Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Sciatica Physical Therapy Guide

What Is Sciatica?

Sciatica is a painful condition that begins in the lower lumbar spine and radiates into the buttock and down the back of one leg. Sciatica is very common and typically occurs in approximately 1-6% of the adult population, it rarely develops before the age of 20 and becomes more likely in middle ages (30-40). Pain is caused by the irritation or compression of the sciatic nerve, which is the longest nerve in your body, starting at your pelvis and ending at your feet. The intensity of pain from sciatica can vary from infrequent and irritating to constant and incapacitating! Symptoms are typically based on the location of the nerve pinch. While this all sounds scary and debilitating, it is rare that permanent nerve damage will result, and typically gets better within a matter of weeks.

What Causes Sciatica?

Sciatica can be caused by a number of different conditions that irritate and compress the long sciatic nerve. These can include:

  • Herniated Disc: The gel like centre of a spinal disk can bulge or rupture through a weakened area. If the disc bulge protrudes far enough it can press on and compress the sciatic nerve.
  • Piriformis Syndrome: The sciatic nerve passes through the small piriformis muscle and if there is a pathology with the muscle such as a tightening or spasm, the sciatic nerve can be pinched, causing sciatica.
  • Trauma: A sports injury or heavy fall can result in a fracture of the spinal cord and damage muscles and nerves.
  • Spinal Stenosis: Narrowing of the bony canals of the spine can compress the spinal cord and associated nerves.
  • Osteoarthritis: As spinal discs naturally age they dry out and shrink. Small tears in the disc wall can be very painful, and result in bone spurs forming.
  • Spondylolisthesis: A weakness or stress fracture in the facet joints of the spinal segments can can allow a vertebra to slip out of position and pinch nerves.

What Are The Symptoms?

Typical sciatica pain starts in the lower back and buttocks, it affects one leg travelling down the back of the thigh, past the knee, and sometimes in to the calf and foot. The pain normally feels a lot worse in the leg than it does the back. Pain levels range from a mild ache to a severe shooting burning pain. Numbness or tingling such as pins and needles may occur in the leg or feet.

Sciatica Symptoms: 

  • Lower back, posterior thigh, calf and foot pain
  • Shooting and stabbing pains.
  • Numbness and pins and needles in the leg, calf and foot.
  • Foot drop (muscle weakness)
  • Sitting exacerbates pain.
  • Bending over to pick something up increases pain.

Red Flags

A “red flag” is the term given to the identification of dangerous or potentially dangerous findings during an objective examination. If a red flag is present during an examination, patients are usually referred to medical specialists for immediate assessment and treatment. When examining the lumbar spine there are many red flags to look out for, these include:

  • Previous history malignancy.
  • Unexplained weight loss
  • Recent infection
  • Saddle anaesthesia (numbness when wiping bottom)
  • Progressive spinal deformity
  • Urinary and faecal incontinence
  • Bilateral leg pain (both legs very painful symptoms)
  • Hyper-reflexia
  • Erectile Dysfunction

If you present with any of these symptoms you should seek medical assessment immediately.

What Are My Treatment Options?

The treatment options for lower back pain have been adapted over the last decade or so. The current treatment options stem from a large body of evidence demonstrating the benefit of early return to normal daily activities and early movement. The previous school of thought that prolonged bed rest would reduce pain showed no clinical benefits in any scientifically controlled rigorous studies. Thus the new saying “Movement is Medicine!” was coined. It is imperative that you stop doing the movements that caused the sciatic pain to begin with and avoid activities that agitate it further. This normally includes movements that involve bending down to pick something up from the floor, twisting  and reaching. Gentle movement away from the direction of pain coupled with walking is the best thing you can do. 

In many cases, sciatica will eventually solve itself, however more often than not, people require some basic treatment and advice, this can be found below.

Sciatica Cushion

If you are sitting for long extended periods of time on a hard chair, you may experience the pain in your back, buttock, legs and calves getting worse! This is because whilst sitting uncomfortably the lumbar spine is typically forced into flexion, stretching the sciatic nerve and making it more likely to get compressed. A great way to decrease this pain and uncomfortable feeling is to use a memory foam seat cushion. Our favourite cushion is available here!

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Sciatica Exercises

1) Lumbar Extensions

Early mobilisation of the lumbar spine is highly recommended in the management of lower back pain and sciatica. It is advised that the patient commences lumbar movements throughout the range of motion within comfortable limits as soon as possible! Failure to move your back adequately is likely to prolong the symptoms of sciatica and delay recovery rates. As a result, bed rest is no longer a recommended form of treatment. Lumbar extensions are the go to exercise for disk related lower back problems as this exercise helps push the squishy disc centre back into the middle! 

