Article by John Miller
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
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.
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 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 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.
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.