Sciatica is a type of nerve-related lower back and leg pain that causes mild to severe discomfort for many of our clients across our Hong Kong Central and Wong Chuk Hang physiotherapy clinics. Given the complex nature of nerve pain, it can be confusing as to who the best practitioners are to see to help you manage your sciatica. As physiotherapists, we work alongside doctors and other health professionals to play a vital role in the management of sciatica, with research confirming improved outcomes in terms of lifestyle and movement testing when physiotherapy is added to medical treatment compared to opting for medical treatment alone. Here’s a closer look into what sciatica is and how a physiotherapist can help.
What Is Sciatica?
Sciatica is characterised by pain that starts in the lower back or the buttocks region and travels down into one or both legs. It gets the name sciatica because the pain travels down the path of the sciatic nerve, the largest nerve in the body at approximately 20 mm wide, that starts in the lower back (the lumbosacral plexus) and passes through the glutes and down the back of the thigh, splitting into different branches down the leg and all the way down to the foot.
Many of our clients experience sciatic nerve pain quite differently, with its intensity and frequency ranging from person to person. Some people will experience sudden, sharp shooting pains that may feel like electric shocks down to the legs. Others may feel more dull pain paired with burning, numbness or tingling. Due to the role of the sciatic nerve in innervating muscles in the legs and feet, it is not uncommon to experience muscle weakness and gait dysfunction, including symptoms like foot drop. As the hallmark sign of sciatica is pain that radiates down from the lower back into the leg, if you’re experiencing this, you should see your physiotherapist for an assessment.
What Causes Sciatica?
The most common cause of sciatica that we see is a herniated (or ‘slipped’) disc. This is when one of the rubbery spinal discs that sit between the vertebrae (which function to absorb shock, support the vertebrae and allow for some mobility in the spine) bulges and rubs against or compresses the sciatic nerve. Sometimes, a disc may herniate, breaking open the outer fibrous layer of the disc and pushing the inner toothpaste-like material out.
Another common cause of sciatica that we see is spinal stenosis. This is an age-related condition where the nerve passages in your spine narrow over time, which irritates or compresses one or more spinal nerves. Less common causes of sciatica include:
- Spondylolisthesis: this is when a vertebra slips out of position and irritates or compresses a nerve root
- A spinal or back injury or infection
- A growth within your spine, such as a tumour
- Cauda equina syndrome, a rare but serious condition caused by compressed and damaged nerves in your spinal cord.
In some cases that we see, there may be no single obvious cause. Risk factors for sciatic include being aged between 30 and 40 years, working in a role that requires heavy lifting for prolonged periods, and those who live a sedentary lifestyle – including those sitting for long periods at work.
It’s important to have sciatica diagnosed by a medical professional and not self-diagnose, as there are various other conditions that may produce back pain, but not be related to the sciatic nerve. Your physiotherapist will perform a comprehensive assessment to understand your symptoms and their trigger, and may refer you for medical imaging if needed.
Physiotherapy Treatment For Sciatica
Physiotherapy uses safe and non-invasive treatment approaches to help reduce your sciatic nerve pain and symptoms. Since the most common causes of sciatica involve pressure being placed on your sciatic nerve by something, physiotherapy for sciatica focuses on reducing this pressure where possible, as well as helping to alleviate any muscle tension in the buttocks, legs and back associated with pain to help support mobility.
Your management plan may include hands-on care, mobilisation and targeted exercises. Your plan will be carefully put together considering the underlying cause of your sciatica, as well as your pain levels, activity levels, work requirements, and your personal goals. We may recommend:
- Spinal mobilisation
- Massage therapy and trigger point therapy
- Postural correction or support
- Joint and tissue mobilisations and release
- Dry needling
- Strengthening exercises: these exercises include bodyweight and resistance exercises to strengthen the muscles of the core, low back, hips, and legs. These include both isometric exercises (like a prone hold) or isotonic exercises like using resistance bands.
- Extension and flexion back exercises: these exercises help to relieve pain by encouraging movement of the spine. Often, people with lower back pain and sciatica feel relief with specific spinal movements. A physiotherapist typically looks at your directional preference (bending forward or backward) before prescribing specific exercises
For those undergoing surgery for more severe cases of sciatica such as those caused by bone spurs or disc herniations, we work alongside clients both before surgery to prepare you, as well as looking after you during your recovery to help you get the best outcomes and recover your mobility as quickly as possible.
Knowledge Is Power When It Comes To Sciatica
Another big part of what our physiotherapists do is educate our clients on sciatica, the triggers, what is likely to worsen your pain, as well as what you can do to help relieve your symptoms in your particular case. Sometimes, small changes to your daily routine like regular movement breaks from a desk job can play a large role in reducing the risk of pain in the future, as well as postural corrections at your desk. Once you have a good understanding of the effects of your sciatica on your body, you can make well-informed decisions about how to best care for your back in the future.
Leading Physiotherapy In Hong Kong
Here at PhysioCentral, we’re proud to offer leading physiotherapy services across our clinics, including having our own Pilates studio to best support your strength and flexibility throughout your recovery from sciatica pain. Our physiotherapists are highly experienced and have been trusted to care for our community for almost 20 years.