“Exercise is like cleaning your teeth. Exercise prevents problems.”

WHAT IS SCIATICA?

Sciatica is pain felt along the sciatic nerve. This is the longest nerve in the human body as it runs from the lower back down to the foot. Sciatica results from pinching or irritation of the nerve which can often come and go without needing to be addressed. When the pain begins to interfere with daily activities, a diagnosis is necessary to begin treatment. Diagnosing sciatica is usually quite simple, but identifying the source of the pain can be more difficult as the sciatic nerve interacts with such a large area of the body. In seeking out the source, an extensive investigation may be necessary.

WHAT CAUSES SCIATICA?

Sciatica is most common among 30 to 50-year-olds and can occur for a variety of reasons, (usually found in the lower spine), including bulging lumbar disc, spine degeneration, facet joint dysfunction, piriformis spasm. These can be caused by any mal-alignment in the body due to habitual poor postures, poor work ergonomics or trauma, (such as a car accident). The pain can feel like a dull ache or sharp, burning sensation that shoots down the buttock and back of the leg. It can also be associated with numbness, tingling and weakness.

HOW IS SCIATICA DIAGNOSED?

Long-term nerve compression can cause permanent damage to the nerve leading to altered function. Physiotherapists use a variety of methods to identify the source of sciatica. They may perform a physical examination of the entire body alignment, spine alignment and legs for muscle weakness, sensation deficits and altered reflexes, as well as inquire about your medical history including physical activities, injuries, bladder control, work tasks and weight fluctuations. If further investigation is needed, X-Rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) may be required.

TREATMENT

Treatment involves addressing the alignment and movement issues that are causing compression and irritation to the sciatic nerve.  This will involve:

1)   Manual Therapy – To free stiff joints, optimize joint function and alignment, release soft tissue restrictions, e.g. hamstrings, piriformis.
2)   Posture and movement Training – Teaching the patient to sit, stand, walk, bend, lift and move correctly in a way that balances forces on the entire body and reduces load on the lumbar spine and sciatic nerve
3)   Mechanical Traction – In cases of disc bulge or reduced space between two vertebrae from which the sciatic nerve emerges. Traction may reduce compression around the nerve. 
4)   Electrotherapy Machines – Such as ultrasound and interferential therapy reduce pain and inflammation
5)   Home exercise program – Specific strengthening exercises such as to abdominal and back muscles may need to be implemented to improve lower back stability as well as stretching to tight muscles contributing to the problem.

Physiotherapy treatment is implemented once the source of sciatica has been identified. Physiotherapists will work with the patient to restore flexibility, posture and strength to correct the source of sciatica, as well as prevent future occurrences. The physiotherapist will work with the patient towards reaching their personal physical goals. Once a patient can accomplish daily tasks pain-free the focus may switch to sports and leisure activities. If sciatica is persistent and intense after six months of conservative treatment, surgery may be considered. Some other treatment options include acupuncture, massage therapy and orthotics for excessively pronated feet.

PREVENTION

Sciatica may come and go. Usually, insufficient rehabilitation is cited as the reason. Proper diagnosis and rehabilitation are necessary to avoid any reoccurrence. Recurrences happen because the root cause and core strength deficits have not been addressed.  It is important to practice correct posture when walking, sitting and sleeping, as well as engaging in sports.  Paying attention to your posture while on the computer or watching TV is important as any prolonged slouching, turning of the head or body to one side in a rotated or side bent position for prolonged periods can be a recipe for sciatica.

By PHYSIONIQUE – Physiotherapy & Rehabilitation Centre, Singapore