pain that refers from your lower back into your buttock and down the back of your leg is a hallmark of sciatica. You may feel the discomfort almost anywhere along the nerve pathway - including your calf and foot, but it's more likely to follow a path from your lower back to your buttock and the back of your thigh and knee.

The pain can vary widely, from a mild ache to a sharp, burning sensation or numbness. Sometimes it can feel like a shooting pain or electric shock. It can be worse when you cough or sneeze, and sitting for long periods can aggravate your symptoms. Usually only one side of your body is affected.

Some people also have tingling (paresthesia) or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.

Physiotherapy

Your physio may prescribe a combination of various types of physical, manual, soft tissue mobilization, and/or exercises aimed at treating sciatica. Specific exercises depend on the underlying cause of your sciatica, as well as other factors such as your level of pain, your previous activity levels, and your work requirements.

The list below highlights the common techniques:

  • Extension and flexion back exercises 

These exercises help to relieve pain by encouraging movement of the spine. Often, people with lower back pain and sciatica feel relief with specific movement of the spine. A physiotherapist typically looks at your directional preference (bending forward or backward) before prescribing specific exercises

  • The McKenzie Method 

The McKenzie Method is a technique that involves a series of active movements to identify and treat a painful source in the spine, muscles, or joints. The technique focuses on moving your referring pain closer to the center of the body through exercise, for example, moving your leg pain closer to your spine. The theory of this approach is that centralizing the pain indicates improvements in symptoms. The goal is to reduce referring symptoms originating from the spine

  • Strengthening exercises

These exercises include bodyweight and resistance exercises to strengthen the muscles of the core, low back, hips, and legs.

    • Isometric exercises involve contracting muscles without moving the joints. Examples of these exercises include planks or a prone hold. These exercises can help strengthen muscles when symptoms are more acute.

    • Isotonic exercises include the contraction of your muscles to resist a constant load. Often with these exercises we use such things as resistance bands and cables to help increase muscle strength through constant resistance to specific movements.

  • Nerve glides

Nerve glides usually involve active techniques on a symptomatic nerve when it is placed into and out of tension to facilitate movement and reduce symptoms.