Role of Physical

therapy on treatment
of Sciatica
Under supervision of:
Dr. Eman El Sayed El Fekey
 • By:​

 Esraa El-Saied Ibrahim 201902321​

 Fai Sami Ahmed 201902475
 Hadeer Hassan Mahmoud 202004700
 Fedaa Elsaied Mansour 201800765
 Introduction
• Physical therapy and exercise are typically first-line treatments for
relieving, treating, and preventing sciatica symptoms. Typical
sciatica signs and symptoms include:
• Lower back, hip, and/or leg pain
• Numbness, tingling, and/or weakness in the buttock, thigh, leg,
and/or foot
• Underlying medical conditions, such as a herniated or degenerated
disc, or nerve root compression in the lumbar spine may cause
radiating symptoms into the leg, commonly known as sciatica.
 The essential of physical therapy
for sciatica
• In treating sciatica, physical therapy may:
• Provide symptom relief
• Promote healing of the underlying cause
• Prevent recurrences and flareups
• Several types of health professionals specialize in providing medical care and
treatment for radiating lower back pain, including physical therapists,
chiropractors, physiatrists (also called physical medicine and rehabilitation
physicians), and certified athletic trainers. Physical therapists are specifically
trained in providing manual therapy, exercise programs, and rehabilitation for
radiating lower back pain
 Goals of Physical Therapy and
Exercise in Treating Sciatica
• Physical therapy for sciatica focuses on strengthening lower back
and hip muscles.
• Physical therapy and exercise help strengthen and mobilize tissues
in the lower back, pelvis, abdomen, buttocks, and thighs.
treating the signs and symptoms of sciatica are to:

• Restore pain-free functional movement patterns

• Relieve lower back, buttock, thigh, and leg pain
• Reduce muscle spasm
• Restore the function of the lumbar spine and the sacroiliac joint
• Improve mobility of the lower body
• Foster a better healing environment in the lower back
• Promote neurologic adaptations to reduce the perception of pain
• Prevent future pain flareups and reduce fear associated with movement

Commitment and frequency are important attributes to a successful treatment outcome when
using physical therapy and exercise for sciatica. Physical therapy may or may not be combined
with the use of pain-relieving treatments, such as over-the-counter (OTC) or prescription
medications or epidural steroid injections.
Physical Therapy and Exercise Techniques for
Treating Sciatica:
• A physical therapist may prescribe a combination of various types
of physical, manual, soft tissue mobilization, and/or exercise
therapies in treating sciatica. Specific exercises depend on the
underlying cause of sciatica, 1 , 2 as well as other factors, such as
the patient’s level of pain, overall conditioning, and the physical
therapist’s training and experience.

• The list next slides highlights the common techniques:

• 1) Extension and flexion back
exercise:

Flexion exercises are an essential component

of physical therapy for sciatica.

These exercises help relieve pain by promoting

spine movement. Often, individuals with lower
back pain and sciatica feel relief with specific
directional movement of the spine. A physical
therapist typically evaluates an individual’s
directional preference before prescribing
specific directional exercises, as these are
tailored to the individual patient and
symptoms. These exercises include backward
(extension) and forward (flexion) bending. This
directional movement is an important
component of the McKenzie Method, also
• 2) The McKenzie Method
(mechanical diagnosis and therapy)

McKenzie's technique may reduce radiating symptoms

by centralizing the pain closer to the spine.

The Mckenzie method is a technique that involves

a series of active directional movements to identify
and treat a pain source in the spine, muscles, and/or
joints. The technique focuses on moving the radiating
pain closer to the center of the body through exercise,
for example, moving leg pain closer to the spine.
The theory of this approach is that centralizing the
pain indicates improvements in symptoms. The goal is
to reduce radiating symptoms originating from
the spine. A therapist who practices this
technique usually has special training in the McKenzie
Method.
• 3) Strengthening exercises:

Leg raise is a type of core-strengthening exercise.

These exercises include bodyweight and resistance

exercises to strengthen the muscles of the abdomen,
low back, hips, and legs.
• Isometric exercises involve contracting muscles
without moving the joints. Examples of isometric
exercises include a plank or a bridge hold. These
exercises can help strengthen muscles when
symptoms are more acute.
• Isotonic exercises include the contraction of a
muscle to resist a constant load, such as
resistance bands and weight training, to help
increase muscle strength through constant
resistance to specific motions.
Functional retraining
• This technique involves
reintroducing movements, such
as lifting, carrying, and
bending or squatting. The use
of proper technique and
healthy movement patterns are
incorporated to reduce pain
and prevent re-injury.
Manual Therapy Techniques for
Treating Sciatica
• Manual Therapy Techniques for
Treating Sciatica
• Specialized manual therapies for
sciatica are discussed below.
• Nerve glides (nerve mobilization)
• Nerve glide includes active or passive
techniques on a symptomatic nerve
when it is placed into and out of
tension to facilitate movement and
reduce symptoms
• Dry needling • Muscle energy technique
• Dry needling is a technique • This treatment is a form of
where a certified healthcare manual therapy that involves the
provider uses a small needle to patient performing gentle muscle
target a trigger point in a contractions in conjunction with
muscle. This technique is the therapist moving the painful
performed to release hyper- joints through a specific range of
irritable and/or hyper-contracted motion. This technique may help
muscle tissue to reduce pain. reduce pain and restore function.
Myofascial release and soft
tissue mobilization
In this method, soft tissues are
mobilized manually. The therapist
uses their hands or an instrument to
mobilize the tissues in the lower
back, hips, or legs to treat fascial
(underlying soft tissue) restrictions
and decrease muscle tension or
spasm.
• Gait training
• A trained therapist analyzes
the patient's walking technique
and retrains the patient to use
correct gait patterns. This
technique may include video
analysis.
• Active assisted range of motion
• This method involves therapist-assisted
movement of parts of the lower body, such
as the hip and legs. This technique helps
facilitate the movement of specific joints
or muscles that cause pain.
• While this list is not exhaustive, therapists
usually use one or more of these
techniques in treating sciatica pain. If a
particular exercise or therapy causes pain
or discomfort, it is advised to inform the
treating therapist immediately.
 Passive Techniques for
Treating Sciatica
Physical therapists may use certain aids and techniques to
supplement active treatment for sciatica. These treatment aids
typically consist of specialized devices and equipment. While some of
these aids are used at the therapist’s office, others may be used to
relieve pain at home.