How to do it:

  • Lying on your front with your pelvis glued to to the floor.
  • Place your hands inline with your shoulders as if you were about to do a push up.
  • Whilst keeping your pelvis on the floor, push your upper body up until your arms are straight.
  • Slowly lower yourself back down towards the floor.

Repeat 10 reps, 3 sets, 3 times per day!

2) Knee To Chest Sciatica Stretch

The knee to chest stretch will place a tensile load through the sciatic nerve and other potentially painful structures, so caution should be taken  with this exercise. Done correctly without pushing in to pain will improve the mobility of your nerves, muscles and tendons and improve your rehabilitation.

How to do it:

  • Lying on your back in a comfortable position, use a cushion to rest your head.
  • Bend your knees and keep your feet straight and hip-width apart.
  • Bend one knee up towards your chest and grasp the knee with both hands. Slowly increase this stretch as comfort/pain allows.
  • Hold the stretch for 20 seconds.

Repeat 5 times, twice a day.

3) Gluteal Stretch

The Glute muscles are often very tight in people who suffer from lower back pain and sciatica. On top of this, Piriformis syndrome can mimic sciatica symptoms! As a result, it is a good idea to lengthen the Glutes by stretching!

How to do it:

  • Lying on your back in a comfortable position, use a cushion to rest your head.
  • Bend your affected leg and rest your foot on your thigh.
  • Grasp your unaffected thigh (with its foot on the floor) and pull it towards you. Keep your tailbone on the floor throughout and your hips in a neutral position.
  • You should feel the stretch deep in the buttock. Hold the stretch for 20 seconds

Repeat 5 times, twice a day.

4) Knee Rolls

As with any injury, the affected area often becomes stiff and tight due to inactivity. Not moving the painful area actually makes things worse! It is therefore a good idea to add lumbar rotations (knee rolls) to your exercise programme.

How to do it:

  • Lying on your back in a comfortable position, use a cushion to rest your head.
  • Bend both legs so that your feet are flat on the floor. Your knees and ankles should be touching.
  • Slowly allow both knees to fall to the left, before bringing them back up, and repeating on the right.

Repeat 10 knee rolls, each direction three times a day.

5) Core Stability Training

The bones and segments of the spine provide the supporting framework for the back. Connected to this frame is a vast system of muscles, tendons and ligaments that increase the strength and stability of the spine, arms and legs. The core stability muscles are key components of this network and provide the strength required to keep body upright prevent the spine from simply collapsing. If a person has very poor core stability, additional stress is placed on the spine  and hinders your recovery.  There are hundreds of core stability exercises but our favourite is the plank.

How to do it:

  • Start by getting into a press up position.
  • Bend at your elbows and rest your weight ono your forearms and elbows and not on your hands.
  • Your body should form a straight line from shoulders to ankles.
  • Engage your core by sucking your belly button into your spine.
  • Hold this position for 60 seconds. Increasing the time as you become stronger.

Repeat 3 reps, twice a day.

6) Cat & Cow Yoga Positions

One of the most well known and widely used yoga positions, fantastic for pelvic and lower lumbar spinal mobility.

  • Start on all fours in a tabletop position, with your shoulders positioned over your hands and your hips over your knees.
  • Whilst carefully control your breathing, arch your back to come into cow pose.
  • Round your back to come into cat pose.

Repeat the two poses 10 times each, three times per day

Posture Training Device

Upright Posture is a novel postural training device that is also piece of wearable technology. You attach the device to your lower lumbar spine and it is configured in such a way that it alerts you when you slouch! It does this by gently vibrating. The Upright posture device is a very interesting piece of tech, and invaluable for people suffering from sciatica who need to improve their core stability and seated posture.

You can buy the Upright Posture Trainer here!

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Sciatica Prognosis

Most cases of sciatica will resolve fully within 6 weeks so long as you stay active, whilst strengthening and mobilising the painful areas. The absolute worst thing you can do for your back pain is nothing! Most people find that if they are experiencing a bout of pain they can make it disappear after walking a few hundred yards. It is important to get into this mindset that movement is medicine. To reduce your chances of getting lower back pain or sciatica again, you must continue to complete range of movement, flexibility and strengthening exercises. Actively trying to improve your posture whilst at work can have a great impact on reducing your chances of re-aggravating the injury and also improving your general appearance!