Sciatica: Special Physiotherapy Tests, Diagnosis & Treatment

Sciatica: Special Physiotherapy Tests, Diagnosis & Treatment

Reviewed By

Shikha Lall (BPT, MPT, RYT)

Sciatica is pain along the nerve root of the Sciatic Nerve. The Sciatic Nerve is the largest nerve in the human body. It innervates the muscles of the back of the thigh and leg. Hence, lower back pain along with pain at the back of anyone or both legs is known as Sciatica and is one of the most common causes of reported cases of lower back pain. 

It is generally termed as pain down the back of the leg. The pain may vary in intensity from being mild or negligible to being severe.

The severity of the pain varies due to the following:

  1. Causative factors such as disc bulge, spinal canal stenosis, inflammation of the nerve.

  2. Lifestyle - prolonged bending, history of previous episode back pain, long hours of travel, improper lifting technique, etc.

  3. Obesity

  4. Over exercise like deadlift without precaution

  5. Occupational hazards like long hours of sitting, labourers, etc

The pain can be either in the midline or can be more on one side only, or present on both sides. Sometimes your body posture may be shifted to one side due to pain. This is an adaptation of the body to pain. The pain may be aggravated by certain activities like getting up from sitting, bending forward turning in bed, coughing or sneezing, etc.

However, sciatica can be easily managed with timely exercise and intervention. As mostly the pain is due to the pressure on the nerve and the related inflammation, it can be reversed by adopting or incorporating proper ergonomics to relieve the pressure along with exercises. It may take from over a few weeks to months for the same.

Causes of Sciatica

Sciatic pain is caused due to compression of the nerve along its course. The compression can be due to many reasons. 

1. In the young or adult population

Due to intervertebral disc prolapse in the lumbosacral area. The commonest exposing factor is Occupation.

2. In older-aged population

Due to repeated stress on the lower back region and age-related degenerative changes

3. Traumatic injury

A cut or stretch in the nerve can also cause pain. A traumatic injury can be due to an accident or a sudden jerky movement. 

Other reasons for sciatica are:

4. Piriformis syndrome

5. Improper spinal posture for long duration

6. The sudden heavy lifting of loads

7. Sudden bending activities

8. Spinal Faulty Alignments

9. Improper sleeping to sitting

10. Osteoporosis, and

11. Spinal and pelvic tumours

Most of these reasons either compress the spinal canal. Or put a load on the spinal canal. This causes additional pressure on the nerve. 

Diagnosing Sciatica

Several tests done by physiotherapists diagnose sciatica. Whereas, imaging scans also help in sciatica diagnosis. The tests shown below should only be performed under a professional physiotherapist’s guidance. 

Special tests to diagnose Sciatica:

1. Flexion Adduction Internal Rotation test

The test is used to check if the sciatic nerve pain is caused due to piriformis muscle. A positive test occurs when pain is produced in the sciatic/gluteal area. A tight piriformis muscle in the buttock can cause sciatic nerve pain.

2. Straight Leg Raising Test

The SLR test is performed when a patient is lying on a bed. This test stretches the sciatic nerve. It is done in the following order:

  1. Straight Leg Raising

  2. Straight Leg Raising with adduction and internal rotation

  3. Straight Leg Raising with external rotation

A pain encountered while lifting the affected leg usually indicates sciatica.

3. Slump Test

This test includes the patient seated upright with hands behind the back. The patient bends (slumps) forward at the hip. The neck is bent down with the chin touching the chest and one knee is extended to a degree possible. If pain occurs in this position, sciatica may be present. 

Physiotherapy Treatment for Sciatic Nerve pain

  1. A detailed patient assessment is a must. The assessment will start with a history followed by an examination.

  2. The physiotherapist enquires about pain types such as tingling, burning, radiating, dull ache, etc. the affected location, the type, severity, and consistency of the pain. Which movements cause more pain and which cause less pain. 

  3. Your physiotherapist might ask you to do some movements. Like bending side-to-side, forward bending, backward bending, twisting your waist. 

  4. The therapist may even ask you to walk for a short distance. Reviewing lifestyle habits. Past Medical history such as any incident of fall or lower back pain, medical conditions like bp, diabetes, and occupational status of the patient is important. 

  5. The physiotherapist will then perform some specific tests on the patient. Pain sensation during the testing is indicative of sciatica. 

  6. The physiotherapist will then confirm his diagnosis using diagnostic scans. Scans like MRI and Pro posture scans are used. X-Ray, CT & BMD can also help in case the former two scanning centres are unavailable.

  7. The therapist will then design a treatment plan. Specific to your pain and goal. As many other options. Physiotherapy requires you to be receiving treatment from the therapist for a long duration. 

  8. The physiotherapist will then suggest some lifestyle changes. Like proper lifting techniques. How to reach for objects, sitting position, sleeping position, and more. 

  9. Passive therapies to reduce sciatica will be performed on you:

a. Hot and Cold Therapy

Hot and cold therapy is of prime importance in sciatica pain. This therapy helps in receiving more blood to the area. Eventually leading to faster healing and a decrease in pain. The hot and cold therapy even brings in more oxygen to the injured area. Reducing muscle spasms and inflammation at the same time. Alternating between hot and cold therapies gives the greatest healing.

b. TENS

Transcutaneous Electrical Nerve Stimulation. It is a device that delivers electrical current to an area. It helps with reducing pain for temporary relief.

c. Ultrasound

Ultrasound waves are targeted onto the area of pain. It travels deep into your muscles and tissues. Creating an enhanced circulation helps in healing. Enhanced circulation reduces muscle spasms, cramping pain, swelling, and stiffness and provides temporary pain relief.

10. Active Physiotherapies to heal sciatica. These are therapies that are manually performed on the patient by the therapist. 

a. Stretching

Stretching the muscles that are tight. Due to the pain, many muscles undergo tightness and the person avoids using that part altogether. The therapist then stretches the muscles individually. This helps in the movement of that part with less to no pain. 

b. Exercises

The therapist will teach you exercises that will help in a faster recovery. Exercises are mainly for improving pain and flexibility. These exercises are targeted to increase your range of motion. 

The therapist will guide you into performing these exercises correctly. The posture, alignment, and position will be emphasised.

c. Hydrotherapy

Hydrotherapy involves therapy with water. This is mainly for sciatica pain management. The resistance and buoyancy provided by the water will help in toning the muscle and faster healing. Water aerobics and swimming are such examples. 

d. Strengthening

Exercises to strengthen muscles are also performed. The muscles of the back, abdomen, and legs are strengthened. This helps in correcting posture and reducing pain. Work-related advice will also be given by the therapist.

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