• In treating sciatica, these aids may be used to promote blood flow,

reduce muscle spasm, and decrease pain. Common methods are
discussed below.
 Heat and Cold Packs
Packs containing granules, beads, or gels that can be heated or
frozen are useful in placing over sore and painful tissues. The
benefits of using heat and cold packs are 1 , 2 :

• Heat packs may relieve pain by reducing muscle stiffness. The

heat from these packs helps dilate blood vessels, improve blood
flow, and reduce muscle tension. Using a heat pack may help
promote relaxation and prepare for a physical therapy
appointment.
• Cold packs may relieve pain by causing a numbing effect. These
packs typically constrict the blood vessels beneath the skin,
helping to reduce pain and swelling. Cold packs also slow down
the chemical reactions that cause inflammation and pain.
• It is advisable to apply heat or cold therapy for 15 to 20 minutes
and take a 2-hour break in between to optimize the tissue response
before reapplication. It is advised to place a barrier, such as a
towel between the body and the source of ice or heat to avoid skin
injury.
 Transcutaneous Electric Nerve
Stimulation (TENS)
TENS therapy uses electrical stimulation to relieve pain by targeting nerves.

A TENS unit applies electric current directly to sensory nerves, creating a tingling
sensation that may reduce the feeling of pain. When used in conjunction with physical
therapy, a TENS unit may help reduce acute lower back pain. This reduction in pain
may help improve a patient’s tolerance for active movements that facilitate healing.

• A TENS unit consists of a device with electrodes that are taped to the skin near the
pain sites. The device may be used in a therapist’s office or at home
Neuromuscular Electric Muscle
Stimulation
Neuromuscular electrical stimulation using different wavelengths and
amplitudes is a therapeutic method of inducing muscle contraction. In certain
cases, when nerve involvement is severe and a patient is unable to voluntarily
contract muscles in their hip or leg, or muscle contraction is weak, electrical
stimulation can help facilitate these contractions to improve function.

• Electric muscle stimulators are available in different forms, including

machines with electrodes that are taped to the body, or smaller devices that
are placed directly on the body. A computer or hand-held remote helps to
adjust the frequency and intensity of electric current that is passed.
 Traction
Traction may be used to create space between the vertebrae, reducing pressure on the
affected nerve roots.

Mechanical traction gently pulls the vertebrae apart to relieve the compression of spinal
tissues. In treating sciatica, traction of the lumbar spine can help:

Temporarily widen spaces in the intervertebral foramina to relieve compression of the spinal
nerves
Provide muscle stretch to relieve spasm
• Relieve pressure on injured discs, reducing nerve symptoms
• A therapist may apply traction manually or use mechanical traction, where the
patient lies on a table and is secured using a harness or straps. The therapist
usually determines the type and amount of force to be used. The tension may
be increased gradually and is usually followed by a period of relaxation.
• Physical therapy and supporting treatments are performed under the
supervision of a certified physical therapist or another qualified health
professional who typically formulates a treatment plan based on the
individual’s condition. Exercises are generally performed at home and may be
continued for a few weeks or months after the therapy sessions are completed.
References:

• 1 Pourahmadi MR, Taghipour M, Ebrahimi Takamjani I, Sanjari MA, Mohseni-Bandpei

MA, Keshtkar AA. Motor control exercise for symptomatic lumbar disc herniation:
protocol for a systematic review and meta-analysis. BMJ Open. 2016;6(9):e012426.
Published 2016 Sep 27. doi:10.1136/bmjopen-2016-012426

• 2 Slater J, Kolber MJ, Schellhase KC, et al. The Influence of Exercise on Perceived Pain
and Disability in Patients With Lumbar Spinal Stenosis: A Systematic Review of
Randomized Controlled Trials. Am J Lifestyle Med. 2015;10(2):136–147. Published
2015 Feb 16. doi:10.1177/1559827615571510

• 3 Koes B. Moderate quality evidence that compared to advice to rest in bed, advice to
remain active provides small improvements in pain and functional status in people with
acute low back pain. Evidence-Based Medicine. 2010;15(6):171-172.
doi:10.1136/ebm1132