Sciatica Treatment Options

A title like this loses the attention of half of the people coming across this pain.  That’s okay.  I’m used to be being boring.   I did find this series of several articles to be interesting.

Most everyone that comes into my office believes that they have sciatica or have been told by an acquaintance that their symptoms must be caused by “pinching off” the sciatic nerve.

While that is not always the case, sciatica or pain referred from the spine to the limbs is a very common. There are a number of factors that can cause pain to be perceived in the leg, for example, as a consequence of an issue at the level of the lumbar spine.  Disc bulges, bone spurring, fibrosis/scarring or even entrapment/irritation in the piriformis muscle can be a cause of radiculopathy (or a pain that travels to the leg in a distribution consistent with “sciatica”).

Sciatica may affect as much as 43% of the population during the course of our lives.[i]  Treatment options for sciatica symptoms include:

• Physical therapy and exercise interventions
• Medications for management of symptoms
• Injections (e.g. epidural steroid injection) to address inflammatory processes at the level of the nerve root
• Surgery to decompress or alleviate pressure on a nerve root

The nuts and bolts of neuromobilization involve stretching techniques aimed at mobilizing nerve tissues (rather than the traditional aim of stretching out muscle tissues).  There is a lot of overlap between traditional seeming stretches and neuromobilization techniques.

Neural flossing of the sciatic nerve, for example, involves something similar to a hamstring stretch with subtle changes to focus on mobilizing the length of neural tissues from the foot to the lumbar spine (pictured to the right).

A recent study in the Journal of Back and Musculoskeletal Rehabilitation looked at case studies of patients that did not respond to three “routine physical therapy sessions” and subsequently received neuromobilization techniques for 6 sessions.  The authors reported significant improvement in pain and function with the employment of these techniques.[iii]

A related study found that “neuromobilization therapy was superior to standard physiotherapy as regards eliminating or decreasing elevated resting muscle tone in response to pain in patients with low back pain.”[iv]

A study from more of a surgical perspective published in the October issue of Spine looked at patients undergoing microdiscectomy procedures had evidence on pathologic examination of “periradicular tissue consisted of the granulation with vascularization and many inflammatory cell infiltrations.”  They concluded that “The presence of periradicular fibrosis will compound the nerve root pain by fixing the nerve in one position, thereby increasing the susceptibility of the nerve root to tension or compression.”[v]

So, if you have an element of radicular-type pain or sciatica think about incorporating neuromobilization exercises in your program.  Or see a physical therapist trained in these techniques.  They may save you from the plague of sciatica that walks into my office.
 

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[i] Spine.  2008. Oct 15; 33(22):2464-72

[ii] http://noineurodynamics.blogspot.com/

[iii] Journal of Back and Musculoskeletal Rehabilitation. 2010. 23: 151-159

[iv] Ortop Traumatol Rehabilitation  2009 Mar-Apr;11(2):164-76.

[v] Spine.  2010.  35(22): 2004-2014