Physical Therapy for Sciatica
What is sciatica?
Sciatica is an umbrella term for pain that radiates (travels) from the lower back and down your leg. The more appropriate way of referring to this is lumbar radiculopathy or sciatic-like pain / sciatic-like symptoms.
What are common sciatica symptoms?
Common sciatic nerve pain symptoms include pain, numbness, and/or tingling that radiates down the leg. Symptoms are typically worse in the morning when waking up. Symptoms are also typically worse with prolonged sitting (at work, on the toilet, etc). Excessive forward bending is typically worse in the acute stage when there is disc-related pain.
How do we diagnose sciatica?
These are the clinical findings that our physical therapists use to diagnose sciatica:
Mid-back and/or low back pain with associated radiating pain in the involved lower extremity
Symptoms are reproduced or aggravated with spinal mobility testing, lower limb tension, straight leg raise, and/or slump tests
Potential signs of nerve root involvement (sensory, strength, or reflex deficits) in the involved lower extremity
The patient may report paresthesias (tingling, “pins and needles”), numbness, and/or weakness in the legs
Why does sciatica happen?
According to this research article, Sciatica occurs when there is a compression or irritation of the nerve roots in the lower back. It can be caused by a lumbar disc herniation, degenerative changes in the spine, and narrowing of the foramen (space) where the nerves exit the spine.
This compression or irritation of a spinal nerve creates nerve signals that are perceived as pain, numbness, and tingling along the nerve distribution in the leg.
Nerve Root Compression
Can physical therapy treatment help with sciatic nerve pain?
Physical therapy can help with sciatic nerve pain.
Treatment for sciatica typically includes:
Patient education in positions that reduce strain or compression to the involved nerve root(s) or nerves
Sleeping positions, pillow placements to maintain a neutral spine, etc.
Manual or mechanical traction
These are techniques that create separation in the spinal joints to decompress the nerve roots
Manual therapy to improve mobility of the joints, muscle, and nerves surrounding the affected nerve
Nerve mobility exercises to improve the mobility of the sheath that surrounds the nerves
These should be performed in a pain-free and non–symptom-provoking range of motion
Therapeutic exercises to build strength and endurance in muscles that stabilize the spine
Gluteus maximus
Gluteus medius
Transverse abdominis
Multifidi
Abdominals
Patient education pain management strategies
How long does sciatica take to heal?
This can vary depending on the person's history of low back pain, chronicity of your symptoms, degree of the injury itself, etc. The literature also states that those with a negative attitude or outlook about their injury may have a worse prognosis. Therefore, our therapists make sure to educate you about coping strategies that help you realize that you have control over this.
The literature also suggests that it’s important not to be fear-avoidant - this means that you should do all the things that you can do that aren’t producing pain. Sometimes patients become too fearful of movement and the brain starts to learn that movement isn’t safe (we call this kinesiophobia). As a result, you don’t try things that otherwise would have felt just fine to do. We don’t want your brain to learn that because unlearning that is a challenge. As evidenced by this study, kinesiogphobia is a major predictor of chronic low back pain, and we don’t want your acute symptoms to become chronic due to emotional and/or cognitive factors.
Best Exercises for Sciatica Pain
Some of the best exercises for sciatica pain include repeated motions into a directional preference (if one exists), general, pain-free movement of the spine and pelvis, breathing exercises, and core and hip muscular recruitment to provide a sense of stability around the spine.
Below are some of the exercises that we typically start with. Our therapists progress these exercises as our clients’ symptoms improve.
Lumber Extension Repeats Variations
Quadruped Pelvic Tilts
Lower Trunk Rotations
Isometric Deadbug
Tall Kneeling Hip Hinge
Best Sciatica Stretches | Sciatic Nerve Glides
Ankle Plantar Flexion / Dorsiflexion on Pillow
Supine Sciatic Nerve Glide & Tensioners
Advanced Sciatic Nerve Glides (Tensioners)
Exercises to avoid with sciatica
In the more irritable stages of sciatica, you’ll want to temporarily avoid exercises and activities that involve stretching the hamstring and calf with a flexed hip. Examples of these activities include bending down with stiff knees and high kicks.
Exercises to avoid and their modifications include:
Barbell deadlift
Temporary modification: trap bar deadlift
Romanian deadlift
Temporary modification: hamstring curl
Straight leg raise
Temporary modification: seated knee extension
Downward dog
Temporary modification: standing calf stretch or forward plank
How to ease sciatic nerve pain at home
You can ease sciatic nerve pain at home by changing positions often throughout the day. Avoiding prolonged sitting to the best of your ability in the early stages. Our therapists recommend going for daily walks provided you are tolerant of walking.
According to the literature, staying active is one of the best ways to facilitate long-term healing in those who are experiencing sciatic nerve pain.
You can also rely on ice/cold packs, menthol creams, over the counter lidocaine patches, and transcutaneous electrical nerve stimulation (TENS) for some temporary relief of symptoms. This won’t facilitate healing, but it will alleviate your symptoms and allow you to remain more functional as things heal
How to Sleep with Sciatica
If you are having difficulty sleeping with sciatica, you should try sleeping with a pillow between your knees (if you are a side sleeper). If that is still not tolerated well, then we often recommend that our patients sleep on their back with 1-2 pillows under their knees. This position allows the knees to remain bent, which places tissue slack on the hamstrings and sciatic nerve. That is most likely to alleviate symptoms. You can also consider over the counter or prescription antiinflammatory medication at night, as prescribed by your medical doctor.
How to prevent sciatica
Preventing sciatica is multi-faceted, and includes working on nerve mobility, hip flexibility and mobility, and hip and core strength. We also encourage our clients with sciatica to prioritize their overall health, including their stress adaptability, sleep optimization, and a minimally processed diet.
Closing Remarks
If you are experiencing sciatic-like nerve pain and would like to consult us, please contact us below to speak with a physical therapist.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioner. Please consult with a trusted provider.
Dr. Paul Nasri PT, DPT, OCS, COMT
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy