Sciatica is one of the most familiar terms used to describe pain radiating into the leg from the back. Often painful and debilitating, sciatica may also cause numbness, tingling or weakness. Most cases of sciatica are the result of cumulative stress on the spine over an extended period of time – not an isolated incident. The good news is that sciatica can often be alleviated with proper conservative care without the need for surgery.
Leg symptoms associated with sciatica are due to impaired function of one or more nerves exiting the low back. Direct mechanical pressure and inflammation from a herniated disc is the most common cause. Other common causes include spinal stenosis, narrowing of the nerve openings; spondylolisthesis, slipping of one vertebrae on another; and trauma to the nerve or related tissues.
The duration of sciatica can vary considerably based on many factors: the severity of spine degeneration, the severity and number of disc herniations, inflammation affecting the nerves and overall health. These factors also affect the progression of recovery.
The tissues of the back need a good environment in which to heal – an effective treatment program must address posture, flexibility, stability and lifestyle.
In the physical therapy practice, we often find that the most important factor in recovery is a person’s willingness to adopt a healthier lifestyle, which may include achieving proper posture, modifying activities and performing prescribed exercises.
“Jane” came into my office with moderately severe low back and right leg pain that started three weeks earlier for no apparent reason. She reported that her symptoms were almost constant, worse in the morning, aggravated by sitting and standing for extended periods and improved when walking.
She also said that bending and lifting activities provoked the back and leg pain. The pattern of Jane’s symptoms suggested a mechanical problem (with pain provoked by movement) and an inflammatory problem. Increased pain or symptoms in the morning out of bed often indicates greater levels of inflammation.
The initial interview was useful in determining whether Jane was sensitive to certain positions, weight on the spine, repetitive activities, direct pressures or a combination of these. She was sensitive to positions where the back is rounded, or flexion-position sensitive, and prolonged positions, also known as static-sensitive. Because we know that the flexed position is inherently harmful to the discs, joints and ligaments of the spine, treatment will include more dynamic activities that avoid this position, such as walking.
On initial examination, Jane had a stiff right hip joint, a mild shift of the right pelvic bone, spasm of the right hip muscles and tenderness of the low back and pelvic ligaments. Weakness of the deep-spine muscles and instability of the vertebrae in the low back were also observed.
Initial treatment is intended to affect the mechanical restrictions, improving back and nerve function while also trying to reduce the inflammation. Healing of the disc often comes from positive mechanical stress, not necessarily rest.
Jane’s treatments consisted of posture education, mobilizing the pelvic and hip joints, stretching the tight and guarded hip muscles, releasing the soft-tissue spasms, spine coordination and strengthening exercises and ice for the inflammation.
In addition to treatment in the office, Jane received instruction for home exercises and self-treatment techniques that correspond with clinic activities.
Jane’s sciatica resolved in eight weeks and she is now exercising three to four times each week and taking more frequent breaks from sitting.
If she had not improved in a timely fashion, follow-up with the referring physician would have been indicated – adjustments in the components of medical care can facilitate the therapy process.
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