According to the University of Maryland Medical Center, sciatica refers to symptoms of irritation of the sciatic nerve. Sciatica can be caused by a variety of ailments, the most common being disk disorders such as herniated disks, spinal abnormalities such as narrowing of the spinal canal and muscle spasm. Symptoms of sciatica include pain in the lower back that radiates down the leg, numbness and tingling. Physical therapy, also known as physiotherapy, is commonly prescribed for the treatment of sciatica.
Diagnosis
According to Anthony Delitto, chairman of the University of Pittsburgh's Physical Therapy Department, the first step is making sure the diagnosis of sciatica is correct. The "Textbook of Disorders and Injuries of the Musculoskeletal System" by Robert B. Salter recommends the bowstring test as being one of the most specific for diagnosing for true sciatic nerve irritation. In this test, the patient lies on a table and allows the professional to lift one of his legs, keeping the knee straight. At the point of pain, the professional then bends the patient's knee. If putting pressure on the medial popliteal nerve reproduces the pain, the test is positive for sciatic nerve root irritation.
Posture Modification
Since the majority of sciatica causes begin with the spine, physical therapists usually discuss a posture modification program. Delitto suggests avoiding prolonged sitting or any other postures that encourage forward flexion of the spine. When sitting is required, using a lumbar roll behind the curve of the back helps support the spine, and keeping the feet flat on the floor encourages better posture. Ensuring that work stations are ergonomically correct and taking frequent breaks to stand and stretch can also help ease sciatica pain.
Piriformis Stretch
Sometimes, a tight piriformis is the culprit behind sciatic nerve pain. The piriformis is a short, thin muscle that crosses over the sciatic nerve in the buttocks region. According to "Evaluation, Treatment, and Prevention of Musculoskeletal Disorders" by H. Duane Saunders, an overly tight or spasming piriformis can put pressure on the sciatic nerve and lead to pain. Regular stretching of this muscle via hip flexion and internal rotation may help.
Exercises
According to the University of Maryland Medical Center, exercises are a part of a physical therapy program for sciatica. Exercises that extend the lower back are often recommended, especially for those patients with suspected disk bulges who experience pain when they bend forward. Also, spine stabilization exercises like pelvic tilts, bridging and quadruped progressions strengthen the core and may help prevent recurrence of sciatic pain. Stretching tight muscles that affect the spine, such as the hip flexors and back extensors, is also indicated.
Manual Therapy
Manual therapy often plays a large role in physiotherapy treatment for sciatica. Joint mobilizations can both help ease pain and restore normal range of motion to the spine. Muscle energy techniques to realign the sacroiliac joint may also prove beneficial, especially if the piriformis is involved.
References
- NPR: Physical Therapy and Back Pain
- University of Maryland Medical Center: Back Pain and Sciatica
- "Evaluation, Treatment, and Prevention of Musculoskeletal Disoders (Volume 1: The Spine)"; H. Duane Saunders; 2004
- "Textbook of Disorders and Injuries of the Musculoskeletal System"; Robert B. Salter; 1999
