Less common causes of sciatica
- piriformis syndrome
- facet joint hypertrophy
- spinal instability
- spinal stenosis
Sciatica Physiotherapy treatment
Physiotherapy treatment in the initial phases of an acute sciatica is primarily geared towards reducing the pressure on the trapped nerve by combinations of graded manual therapy. It is essential manual therapy in this phase reduces the severity of sciatica. Inappropriate manipulation at this point can make a bad situation worse. Trying to “put the disc back” with vigorous manipulation can be highly detrimental and can lead to catastrophic nerve damage.
Treatment is also focused on reducing the inflammatory response both around the bulging disc and also in the irritated nerve itself.
A careful inventory of individual aggravating an easing factors must be established with specific guidelines which are tailored to your presentation. In nearly all cases it is recommended to remain as active as possible but without provoking the sciatic pain.
Formulating these parameters requires detailed questioning and analysis of your symptoms and their behaviour in order to make accurate recommendations and progress the treatment.
As the severity of symptoms improve the emphasis of treatment can shift from first-aid, palliative measures to restoring range of movement and functional capacity. This is achieved by rehabilitating directions of movement that are most restricted (commonly bending forwards).
As specific, painful movements become the focus of treatment it is imperative that the combination of techniques must be applied in a very structured manner in order to be helpful rather than counter-productive. The duration of this sub-acute phase is quite variable and could be between 2 to 6 weeks.
The next phase of treatment is to target muscle control and movement patterns and to identify the underlying mechanics which have contributed to the sciatica. Again this requires detailed analysis of spinal motion, individual spinal segments elasticity, muscle control in the area (frequently referred to as the “core” but the term has become overused, in my opinion) and functional movement patterns.
A huge number of corrective rehabilitation exercises need to be carefully selected, honed and programed into a customised regime to meet your needs. This should follow a sequentially structured progression in order to improve spinal function. As the choice of potential exercise is so vast it is important to zone in specifically on the correct target to ensure a speedy, cost-effective recovery.