Sciatica 1

Sciatica

Article by John Miller

Sciatica Treatment

While every case of sciatica requires an individualised assessment and a subsequent treatment plan, here are some sciatica treatment guidelines

PHASE I - Pain Relief & Protection

You are managing your pain. Pain is the main reason that you seek treatment for sciatica. In truth, it was the final symptom that you developed and should be the first symptom to improve.

You are managing your inflammation. Inflammation is a normal part of your healing process post-injury. But, excessive inflammation can be the leading cause of your sciatica.

Please get in touch with your physiotherapist or doctor for their professional opinion.

PHASE II - Restoring Normal Flexibility, Posture & Strength

As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your regular back joint range of motion and resting muscle tension, lower limb muscle flexibility and posture.

Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises specific to your needs. They may recommend that you undertake an ultrasound-guided exercise program where you can view your deep core muscle contractions on a monitor.

PhysioWorks has developed a Back Pain Core Stabilisation Program to assist sciatica patients in regaining standard core muscle control. Other more advanced programs can include stability exercises and equipment such as a Swiss exercise ball. Would you please ask your physio for their advice?

Swimming and hydrotherapy exercises are beneficial in early injury repair due to lesser body weight in the buoyancy of water. Less weight allows more movement without causing pain.

PHASE III - Restoring Full Function & Dynamic Control

The next stage of your rehabilitation is aimed at safely returning you to your desired activities. Everyone has different demands, which will determine what specific treatment goals you need to achieve. Your physiotherapist is the best person to guide your rehabilitation.

PHASE IV - Preventing a Recurrence

Sciatica does tend to return. The main reason it is thought to recur is due to insufficient rehabilitation.

Fine-tuning your back mobility and core control and learning self-management techniques will ultimately help you achieve your goal of safely returning to your previous sporting or leisure activities without sciatica.

Exercise is like cleaning your teeth. Exercise prevents problems. For specific advice regarding your sciatica, please seek the advice of your trusted healthcare professional.

Surgery for Sciatica

Surgery is occasionally required when your leg pain does not settle with a conservative (non-operative) approach. Persisting symptoms over six months may need the attention of a surgeon who specialises in treating back pain and sciatica. If you have severe bowel or bladder dysfunction or extreme muscle weakness symptoms, you may require emergency surgery.

Would you please check with your physiotherapist or doctor for their professional opinion?

What is the Prognosis for Sciatica?

Fortunately, sciatica usually eases after a short period of rest and avoiding aggravating activities. Everyone is different because of the various pathologies that cause sciatica, but about 90% of sciatica will be asymptomatic within six weeks.

About one in every 50 people experiences sciatica as a result of a herniated disc. Of these, 10-25 per cent has symptoms lasting more than six weeks. About 80-90 per cent of people with sciatica get better over time.

All sciatica patients who suffer pain lasting longer than six weeks should undertake a specific exercise regime to regain control of their symptoms and avoid spinal surgery.

Other Treatment Options

Back Brace

A back brace or corset can provide excellent relief for most sciatica sufferers. Those who gain the most benefit find their pain eases when they wrap/bind a towel or sheet (folded-lengthwise) tightly around their stomach and back. If this simple test relieves your pain, you should use a back brace in the short term. Back braces and strong deep core muscles help to avoid a recurrence in the future.

Back braces are available from PhysioWorks or via the following web link: Back Brace.

Massage Therapy

Your spinal muscles will often present in muscle spasms, which respond favourably to soft tissue techniques such as massage therapy. You should seek the assistance of a quality remedial massage therapist to assist your sciatica treatment.

Discover more about Massage.

Acupuncture

Acupuncture has been an effective source of pain relief for over 5000 years. While we do not fully understand how it works, acupuncture can assist you with pain relief. Ask your physiotherapist for advice as most of our PhysioWorks physiotherapists have acupuncture training.

Find out more about: Acupuncture.

TENS Machine

TENS machines are electronic pain-relieving devices that will reduce your pain and your need for pain-relieving drugs.

More information: Tens Machine.

Swiss Exercise Ball

The unstable surface that your Swiss Exercise Ball provides can help awaken your deep core stability muscles. Your physiotherapist can advise you on specific exercises, or you can download some exercise plans from the following web link: Ball Exercises.

Posture Supports

Poor sitting posture is a common cause of sciatica. Many simple and effective products assist the support of your lower back. These include:

Would you please ask your physiotherapist for their advice on what will help you most?

When Should You Contact Your Physiotherapist?

Contact your Physiotherapist if sciatica pain grows worse over a few days or if it begins to interfere significantly with your daily activities.

Call your physiotherapist or doctor immediately if you experience sudden, extreme weakness in a leg, numbness in the groin or rectum, or difficulty controlling bladder or bowel function. Patients with these symptoms may have cauda equina syndrome and should seek immediate medical attention. This condition can cause permanent damage if not quickly treated.

