Does Physio Work for Sciatica?

Physiotherapy may be an effective treatment option for the cluster of symptoms often referred to as “sciatica”. Sciatica is a diagnostic term that was coined in the 1980s to describe the classical presentation of pain running down the back of the leg along the path of the sciatic nerve. It has not proven to be a particularly useful diagnostic label as all it really does is describe a location and distribution of pain. It doesn’t really tell us why the symptoms are present. A thorough assessment by a physiotherapist can help answer the question “Why is there pain running down the back of my leg?”.

Why do I have pain along my sciatic nerve?

The most reasonable explanation is that there is (or has been at some time) a mechanical or inflammatory irritation of one or more of the nerve roots in the lower back. Commonly, a patient with classic sciatica symptoms will have an MRI showing compression of the S1 spinal nerve root. This is not always the case though.┬áThe source of irritation could be structural, such as a bulging disc or osteophyte. Or it may be more a product of an ongoing cycle of muscular tightness and nerve sensitivity. Or perhaps a product of autoimmune activity. Like any clinical scenario in which there is spinal pain, and pain referred along the path of a particular nerve, we need to make a clinical judgement about the likely driver of a patient’s symptoms and the likely success of physio interventions.

How does Physio Work for Sciatica?

An effective treatment plan needs to include appropriate education about how pain works, combined with appropriate medication, manual therapy and a graded return to pre-injury or pre-pain activities. Most often this is sufficient for a full recovery to normal recreational and occupational activities. There are of course instances where the source of pathology is not amenable to Physio interventions. In these scenarios, the onus is on me as your physio to recognise your symptoms as such, and to refer you back to your GP and onto an appropriate specialist- usually a neurologist or spinal surgeon, depending on your specific circumstances.

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