How can Physiotherapy help with Sciatica Pain?
If you’re reading this, chances are you may feel you have symptoms similar to sciatica or have been told by another health care professional such as your doctor that you have sciatica. Most doctors will recommend physiotherapy for sciatica and today I will talk about what Physiotherapy can do to help sciatica or radiating pain in the leg.
What is Sciatica?
Sciatica is a condition that occurs when one or more of the nerves in your lower back become compressed by a ruptured or herniated lumbar disc. The Nucleus Pulposus which is similar to the jelly-like substance will leak outwards when there is a break in the surrounding wall or annulus of the lumbar disc.
The pressure on the nerve root may cause pain to radiate or travel down the leg along the pattern of the nerve that is affected. “Evidence suggests that it is not so much the pressure on the nerve root that causes sciatica, but a combination of pressure-related, inflammatory and immunological processes.”
There are rarer cases of sciatica caused by compression on the nerve due to changes in the surrounding bone or vertebral structures (e.g., lumbar stenosis, foraminal stenosis, spondylolisthesis) or in more serious cases due to a malignant structure such as cancer in the region.
Did you know? Another name or term for sciatica that is often used is lumbar radiculopathy.
How do you diagnose Sciatica?
Sciatica can be diagnosed by your physiotherapist or family physician. The diagnostic procedures are mainly based on a combination of the patient’s symptoms and the findings on physical examination. It cannot be diagnosed based on one single symptom or one single physical test.
Signs and symptoms:
- Worse leg pain (more than back pain)
- The location of the leg pain (ie, to assess whether it travels down below the knee and whether it aligns with one or more nerve roots);
- Any changes in sensation and/or sensory loss and whether it aligns with a nerve root
- Weakness and/or reflex changes in line with a nerve root
- An increase in leg pain with coughing, sneezing and/or taking a deep breath.
- No sudden onset but a gradual increase in complaints
Information for other health care practitioners: Additional tests may add small diagnostic value; particularly loss of dorsiflexion of the foot when L5 is affected (often this loss is too subtle to cause foot drop); increased finger-floor distance (>25 cm); absence of tendon reflexes; and a straight leg raise test (in particular, a negative test is informative because it indicates decreased likelihood); and a positive crossed straight leg raise test (increased likelihood).
When several of the signs, symptoms, and physical tests are all positive, it increases the likelihood of the diagnosis being Sciatica. It is even more likely when the results of the history and physical tests point to one particular nerve root.
It is also important to exclude any signs and symptoms of serious medical conditions such as sudden loss of bowel and bladder function, sudden loss of sensation in the groin and hip areas, and/or sudden decreased sexual function. If you display any of these symptoms, please seek immediate medical attention at the nearest hospital. Also, if you continue to have these symptoms and had any serious medical condition ruled out, consider Pelvic Health Physiotherapy treatment.
Do you need an MRI to diagnose Sciatica?
In most cases, you do not need an MRI or any other diagnostic scan such as an X-ray, CT scan, or ultrasound. As you have just read, it is diagnosed with a combination of a thorough history and physical examination. One study showed having diagnostic tests such as X-rays, CT scans or MRIs did not change the management or outlook of treatment of sciatica.
Interestingly, a study by Herzog et al. had a 63-year-old woman with a history of low back pain and right leg pain symptoms was sent to 10 different regional imaging centres within a 3-week period. This study found that all study centres had a different finding by the radiologist and that one third of the total reports included these findings (meaning the other two-thirds didn’t include the findings or diagnosis). This goes to show that each radiologist demonstrated different standards when deciding what to include in the diagnostic report and these reports and diagnostic tests may not be reliable due to errors made by individual radiologists.
How can Physiotherapy treat Sciatica?
Standard practice in the first line of care for sciatica is conservative management. Physiotherapists provide conservative management which means learning about how to self-manage their pain with proper education and continuing to stay active with exercise (see free sciatica exercises below), maintaining proper body mechanics with lifting and carrying, and being mindful of your posture. Click here to read more about our Physiotherapy Services. In addition, physiotherapists can provide manual therapy such as spinal mobilisation, spinal manipulation or soft tissue techniques such as massage for managing low back pain with or without sciatica. Also, Physiotherapists have access to a variety of modalities such as IFC, ultrasound, TENS, and laser, as well, physiotherapists can provide acupuncture and dry needling treatment for pain management and relief.
Surgery or other invasive procedures are only considered once conservative management has not improved pain or function.
Found this interesting? Read our other blog “Want Relief? Low Back Pain Causes and Treatment”
Need Physiotherapy for your pain?
Book with one of our experienced physiotherapists today (take a look at Our Team page) if you need more help or have more questions regarding lower back pain or general health and wellness.
- Ostelo RWJG et al (2020) Physiotherapy management of sciatica. Journal of Physiotherapy 66:83–88] © 2020 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights). Last updated 22 September 2020
- Ashbrook J et al (2020). Systematic Review: The therapeutic management of back pain with and withoutsciatica in the emergency department: a systematic review. Chartered Society of Physiotherapy. Published by Elsevier Ltd. 109: 13–32. https://doi.org/10.1016/j.physio.2020.07.005