For individualised advice regarding the best management for your sciatica, please consult your physiotherapist or doctor.

More info:

Common Causes of Back Pain

Article by John Miller

What Causes Sciatica To Flare Up?

Sciatica is the pain you experience when your sciatic nerve is irritated.  This may be a physical pinching or a chemical irritant in the vicinity.  How you cure sciatica permanently is essentially identifying why your sciatic nerve is being irritated. Please seek a professional assessment from your spinal physiotherapist or a doctor with a particular interest in managing sciatica.

Sciatica Prevention Tips

Avoid Postures that Hurt.

Depending on your nerve is pinched, you may experience pain when sitting, standing, walking, or lying down. It is essential to avoid whichever postures aggravate your pain. If it’s painful to sit for more than 5 minutes, limit your sitting to 4 minutes. Take regular breaks to stand and walk around. If you must be on your feet, prop one foot on a small block or footrest and switch feet throughout the day. Your body provides heaps of painful hints. Listen carefully, and you will recover quicker.

If your life involves excessive sitting, a back brace or external ergonomic support such as a Lumbar Roll or Bassett Frame can be beneficial in avoiding future bouts.

Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it's always possible for your disk to rupture again. Reinjury happens to about five per cent of people with sciatica.

Once the pain of sciatica passes, there are strengthening and postural exercises, stretches and other measures that help prevent its return. Would you please get in touch with your physiotherapist for specific advice? Here are some steps you can take in the meantime:

Practice Good Posture.

Stand up straight and stretch yourself upwards, “trying to grow as tall as you can”. This posture will help turn on your deep abdominal muscles that open the spaces in your spine where your nerves are vulnerable to pinching.

Posture Improvement

Walk/Swim.

Walking and swimming can help to strengthen your lower back. Lift objects safely. Always lift from a squatting position, using your hips and legs to do the heavy work. Never bend over and lift with a straight back. Look up as you lift.

Use Proper Sleeping Posture.

Ease your back's pressure by sleeping on your side, or supine, with a pillow under your knees. If you don’t feel pain, you are in the correct position.

Avoid Wearing High Heels.

Shoes with heels that are more than 1½ inches high shift your weight forward, excessively arches your back and can further pinch the sciatic nerve.

For more advice about Sciatica, don't hesitate to get in touch with your physiotherapist.

Why Does Pinching a Nerve Hurt?

Nerves have many functions, transmitting messages around the body, rather like a telephone system. They allow us to feel things that happen to us, such as things we touch or that touch us, hot and cold, and pain and they cause our body to do something, e.g. making your leg muscles contract when you want to walk.

When a nerve is pinched, it may malfunction, and we might feel pain, numbness, pins and needles, and we might find our limbs are weak or do not work in the way they should. The nerve may also get inflamed and irritated by chemicals from the disc's nucleus without surgery.

Pressure on the sciatic nerve from a herniated disc usually causes sciatica. The problem may be termed radiculopathy, meaning that a disc has protruded from its normal position in the vertebral column and pinched the sciatic nerve's root (origin).

The degree of pain is often "ridiculously" high as well. Less direct nerve pinching, e.g. swelling around the nerve, is usually a less severe dull ache. However, this can progress into radiculopathy as swelling increases.

Other things can cause irritation or pressure on a nerve in the spine. Sometimes this may be a rough and enlarged part of one of the bony vertebrae, brought about by ageing. Rarely, infections and tumours are to blame. Most times, the cause is nothing too serious, but one of the reasons for seeing your physiotherapist or doctor if the pain persists is to exclude these serious and treatable causes.

More info

What is Dry Needling?

Dry needling is an effective and efficient technique for the treatment of muscular pain and myofascial dysfunction. Dry needling or intramuscular stimulation (IMS) is a technique that Dr Chan Gunn developed. Dry needling is a beneficial method to relax overactive muscles.

In simple terms, the treatment involves the needling of a muscle's trigger points without injecting any substance. Western anatomical and neurophysiological principles are the basis of dry needling. It should not be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture. However, since both dry needling and acupuncture utilise the same filament needles, the confusion is understandable.

In his IMS approach, Dr Chan Gunn and Dr Fischer, in his segmental approach to Dry Needling, strongly advocate the importance of clearing trigger points in both peripheral and spinal areas.

Dry needling trained health practitioners use dry needling daily for the treatment of muscular pain and dysfunction.

dry needling

What Conditions Could Acupuncture or Dry Needling Help?

Acupuncture or dry needling may be considered by your healthcare professional after their thorough assessment in the following conditions:

Private Health Fund Rebates

Most private health funds offer rebates on acupuncture or dry needling treatments as a component of your physiotherapy or acupuncture consultation.

More Info

The internet is full of potentially unreliable information. Please source trusted healthcare information from reputable websites such as the following.

https://www.health.gov.au/

https://australian.physio/

https://www.ama.com.au/

British Medical Journal

https://www.mayoclinic.org/

https://www.hopkinsmedicine.org/