Sciatica is a syndrome that causes radiating leg pain, nerve sensations and even numbness anywhere along the distribution of the sciatic nerve.
For patients it’s a very uncomfortable condition and can even cause pain and tightness into the buttocks, and lower-mid back. Sciatica can make it difficult to sit, sleep and do all kinds of activities, which is why some kind of treatment is necessary.
What are effective physical therapy treatments for sciatica?
When determining effectiveness of sciatica treatments, one step you could take is to look at the evidence base for practice, specifically systematic reviews because they look at the effectiveness of a wide range of treatments and provide you with faster answers.
Doing a search on PubMed for “Physical Therapy Sciatica systematic review” results in a few interesting studies:
- Clinical effectiveness of management strategies
- Advice to stay active or not
- A review of piriformis syndrome as a possible cause of sciatica
- Neurostimulation as treatment
- Cost effectiveness of different management strategies
- Risk factors for first time sciatica incidences
As you can see, there is no doubt a lot you could gather from reading all those studies. Right now, let’s take a brief look at the first two, as these are the most recent ones.
Clinical effectiveness of management strategies
Out of 122 studies evaluated, 90 of those being randomized control trials, the findings show the following treatments are effective:
- Nonopioid medication
- Epidural injections
- Disc surgery
- Spinal manipulation
- Anti-inflammatory biological agents
Interestingly, in this review, the following show no evidence of effectiveness:
- Opioid analgesia
- Bed rest
- Exercise therapy
- Education/advice (when used alone)
- Percutaneous discectomy
Advice to stay active or not
This review shows that exercise provides benefits for leg pain reduction over no activity, by about 11%. Though, over the long term, these results appear to be less significant.
Looking at this evidence you could say, why bother with physical therapy for sciatica because there’s not much to support its effectiveness. However, there’s always more to the picture. Evidence is just one piece of the puzzle so often you do have to dig deeper.
As you can see above, spinal manipulation is effective, and this does not necessarily refer to chiropractic adjustments, because manipulation can be by way of soft tissue manipulation, core exercises and postural adjustments.
What is causing the sciatica?
Firstly, while true cases of sciatica are caused by disc herniation, many patients don’t have true sciatica. For many, it may be muscular tightness or skeletal imbalances, which of course, can be treated effectively with physical therapy treatment.
As a physical therapist, you can assist in diagnosis of whether it is true sciatica or one of the more common causes.
Pain science states these causes, in line of importance, are:
- Muscle knots/ spasms – in the low back and glutes
- Piriformis impingement
- Anatomical variations
- Herniated discs
- Hamstring syndrome/ impingement
As you can see, three of these causes can be directly influenced by a range of physical therapy treatments, including:
- Soft tissue manipulation
- Dry needling
- Active muscle release
- Trigger point therapy
- Heat and vibration
- Gentle nerve stretching
- Piriformis stretching
- Mobilization of the hips
- Postural improvements
- Core strength and stability
Physical Therapy Stretches and Strategies for Sciatica
3 effective stretches
1 minute stretch routine
Medically proven stretches for true herniated discs, pinched nerves and sciatica
Physiotherapist Tim Keely demonstrates his whole process of treatment for true disc bulge