Management of Sciatica with physiotherapy

Have you been suffering in silence? You don’t know what is causing that nagging lower back pain and the pins and needles feeling all around at the back of your thigh, medial side of your hips and in the calf muscles? Well, it could be Sciatica.

Usually sciatica causes sharp and shooting pain in the lower back region and at the back of the thigh. But at times, there is mild to moderate pain limiting only in the low back region. Also at times, the radiating pain might only be felt in the medial or lateral side of the hips. If more nerve roots are involved then the radiating pain is felt at the back of the thigh and in the calf muscles and also in the shin area of the leg and to the base of the big toe of the foot.

Causes of sciatica-

1. Disc bulge- if there is disc bulge in the lumbar region or the upper sacrum region, then this might compress nerve roots which causes sharp and shooting pain in the region of their supply.
2. Osteoarthritis- often osteoarthritis leads to osteophyte formation that is formation of spikes at the edges of the bones which presses the nerve roots causing numbness, pain and pin and needles feeling in the region of the supply of the nerve root.
3. Spinal stenosis- narrowing of the area of the spinal cord through which the nerve comes out might lead to compression of the nerves, causing pain throughout their supply region.
4. Spondylolisthesis- This is a condition in which one of the vertebrae moves forward than the above vertebra hence causing the compression of the nerves and leading to pain, numbness, pins and needles feeling in the area of their supply.
5. External trauma or injury to spines

Symptoms- Sharp and shooting pain in the lower back region, in the medial side of the hip plus the back of the thigh, calf muscles, the shin area of the leg and at times the big toe as well. There is numbness, pins and needles feeling in the leg and at times certain muscle groups also become very weak.

Physiotherapy management- if the pain doesn’t go away with analgesics or rest, then physiotherapy treatment is started.

1. Hot and cold packs- The patient is advised to apply hot and cold packs simultaneously for 15 minutes at the lower back region, since hot and cold packs increase the blood flow at the site of their application it reduces the pain and swelling to a great extent as it contains natural healers and pain relievers.
2. I.f.t- interferential therapy is given to the patient at the lower back region to reduce the pain and swelling. Interferential therapy involves two medium frequency currents which intersect when placed diagonally at a point producing a low frequency current which penetrates deeply beneath the skin increasing the blood flow at the site of injury leading to healing and reduction of pain.
3. Transcutaneous electrical nerve stimulation is given to the patient in the radiating area of the pain starting from the lower back region to the calf muscles. This leads to reduction in pain and also reduction in the feeling of pins and needles and hence regenerating the nerves.
4. Ultrasonic therapy is also given to the patient to reduce pain and swelling at the lower back region and also to reduce the feeling of pins and needles at certain areas.
5. stretching of all the muscle groups involved in sciatica is a must in the physiotherapy treatment. Stretching of hip muscles,hamstring muscles, calf muscles is a must to relieve pain. Piriformis muscle is also stretched to prevent piriformis syndrome.
6. Strengthening of core muscles start only when the pain has subsided to a great extent. The pelvic bridging exercise, abdominal isometric, back extension exercise, cat and camel exercises, butt squeezing exercises i.e, kiegels exercise are advised to the patient to increase the strength of the core muscles.