SCIATICA.. HOW DO WE TREAT IT?

As discussed in part 1 there are numerous causes of sciatica, so if you missed part 1 you can read it HERE.

Part 2 of this blog will be discussing some of the treatment options that are available to help relieve sciatica. Remember these are only a guide and we always recommend you see your Physio for a thorough examination to ensure the exercises are appropriate for you.

Trigger Balls

Trigger Balls or foam rolling are both great tools to help provide short term pain relief. Our suggested focus areas would be the lower back, glutes and hamstrings. We always recommend these should include an active component to get the muscles moving. The reasoning behind the effectiveness of a trigger ball is still a bit of a mystery but studies have suggested that it can have a short term analgesic response. Reduction in pain may enable you to complete further exercises that will be effective in creating longer change.

Stretching and Mobility 

Light stretching and mobility can also be beneficial in providing short term relief. Stretching should be pain-free and gentle to begin with, again focusing on the lower back, glutes and hamstrings. In certain cases some stretching positions can actually further aggravate sciatica so if you are unsure make sure you check with your physio!  Mobility work should be about controlling movement of joints through pain-free range of motion. Avoiding positions that create pain should be paramount during these exercises.

Neural Gliding

Neural gliding is essentially a stretching exercise that focuses on ‘sliding the nerves’. We use the analogy of the nerve being a piece of string traveling from the base of the skull down the spine out into the leg and down too the foot (this is the route of the sciatic nerve). Along its path it crosses underneath, between and over certain muscles. In order to function efficiently this nerve slides freely along this path. Sometimes with Sciatica the neural pathway gets ‘stuck’ and this sliding mechanism is affected. A neural gliding exercises aims to restore the smooth sliding of the nerve along its path. These exercises are different to static stretches, should be pain free and form an important part of the rehabilitation for neural irritations that are causes by muscles and joints. Due to their ability to aggravate symptoms further we would recommend checking with your physio before you begin.

Strengthening

Re-estabilishing strength shoulder be the long term focus of treatment. It is vital to firstly figure out why the nerve is irritated. Not all lower back pain and sciatica comes from weak core and glutes so focusing only on these two common areas to strengthen may not be  the solution for everyone with Sciatica. Addressing other muscles like the hips flexors, hamstrings, obliques or lats may be what you require. 

Movement Patterns

Another treatment that is critical towards long term recovery is correcting movement patterns. Potentially the way you run, squat, deadlift and move in general might be contributing to your sciatica. If you get pain every time after you run, your running style may needs to be checked – and the same goes for other forms of exercise. People with chronic lower back pain or siactica also often pick up poor patterns as a response to long term pain so sometimes movement retraining is required. Most commonly individuals become very stiff in their back and develop fear avoidance patterns where never bend their back which will only contribute to further stiffness. Slow exposure to bending and moving the spine may be a way to get rid of this chronic irritation.  

Ultimately to treat sciatica there needs to be a diagnosis and from there a longer term management plan that addresses strengthening what is weak combines with mobilising what is stiff. This will be totally dependent on the individual and one should seek a health care provider’s advice.  There are cases where conservative intervention may fail and more invasive treatments may need to be explored.

If you have any questions about Sciatica, it’s management or any other physio related question feel free to email us activerxphysio@gmail.com or head to our instagram page and send us a message!