Sciatica

Sciatica refers to pain radiating along the sciatic nerve path, from the lower back through the hips and buttocks down the leg. Our physiotherapists use specific techniques to address nerve irritation and restore normal function.

Understanding Sciatica

Common Causes

• Disc Herniation: Most common cause (90%)
• Spinal Stenosis: Narrowing of spinal canal
• Piriformis Syndrome: Muscle compression of nerve
• Spondylolisthesis: Vertebral slippage
• Pregnancy: Mechanical and hormonal factors

Nerve Path

The sciatic nerve:

• Originates from L4-S3 nerve roots
• Largest nerve in the body
• Runs through buttock and down leg
• Branches at knee level
• Can be compressed at multiple sites

Symptoms

Pain Characteristics

• Sharp, burning, or shooting pain
• Typically one-sided
• Worse with sitting
• Pain following nerve path
• Variable intensity
• May worsen with coughing/sneezing

Neurological Signs

• Numbness: Loss of sensation
• Tingling: Pins and needles
• Weakness: Muscle power loss
• Reflex Changes: Reduced reflexes

Red Flags

Seek immediate medical attention for:

• Bowel/bladder dysfunction
• Bilateral symptoms
• Progressive weakness
• Severe neurological deficits
• Saddle anaesthesia

Assessment

Clinical Examination

• Straight Leg Raise: Neural tension test
• Slump Test: Neural mobility assessment
• Neurological Testing: Reflexes, power, sensation
• Lumbar Spine Assessment: Movement and palpation
• Functional Testing: Walking, sitting, bending

Diagnostic Approach

• Clinical diagnosis usually sufficient
• Imaging when red flags present
• MRI for surgical planning
• Correlation of symptoms with findings

Treatment Approach

Phase 1: Acute Management

• Pain Relief: Positioning and support
• Gentle Movement: Avoiding bed rest
• Neural Mobilization: Gentle techniques
• Activity Modification: Avoiding aggravators
• Education: Understanding condition

Phase 2: Recovery

• Progressive Exercises: Gradual loading
• Manual Therapy: Joint and soft tissue work
• Neural Gliding: Restore nerve mobility
• Core Activation: Stability training
• Posture Correction: Reducing nerve stress

Phase 3: Rehabilitation

• Strengthening: Core and lower limb
• Flexibility: Targeted stretching
• Functional Training: Return to activities
• Prevention Strategies: Long-term management

Treatment Techniques

Manual Therapy

• Lumbar mobilization
• Soft tissue release
• Hip joint techniques
• Sacroiliac treatment
• Thoracic manipulation

Neural Mobilization

• Sciatic nerve gliding
• Nerve tensioning techniques
• Progressive neural stretching
• Slump mobilization
• Straight leg raise progression

Exercise Therapy

• McKenzie Exercises: Directional preference
• Core Stabilization: Deep muscle training
• Hip Strengthening: Gluteal exercises
• Flexibility Work: Hamstring and hip flexors
• Aerobic Exercise: Walking program

Specific Conditions

Disc-Related Sciatica

• Directional preference exercises
• Avoiding flexion initially
• Progressive loading
• Postural education
• Long-term spine care

Piriformis Syndrome

• Piriformis stretching
• Hip mobilization
• Gluteal strengthening
• Running technique analysis
• Activity modification

Pregnancy-Related Sciatica

• Safe positioning techniques
• Modified exercises
• Support belts if appropriate
• Gentle manual therapy
• Post-natal follow-up

Self-Management

Pain Relief Strategies

• Ice for acute pain
• Heat for muscle tension
• Optimal sleeping positions
• Gentle movement
• Stress management

Exercises

• Knee to chest stretches
• Piriformis stretching
• Neural glides
• Walking program
• Core exercises

Activity Guidelines

• Avoid prolonged sitting
• Regular position changes
• Proper lifting techniques
• Gradual return to activities
• Maintain general fitness

Recovery Timeline

Typical Progress

• Week 1-2: Initial pain reduction
• Week 2-4: Improved function
• Week 4-8: Strength building
• Week 8-12: Return to activities
• 3+ months: Full recovery

Factors Affecting Recovery

• Severity of nerve compression
• Duration of symptoms
• Age and general health
• Compliance with treatment
• Underlying pathology

Prevention

Risk Factor Modification

• Core strengthening program
• Flexibility maintenance
• Weight management
• Posture awareness
• Ergonomic optimization

Long-Term Management

• Regular exercise program
• Periodic physiotherapy review
• Early intervention for flare-ups
• Lifestyle modifications
• Stress management

When Surgery May Be Considered

• Failed conservative treatment (3-6 months)
• Progressive neurological deficit
• Severe, disabling pain
• Cauda equina syndrome
• Patient preference with persistent symptoms