Physical Therapy to Relieve Sciatica

Your spine doctor may refer you to a physical therapist as part of your multidisciplinary sciatica treatment plan. Physical therapy (PT) typically involves passive and active therapies. Passive PT refers to treatments (eg, heat/cold packs) administered by the physical therapist and active PT requires your “active” participation (eg, therapeutic exercise).

Why is physical therapy beneficial for people with sciatica?

Because it can help reduce inflammation and pain, improve physical function, and prevent recurrence of sciatica symptoms. Plus, your physical therapy program may teach you how to improve your posture and often includes a home exercise program for long-term improved physical health.

passive physical therapy knee to chest stretchPassive physical therapy may include therapeutic exercise movements to increase range of motion. Photo Source: 123RF.com.

Physical Therapy for Sciatica: What to Expect

During your first PT appointment, the therapist reviews your medical history, lifestyle habits, and asks you questions about your sciatica experience. He/she may ask when sciatica started, if an injury or specific event triggered sciatic symptoms, and inquire about your activity level before low back and leg pain developed.

Next, your physical therapist may ask you to perform a series of simple movements to evaluate your range of motion, posture, reflexes and movement ability. You may be asked to bend side-to-side, flex forward at the waist, extend backward, or twist at the waist. The therapist observes you walking too. This part of your exam provides your therapist with a baseline assessment of your current condition and how sciatica affects your physical functional ability to perform activities of daily life.

Then your physical therapist combines what he/she learned from your evaluation and crafts an organized PT program for you. Your passive and active therapy program is designed to include realistic goals you want to reach. As back and leg pain subsides and becomes more manageable, your therapy plan may be adjusted to include different types of stretches and exercises.

Like many treatment options, physical therapy is not a quick fix and may require several weeks to achieve the desired results. Your treatment plan will likely include a mix of clinic visits with your physical therapist in addition to an at-home exercise regimen.

  • What should I wear to PT? Because physical therapy involves passive and active therapies, you should wear comfortable clothing to your treatment sessions. If you’re unsure what to wear or bring to PT, call the provider beforehand for a recommendation.

How Passive Physical Therapy Reduces Sciatica

The goal of passive physical therapy is to gently relieve painful soft tissue tension by relaxing your body, thereby preparing your body for active therapies that promote strength, flexibility, and long-term pain prevention. Your individualized passive PT plan may include some of the treatments below.

Deep tissue massage
Deep tissue massage targets specific spinal muscles and fascia (muscular connective tissue) in the lumbar spine (low back), hips and buttocks that may be compressing the sciatic nerve and/or nerves that branch off from the sciatic nerve. The therapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles).

deep tissue massage, gluteal area of the buttockDeep tissue massage may involve application of direct pressure to a muscle group to release tension and pain. Photo Source: 123RF.com.

Hot and cold therapies
Using heat, the physical therapist seeks to get more blood to the target area—more blood flow brings more oxygen and nutrients to that area. For example, a heat pack placed on your piriformis muscle may help reduce muscle spasms that could be causing your sciatica. On the other hand, cold therapy slows circulation, helping reduce inflammation, muscle spasms, and pain. Your physical therapist will alternate between hot and cold therapies to get the greatest benefit from each.

TENS (transcutaneous electrical nerve stimulation)
TENS is enabled by a machine that stimulates your muscles through variable (but safe) intensities of electrical current. TENS helps reduce muscle spasms, and it may increase your body's production of endorphins—your body’s natural painkillers. You could even use this at home if your therapist thinks it's necessary. The TENS equipment your physical therapist uses is larger than the "at-home" use machine. However, whether large or small, a TENS unit can be a helpful therapy.

Ultrasound
Ultrasound generates sound waves that travel deep into your muscle tissues and creates gentle heat that enhances circulation and helps speed healing. Increased circulation helps reduce muscle spasms, cramping, swelling, stiffness, and pain.

Active Physical Therapies to Ease Sciatica

In the active part of physical therapy, your therapist teaches you various therapeutic stretches and exercises designed to improve flexibility and muscle strength. Your PT program is individualized, taking into consideration your health and history. It may include aerobic conditioning, strengthening exercises, and movements to increase flexibility and range of motion.

As anyone with sciatica knows, having debilitating nerve pain in your low back and legs makes exercise less appealing. However, strong muscles are a strong defense against pain. In truth, some strenuous exercise can put a lot of stress on your spine when done improperly. Fortunately, active therapies aren’t intended to push you to the limit; rather, your physical therapist will teach you gentle exercises to condition your spine and core (abdominals).

Hydrotherapy is a type of gentle exercise your PT may recommend as part of your sciatica management plan. Hydrotherapy uses the gentle resistance of water to build and tone muscle—and many people who find weight-bearing exercise on land painful have great success with this form of activity. Water aerobics and swimming are types of hydrotherapy.

In addition to gentle exercises to help strengthen your core, low back, and legs, your physical therapist may help you learn how to correct your posture and incorporate ergonomic principles into your everyday activities to better protect your spine. These simple changes in daily movement will go a long way toward preventing future episodes of sciatica.

Updated on: 08/07/19
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