A Guide Physical Therapy for Sciatica (Lumbar Radiculopathy)
Sciatica, the most common form of lumbar radiculopathy, is a condition that can cause leg pain, numbness, tingling, and weakness. This guide will provide an overview of symptoms, causes, and physical therapy treatment for sciatica.
Sciatica, not to be confused with generalized low back pain, is more prevalent in individuals with poor health due to comorbidities, sedentary lifestyles, and mental health issues.1
For most cases of sciatica, conservative treatment is effective.2 Physical therapy interventions including both exercise and education tend to yield the best long-term results. Thus, working with a CityPT physical therapist is one of your best choices for pain relief and recovery.
- Understanding Sciatica
- Sciatica Symptoms
- Causes of Lumbar Radiculopathy (Sciatica)
- Diagnosing Sciatica
- What to Expect from Physical Therapy for Sciatica
- What If Conservative Care Doesn't Work?
- How to Prevent Sciatica
- Is It Time for Treatment?
Sciatica is a common term for radiating leg pain. The sciatic nerve is the largest and longest nerve in the body. It originates in the lower back and runs down the back of each leg into subsequent branches. When this nerve is compressed or irritated, it can cause sciatica symptoms.
Lumbar radiculopathy is a more technical term that refers to nerve compression in the lower back — between nerve roots L1 and L5/S1 — causing sciatica pain down the leg. Symptoms are significantly more common at L5, the lowest nerve root of the low back where part of the sciatic nerve originates. Thus, sciatica and lumbar radiculopathy are often used synonymously.3
The most common symptom of sciatica is pain that radiates from the low back or buttock down into the leg. This sciatica pain is often described as sharp, searing, or shooting pain. Other sciatica symptoms may include:
- Numbness, tingling, or changes in hot/cold detection in the leg
- Muscular weakness
- Discoordination with gait (walking) and general balance
- Impaired reflexes
- Morning stiffness and pain
- Trouble tolerating any posture for an extended amount of time
- Postural changes due to pain avoidance
- Increased pain with sneezing, coughing, or reaching
- Changes in bowel or bladder control, such as loss of control, urine retention, or numbness in the saddle region (Seek medical attention immediately if these symptoms onset suddenly!)
These symptoms will occur relatively predictable along the pathway of affected nerve roots, most often between L4/L5 and L5/S1.
There are many potential causes of sciatic nerve compression or irritation. Some common causes include:
- Herniated disc
- Degenerative disc disease (DDD)
- Bone spurs
- Spinal stenosis
- Piriformis syndrome
- Inflammation (often from an injury, chronic disease, and/or poor general health)
- Overstretching of neural tissue (from an injury or chronically poor posture)
A physical therapist will perform a comprehensive physical examination to help diagnose the cause of your symptoms and make treating sciatic pain more effective. This examination will assess:
- Medical history and lifestyle
- Current symptoms and what affects them (sitting, lying, standing, etc.)
- Neurological status
- Spine range of motion and tissue extensibility
- Muscle strength and endurance
- Balance and coordination
- How symptoms are affecting daily activities
- Assessing personalized goals for recovery
- Special tests to rule out other causes of low back pain
If needed, your physical therapist can refer you to a physician for further diagnostic imaging and tests to determine the likelihood of a herniated disc, bone spur, or other tissue dysfunction. These might include an MRI, CT scan, X-ray, or blood panel. Unless symptoms are severe or more information is needed to determine the cause of sciatica, imaging is typically unnecessary and can even be detrimental.4
The primary goals of physical therapy treatment for sciatica are to reduce pain, improve function, and prevent further injury. Depending on the severity of your symptoms and the underlying cause(s), your physical therapist will design an individualized treatment plan to help you achieve these goals.
Common sciatic physical therapy interventions include:
- Education: Back pain caused by sciatica is often associated with fear-avoidance behaviors.5 This makes education vital to understanding the cause of your pain and making forward progress with confidence. The ultimate goal is to help you recognize what needs to be done for short-term pain relief and long-term recovery and to prevent unnecessary aggravation in the future. This can also include factors like mental health and lifestyle habits to make treatments even more effective.
- Exercise: A comprehensive exercise program will be designed to achieve multiple goals. These might include reducing nerve pain, improving spine flexibility and range of motion, strengthening core muscles, and improving overall coordination and balance (see examples below).
- Manual therapy: Interventions such as soft tissue massage, joint mobilization, and nerve gliding techniques can effectively provide short-term pain relief.1 If needed, this treatment is best when combined with exercise and education.
