Physical Therapy Exercises for Sciatica

Common Causes of Sciatica

Sciatica is the experience of pain in the low back that spreads down the distribution of the sciatic nerve, from the buttock down the back side of the thigh into the calf. Sciatica can be caused by  compression of the nerve or irritation along the path of the nerve, which can cause pain, numbness, and/or altered sensation down the nerve. Although it is more common for sciatica to affect one leg, it can occur in both at the same time. If someone has sciatica symptoms for two months or less it is considered acute sciatica while chronic sciatica lasts three months or more. When sciatic nerve pain lingers on for months to years, it is more difficult to treat and can result in permanent nerve damage, numbness, and weakness in the leg. 

The leading cause of sciatica is believed to be disc herniation, where part of the disc between two spinal segments pushes onto the nerve. Other causes of sciatica include foraminal stenosis, degenerative disc disease (DDD), a piriformis muscle spasm, and spondylolisthesis. Foraminal stenosis creates a narrowing of the gap where the nerves leave the spine, putting pressure on the sciatic nerve. Degenerative disc disease (DDD) results in the spinal discs shrinking and causes compression on the root of the sciatic nerve. The nerve can be compressed by the piriformis muscle as it travels directly under the muscle. Spondylolisthesis occurs when a spinal segment is shifted forward with respect to the vertebrae beneath it, which can also pinch the sciatic nerve. Although this list of causes sounds intimidating, the good news is that prescriptive exercise and manual therapy can typically improve sciatica of all causes!

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Exercises to Treat Sciatica

Sciatica can be debilitating for anyone who has to endure it. The goal of physical therapy for sciatica is to reduce pressure on the nerve and to eliminate pain and numbness in the legs. Your physical therapist will guide you in movements to create more blood flow, space, and mobility of neural structures, which will decrease irritation in the spine. This movement needs to be repeated until the patient no longer feels numbness or pain in their leg. Over time, these movements will increase the space for the nerve, allowing the return of normal movement without causing symptoms in the legs!

Other physical therapy interventions and graded exercises focus on increasing abdominal and gluteal muscle strength and improving flexibility in tight muscles surrounding the low back. The gluteal and abdominal muscles help to support the lower body and the low back during normal movement and tasks. Maintaining good flexibility of the hamstrings, piriformis, hip flexors and calves can be very helpful to maintain good movement to alleviate lower back and sciatic pain.

How A Physical Therapist Can Help Your Sciatica

You may be wondering if physical therapy will help relieve your back and leg pain or if surgery is your only option. Physical therapy is one of the best treatments for sciatica because you will be working on correcting the original cause of your sciatica, without the risks that accompany surgery. Physical therapists are trained in recognizing the source of sciatica and training their patients on how to move without pain. Physical therapy for sciatica involves exercises, education on safe movements, ways to modify activities that allow low back pain to improve, and strategies for preventing the return of sciatica. Between modifying your movements to stop your leg pain, completing specific exercises customized to you, and making progress with the mobility in your spine over time, your sciatica should go away. The best part of physical therapy for sciatica is that you will have tools to use in the future if your leg pain does come back.

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