From the Guidelines
Physiotherapy for sciatica should prioritize exercise therapy, including individual tailoring, supervision, stretching, and strengthening, as it is moderately effective in reducing symptoms and improving outcomes. According to the American College of Physicians and the American Pain Society guideline 1, exercise programs that incorporate these elements are associated with the best outcomes.
Key Components of Physiotherapy for Sciatica
- Gentle nerve gliding exercises to reduce nerve compression
- Specific stretches targeting the piriformis muscle, hamstrings, and lower back to improve flexibility
- Core strengthening exercises, such as bridges, bird-dogs, and gentle planks, to stabilize the spine
- Manual therapy techniques, including spinal manipulation and soft tissue mobilization, to reduce nerve compression and improve spinal alignment
Additional Considerations
- Heat therapy for 15-20 minutes to relax tight muscles
- Ice therapy for 10-15 minutes to reduce inflammation
- Patient expectations of benefit from a treatment should be considered in choosing interventions, as they seem to influence outcomes 1
Duration and Progression of Therapy
Most patients see improvement within 2-6 weeks of consistent therapy. If symptoms worsen or don't improve after 2 weeks of home exercises, professional physiotherapy assessment is recommended.
Evidence-Based Recommendations
The guideline 1 suggests that while there is insufficient evidence to recommend any specific treatment as first-line therapy, exercise therapy is a moderately effective nonpharmacologic therapy for chronic low back pain, including sciatica. Transcutaneous electrical nerve stimulation and intermittent or continuous traction have not been proven effective for chronic low back pain, including sciatica 1.
From the Research
Physiotherapy Options for Sciatica
The following physiotherapy options are available for sciatica (lumbar radiculopathy):
- Advice to stay active is the primary management strategy for sciatica 2
- Neural management techniques, such as neural mobilisation and soft tissue mobilisation, may contribute to sciatica recovery 2
- Spinal manipulation and mobilization forces, including Cox Technic flexion distraction decompression (CTFDD), can be used to treat sciatica 3
- General exercise, motor control exercise, and spinal manipulative therapy can be effective in managing chronic low back pain, which may be associated with sciatica 4
- Strengthening exercises can be effective in reducing pain and improving function in patients with non-specific lower back pain, which may be related to sciatica 5
- Instrument-assisted soft tissue mobilization (IASTM) may not be effective in improving pain, function, or range of motion in individuals with spinal conditions, including sciatica 6
Specific Techniques
Some specific techniques that may be used in physiotherapy for sciatica include:
- Neural mobilisation techniques 2
- Soft tissue mobilisation techniques 2
- Cox Technic flexion distraction decompression (CTFDD) 3
- General exercise, such as strengthening, stretching, and aerobic exercises 4
- Motor control exercise, which involves retraining specific trunk muscles using ultrasound feedback 4
- Spinal manipulative therapy, including joint mobilization and manipulation 4
- Strengthening exercises, which can be effective in reducing pain and improving function in patients with non-specific lower back pain 5
Treatment Plans
Treatment plans for sciatica may involve a combination of these techniques, and may be tailored to the individual patient's needs and goals. For example:
- A treatment plan may include neural mobilisation techniques and soft tissue mobilisation techniques, plus advice to stay active 2
- A treatment plan may include CTFDD, pre-modulated electrical muscle stimulation (EMS), infrared light therapy (ILT), and a home stretching and strengthening program 3
- A treatment plan may include general exercise, motor control exercise, and spinal manipulative therapy 4
- A treatment plan may include strengthening exercises, which can be effective in reducing pain and improving function in patients with non-specific lower back pain 5