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A Physical Therapy Guide to Sciatica (Lumbar Radiculopathy)

Introduction

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.

For most cases of sciatica, conservative treatment is effective.1 Physical therapy interventions surrounding exercise and education tend to yield the best long-term results.

Table of Contents

Understanding Sciatica and Lumbar Radiculopathy

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 symptoms of sciatica.

Lumbar radiculopathy is a more technical term that refers to nerve compression in the lower back between nerve roots L1 and L5/S1 causing 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.2

Overall, these terms are often used synonymously. Lumbar radiculopathy is just simply attributed to a specific underlying cause, whereas sciatica can have many different causes.

Symptoms of Sciatica

The most common symptom of sciatica is pain that radiates from the low back or buttock down into the leg. This pain is often described as sharp, shooting, or searing. Other 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, couching, 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!)

All of these symptoms will occur in a relatively predictable manner along the pathway of affected nerve roots, most often between L4/L5 and L5/S1.

Causes of Lumbar Radiculopathy (Sciatica)

There are many potential causes of sciatic nerve compression or irritation. Some common causes include:

Diagnosing Sciatica

A physical therapist will perform a comprehensive physical examination to help diagnose the cause of your symptoms. 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
  • Reflexes
  • 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. 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, typically imaging is not necessary and can even be detrimental.3

What to Expect from Physical Therapy Treatment of Sciatica

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 interventions for sciatica include:

  • Education: Back pain caused by sciatica is often associated with fear-avoidance behaviors.4 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 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.
  • Manual therapy: Interventions such as soft tissue massage, joint mobilization, and nerve gliding techniques can be very effective in reducing pain short term.5 If needed, this form of treatment is best when combined with both exercise and education.
  • Modalities: Your physical therapist may also use modalities to help reduce pain and inflammation acutely and allow better tolerance for long-term treatment strategies. Common modalities used for sciatica include heat, ice, traction, electrical stimulation, and ultrasound.

What If Conservative Care Doesn't Work?

In most instances, sciatica resolves on its own making conservative care the best choice. However, if your symptoms are severe you can discuss the next steps with your physical therapist and orthopedic surgeon. Typically, surgery is reserved for those that had positive (but short-lived) results with an epidural or are experiencing severe neurological symptoms.

Regardless of 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.

How to Prevent Sciatica

There are a few things you can do regularly to help prevent sciatica or relieve symptoms:

  • 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 better support the spine with less strain.
  • Take frequent breaks: If you have a hobby or occupation the 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.
  • 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, 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.

Is It Time for Treatment?

Physical therapy for sciatica is all about reducing pain while regaining function. This is best done by actively participating in the recovery process with a high-quality medical provider.

Ready to say goodbye to sciatica pain and other symptoms?

Book an appointment with one of your 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.

References


  1. Yang S, Kim W, Kong HH, Do KH, Choi KH. Epidural steroid injection versus conservative treatment for patients with lumbosacral radicular pain: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020 Jul 24;99(30):e21283. doi: 10.1097/MD.0000000000021283. PMID: 32791709; PMCID: PMC7386972.
  2. 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
  3. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.
  4. Dupeyrona A, Ribinik P, Gelisc A, Clausef D, Herissong C, Coudeyreef E. Education in the management of low back pain. Literature review and recall of key recommendations for practice. Annals of Physical and Rehabilitation Medicine Volume 54, Issue 5, July 2011, Pages 319-335. https://doi.org/10.1016/j.rehab.2011.06.001
  5. Physiopedia. Sciatica. Physiopedia.com. Accessed July 3, 2022. https://www.physio-pedia.com/Sciatica#cite_note-p2-11