The sciatic nerve runs from the lower back down through the buttocks and along the back of each leg. Sciatica is pain along this nerve and is relatively common and, thankfully, regularly treated and with terrific results.
Sciatica is usually caused by pressure or irritation of the sciatic nerve somewhere along its route out of the lumbar spine and down into the leg. You can see our blog on the presentation and causes of sciatica here. This blog will be focused on treating sciatica.
While sciatica can be extremely painful and uncomfortable, it is rare that permanent nerve damage results. Most pain is due to inflammation, which irritates the nerve, and will improve within a period of time. Nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centred on relieving both of these conditions.
Treatment of Sciatica?
Treatments for sciatica will vary depending on the severity and cause of the sciatica, though we will generalise the approach to treatment for the purpose of this blog. “Treatment” will include manual therapy and rehabilitation, as you will see below.
Our manual therapy main objectives are:
- Reduce pain
- Restore movement
- Release tension and muscle spasms
- Promote blood flow and optimize the healing response
If sciatica is due to pressure on the sciatic nerve or irritation from inflammation of nearby structures, it stands to reason that treatment involves removing this pressure or correcting issues causing an inflammatory process. Our manual therapies aim to achieve this by restoring motion to poorly moving spinal joints as well as easing muscular tension in the lower spine, buttock and leg. This is achieved by using a combination of the following techniques:
- Spinal mobilisations
- Massage therapy and trigger point therapy
- Dry needling
- Stretching or activating muscles
- Advice in relation to how to minimise pressure and irritation of the sciatic nerve, such as positioning or reducing the load of a certain activity
The other part of treatment is the rehabilitation process. Exercises will be taught, monitored and progressed throughout the recovery process, these aim to:
- Restore proper biomechanics and motor pattern
- Strengthen and lengthen the spine and muscles of the lower back, abdomen and hip
- Encourage the exchange of fluids and nutrients in the body by light aerobic exercises such as walking, swimming, or pool therapy
Once certain outcomes are achieved these exercises will be progressed so that the body is gradually loaded back into full function and able to tolerate an even greater load then previous to the injury.
While some rest or activity modification may be necessary, it is important to maintain as much activity as possible and avoid prolonged periods of physical inactiveness or bedrest.
Treatment Time For Sciatica?
Some patients can respond within 1-2 weeks, however, most cases of acute sciatica usually respond within 4 to 6 weeks of nonsurgical treatment. For chronic sciatica with pain lasting over 8 weeks, treatment time may take longer. Treatment times vary due to underlying cause, severity, diet, stress, sleep and other lifestyle factors.
Other Treatment Options?
These options are likely not needed for most and are typically used when conservative care fails to help. Your chiropractor will decide if a referral is needed to explore these options.
Medication for Sciatica Pain
Both prescription and over-the-counter (OTC) medications may be used to relieve sciatica pain. An example of OTC medications used would be Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen.
Lumbar Therapeutic Injections for Sciatica
Lumbar therapeutic injections may be used if the symptoms and pain stemming from the sciatic nerve are not responding to conservative care.
Injections are used with the goal of providing enough pain relief to allow the patient to fully participate in, and benefit from a rehabilitation program. Injections may also help in diagnosing the source of the pain and may be used to identify or confirm the nerves involved.
Some common type of injections include:
- Epidural Steroid Injections. The steroids injected in the epidural space disperse into the nerve endings and other tissues. This may help relieve sciatic pain stemming from conditions such as spinal stenosis, disc herniation, or degenerative disc disease. Other results from this form of treatment may include controlling the inflammatory response around the sciatic nerve and reduce the activity of the immune system to decrease the production of inflammatory cells.
- Selective Nerve Root Blocks. This type of injection is administered near the spinal nerve as it exits the intervertebral foramen (bony opening between adjacent vertebrae). The medication reduces inflammation and numbs the pain transmitted by the nerve. Selective nerve root blocks may be given on one or more nerve roots from L4 to S3 to control sciatica pain.
For most therapeutic injections, results vary widely. Some people may experience immediate and sustained pain relief, some may have pain relief for only a few weeks or months, and some may experience no pain relief at all.
As a general rule, if conservative (nonsurgical) methods fail to provide relief after 6 to 8 weeks of treatment or if neurologic deficits increase (such as leg weakness), surgery may be considered.
Some common surgical options include:
- Lumbar laminectomy – widening of the spinal column in the lower back to reduce pressure on the nerves.
- Discectomy – partial or entire removal of a herniated disk.
Depending on the cause of sciatica, a surgeon will go over the risks and benefits of surgery and be able to suggest a suitable surgical option.