- Modalities: Your physical therapist may also use modalities for acute inflammation and pain relief to allow better tolerance for long-term treatment strategies. Common modalities used for sciatica include a heating pad, ice pack, traction, electrical stimulation, and ultrasound.
Examples of Exercises for Sciatica
While it's best to get personalized guidance, let's review some basic exercises you can try if you can complete them without aggravating symptoms. If you feel pain with these exercises for sciatica, it's best to talk to your physical therapist before starting a formal exercise program.
- Pelvic tilt exercise: Lie on your back with your knees bent and feet flat on the floor for a starting position. Then, gently tighten the lower abdominal muscles (belly button toward your spine) as you practice rocking the pelvis back and forth (like you're tucking your tail, then sticking your butt out). Repeat 10 to 15 times for 2 to 3 sets. You can progress to sitting and standing over time. Your physical therapist will add progressive strengthening exercises for your core as appropriate.
- Hamstring stretch: Lying on your back with one knee bent and one straight (the affected leg), keep your leg straight as you gently pull it toward your chest. Stop when a stretch is felt in the back of the leg, being mindful not to elicit pain. Hold for 30+ seconds for 2 to 3 sets. You can also try a standing hamstring stretch if you can do so without pain. You can switch to the other leg to maximize your stretching routine, even if it doesn't have symptoms.
- Reclining pigeon pose: Also known as a figure 4 stretch for addressing tight and sore gluteal muscles. To stretch your right leg, lie on your back with your knees bent and bring the right ankle across to the left knee. Then, reach behind your left thigh and keep the upper body relaxed while you gently pull it toward your chest until you feel a stretch in your right butt. Hold for 30+ seconds for 2 to 3 sets, and don't forget to switch to the other leg.
- Prone press-ups: Lie on your stomach with your hands under your shoulders. Gently push your upper body away from the floor as you arch the back. Keep the entire body relaxed and hold for 60+ seconds. Start with a small range and assess how it affects your symptoms before progressing. If it is helping, try it several times throughout the day.
- Function exercises: It's most important to be able to complete your daily activities with adequate coordination and strength. What exercises can help you with this depends on your activity level and goals. Examples include squats, balance, reaching, and lunges. Get personalized recommendations from a CityPT physical therapist.
In most instances, sciatica resolves on its own — making conservative care like physical therapy the best choice. However, if your symptoms are severe and the pain persists, you can discuss the next steps with your physical therapist and orthopedic surgeon.
More invasive treatment options might include steroid injections or surgery. Typically, surgery is reserved for those with positive (but short-lived) results with an epidural or experiencing severe neurological symptoms.
Whether surgery is needed or not, physical therapy is a key part of recovery to restore balance to the spine and reduce the risk of future complications.
There are a few things you can do regularly to help prevent future injuries, prevent recurrences, or get sciatica pain relief during a flareup:
- Maintain good posture: Set up your desk, couch, bed, and other spaces to keep the spine out of end range positions — such as with reaching, twisting, sleeping, etc. This allows the local muscles to support the spine with less strain better.
- Take frequent breaks: If you have a hobby or occupation that requires awkward positions, such as a dentist, make sure to take frequent breaks. Take this time to stretch and rehydrate.
- Use proper body mechanics when lifting heavy objects: It's good to push yourself and move your spine in various positions often. However, take care to avoid excessively twisting your spine or stooping. Plus, keep the object as close to your body as possible. Most of all, recognize your strength limits. Talk to your CityPT physical therapist for personalized recommendations.
- Stay active and exercise regularly: This helps maintain a healthy weight and improve flexibility and muscle strength. The body is made to move — doing so will boost the health of neural tissues like the sciatic nerve.
- Make healthy lifestyle choices: Avoid smoking, eat a nutritious diet, get enough sleep, and effectively manage your stress and emotional connections of trauma, anxiety, depression, and low back pain. These all help to improve your overall health and spine health simultaneously.
Physical therapy for sciatica is all about reducing pain while regaining function. This is best done by actively participating in recovery with a high-quality medical provider.
Ready to say goodbye to sciatica pain and other symptoms? Our physical therapists can help.
Book an appointment with one of our orthopedic specialists at CityPT today!
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Physiopedia. Sciatica. Physiopedia.com. Accessed July 3, 2022. https://www.physio-pedia.com/Sciatica#cite_note-p2-11 ↩ ↩2
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Randall Wright MD, Steven B. Inbody MD, in Neurology Secrets (Fifth Edition), 2010 Radiculopathy and Degenerative Spine Disease. Accessed July 2, 2022. https://www.sciencedirect.com/topics/neuroscience/lumbar-nerves ↩
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