Physical Therapy for Sciatica in Sterling, VA

What Is Sciatica?

I have treated hundreds of patients dealing with back pain and associated conditions. One of the most common conditions that is linked to back pain is sciatica. Sciatica refers to irritation of the sciatic nerve. The sciatic nerve originates in the low back and forms from the L4-S3 nerves. These are the nerves right above your tailbone (sacrum) along with the nerves that come from your tailbone. The sciatic nerve is the biggest nerve in your body and runs from your low back to the bottom of your foot on each side of your body. Sciatica is a very common condition. The Cleveland Clinic states that approximately 40% of people in the United States will experience sciatica at some point in their lives.

The symptoms of sciatica can range from pain to tingling to numbness and muscle weakness. The least severe symptom is actually pain, as it means that the sciatic nerve is irritated, but not compromised. Tingling can occur when the nerve is partially compressed, and numbness involves a more complete compression of the nerve. Muscle weakness and, in extreme cases, incontinence can result when the nerve is very compressed. These are medical emergencies. Less severe symptoms such as pain and tingling can be treated conservatively with physical therapy and there is a high success rate.

It is important to understand that sciatica has become a blanket term for medical providers. True sciatica refers to compression of the sciatic nerve at some point. This could be in the spine due to a herniated disk, spondylolisthesis, or stenosis. It could also be due to compression from the glutes or the piriformis in the hip. Many medical providers will attribute any radiating pain down the leg to the sciatic nerve. This could be a result of another nerve being compressed, it could be referred pain from a muscle, or it could be a muscle strain. Unfortunately, most physicians do not spend much time with their patients and they are quick to ascribe a diagnosis with minimal testing. X-rays may not give enough information for a definitive diagnosis. MRIs and EMG studies may be needed to give a formal diagnosis for sciatica. Most physicians will not take the time or have the training to perform these tests and they will write a prescription for physical therapy for sciatica and see you again in 6 weeks. Honestly, I love when this happens because it gives me more freedom as a physical therapist to diagnose and treat how I see best.

How Can I Test if I Have Sciatica?

The best tests for sciatica are a straight leg test and a slump test. The straight leg test involves lying flat on your back. Your physical therapist will bring your leg up towards the sky while keeping your knee straight (imagine stretching your hamstrings). If you feel pain with this movement, the physical therapist will bend your ankle to bring your toes towards you (imagine stretching your calf). If this makes the pain worse, and it mimics your typical pain, then you most likely have sciatica.

The slump test is similar, but you perform it yourself. Sit in a chair and slump down like you have poor posture. Stretch your leg out in front of you as if you were stretching your hamstrings. Go until you feel the pain that is similar to the pain that you typically feel. Straighten your back and notice if the pain gets better. If it does get better then you most likely have sciatica.

The reason that these tests work is because they are stretching the length of the sciatic nerve. Remember, the nerve runs from your low back, down the back of your leg, to the bottom of your foot. Slumping down, flexing your hip, extending your knee, and dorsiflexing your ankle are all tightening the nerve. In the straight leg test, the flexing of the ankle is tightening the nerve more without changing the length of the hamstrings. Similarly, the slump test should relieve the pain without changing the hamstrings position. These tests should be used in addition to a thorough history and other components of a physical therapy evaluation, but they are a key starting point.

Physical Therapy for Sciatica

Physical therapy for sciatica should address the individual causes. Muscles along the path of the sciatic nerve will tighten and become painful due to the irritation of the nerve. Treating these muscles with manual therapy including massage and trigger point dry needling can be very effective. Even if the nerve compression is in the back, the calf muscles may be tight. Improving the mobility of the calf can decrease overall strain on the nerve, thus improving symptoms. It is important to treat the entire length of the nerve.

While it is helpful to treat the entire nerve, a skilled physical therapist should be able to determine the area of the greatest irritation. If palpation of the piriformis creates symptoms down your leg, then that may be the problem area. Similarly if mobilization of the spine causes symptoms, then the spine should be the primary area of treatment. A general approach is effective, but more targeted treatment is always ideal.

Exercises for Sciatica

Exercises for sciatica can vary depending on the level of severity of the symptoms as well as the affected area. Most sciatica cases stem from hip or spinal compression, and the exercises that I will discuss benefit those areas. As always, it is best to receive an individual assessment from a physical therapist for specific exercises.

If your pain is severe, then gentle movements are often necessary. A basic clamshell can be a good starting point if you need to work on utilizing the hip muscles with minimal stress. A tight muscle often needs movement and activation to decrease tightness and guarding. Aggressive stretching can be counterproductive because that puts the nerve on an even greater stretch. Gentle movements like clamshells allow the muscles to contract and relax with minimal strain.

If the clamshell becomes easy, then a side plank on your knees can increase load for the low back and hip muscles with minimal strain. This is an isometric exercise which allows for muscular contraction with no change in muscle length and therefore less damage to the muscle itself. It is important to progress as your symptoms allow as too many physical therapists do not progress their patients past the point of basic “stability” exercises, such as planks.

Another exercise that I love to progress hip stability is a standing hip abduction with a band. Wrap a band around your ankles and support yourself with your hand. Keeping your leg straight, bring it out to the side as far as you are able. This targets the muscles to the side of your hip and is a great way to build strength in a direction that is often undertrained.

Bridges are a great exercise for the hamstrings, which are often neglected in strength training. Regular bridges are a great starting point. If you feel your hamstrings cramping or tightening they are probably weak and will benefit from more aggressive strengthening. Once regular bridges and single leg bridges become easy, try putting your feet on a foam roller. Keeping the balls of your feet on the roller, try and elevate your heels so that they are even with the rest of the foot. Lift your hips and maintain the position for 5 seconds. This engages the glutes, hamstrings, and calf muscles, all of which are innervated by the sciatic nerve. Strengthening of these areas will help decrease tightness quickly.

Finally, deadlifts are the best way to train the back of your leg while also incorporating the back muscles. These truly target everything innervated by the sciatic nerve. If your physical therapist does not include some sort of deadlift in your sciatica rehab program then they are doing you a disservice. Deadlifts will help in the later stages of recovery while also decreasing the likelihood of a further injury.

Dealing with Sciatica

Sciatica is a tricky diagnosis. It can take months to resolve, but there is a high success rate with conservative care. A comprehensive physical therapy program including manual therapy and exercises targeted at your specific limitations is the most effective strategy. Find a physical therapist who has experience with spinal conditions and sciatica and stick to a program to put yourself in the best position to recover as quickly as possible.

If you are in the Sterling, VA area and interested in a physical therapy evaluation to deal with sciatica then please reach out. You can email me at danny@eclipsewellnessnova.com and we will come up with a plan to get you out of pain!

Want to learn more and watch Dr. Danny Lehnert demonstrate the exercises discussed above? Check out our YouTube video on sciatica here!