Southwest Florida Neurosurgical Associates


How Can Physical Therapy Help Sciatica?

If you suffer from sciatica, the pain is hard to miss. In mild sciatica, all you may feel is a numb sensation or tingling in your buttocks and legs. However, in severe cases, you may feel incapacitated by shooting pains in the lower back and legs.

Sciatica’s Causes

Whether sciatica is bearable or unbearable depends on its cause, of which these are the most common:

  • Herniated discs – When a lumbar disc becomes misaligned in the spinal column, it is said to have slipped, ruptured, or ‘herniated.’ Discs herniate either from injury or progressive causes (usually genetic or age-based).
  • Spinal stenosis – As the body ages, the spinal column may undergo stenosis (abnormal narrowing). This causes soft tissue to impinge on the spinal column or nearby nerves.
  • Degenerative disc disease – Also related to age, DDD makes discs weaken and bulge over time. When this happens, the exposed discs press against nearby nerves, causing sciatic pain.
  • Sacroiliac joint irritation – If the sacroiliac joint presses against the L5 nerve just above it, this causes pain similar to sciatica.
  • Piriformis pressure – The piriformis is a buttock muscle. Occasionally, it can pinch the sciatic nerve root and cause pain that mimics sciatica.

One of the most familiar warning signs of sciatica is sudden pain that radiates from the buttock through the leg when the leg is lifted. Most patients have a restricted range of motion because their pain doesn’t allow wider movement.

In severe cases, patients may require cortisone injections near the spinal column. More often, though, doctors recommend physical therapy to reduce or manage the pain.

A Typical Physical Therapy Regimen

Before a sciatica sufferer participates in physical therapy, his or her doctor determines the severity of symptoms.

For example, some patients have pain only in their spinal region and buttock. Others have pain that radiates clear down the leg and into the foot. If it’s the latter, doctors want to centralize the pain. The goal is to move the pain closer to the spine so patients no longer feel leg and foot pain.

To do this, rehabilitation teams plan the most effective physical therapy plan for each patient. In most cases, doctors begin with passive therapies first.

Ultrasound Treatments

Until the painful area heals from inflammation, it makes no sense to inflame muscles further through vigorous stretching and exercise. Instead, the therapist may start out with ultrasound treatments.

Ultrasound uses sound waves and warmth to increase circulation around the painful muscles. In turn, this improved circulation calms muscles, reduces spasms, and alleviates swelling and pain.

TENS Units

In tandem with ultrasound treatments, many therapists use transcutaneous electrical nerve stimulation (TENS) unites to further stimulate muscles. Using sticky rubber patches containing electrical wires, your PT will attach several skin patches next to your spinal column. The wired ends of each patch connect to a larger machine that safely stimulates the muscles and nerves.

Most patients find this process relaxing, even pleasurable, as the tiny electric currents pulse into muscle fibers. Although the sensation feels like a massage, the electric impulses completely control the intensity.

In some cases, patients use a portable TENS unit at home to further the stimulation between appointments.

Heat, Cold, and Massage Therapy

To help train muscles to relax, your therapist may try direct pressure in certain areas. Heat packs may reduce spasms, while cold packs alleviate inflammation. Together, all three methods can reduce pain while the healing process begins.

Once a patient progresses to the point where gentle stretches and targeted exercises are appropriate, the physical therapist monitors a series of short exercise sessions. These constitute the active phase of physical therapy.

Core Strengthening Exercises

Although sciatica may signal a degenerative disc disease, it also signals the need for improved core strength and general conditioning.

To help patients in the long term, physical therapists recommend core and aerobic exercises to strengthen the spinal column and adjacent muscle groups. Here are a few exercises for sciatica patients:

  1. For strength: Exercises that involve a ‘core’ ball strengthen the abdomen and back. Your therapist can assign a variety of exercises for gluteal muscles, the back, the front flexors, and the obliques.
  2. For flexibility: Stretching improves overall muscle function and ease of motion. Once muscles become less inflamed, doctors generally recommend gentle stretches for the hamstrings and lower back. Yoga is also a good method for increased flexibility.
  3. For conditioning: All patients can benefit from aerobic exercise, which enhances healing through improved blood flow. The added endorphins also reduce pain naturally. Your doctor and/or physical therapist may recommend low-impact routines such as walking, pool aerobic classes, or swimming.

If the pain doesn’t respond to physical therapy, your doctor may recommend surgery. Make an appointment early so you don’t suffer needlessly.

Remember, only a competent physician can diagnose sciatica or related spinal diseases. See your doctor to begin therapy and loosen the grip of back pain in your life. 

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