Sciatica

with Rehab

ExitCare ImageThe sciatic nerve runs from the back down the leg and is responsible for sensation and control of the muscles in the back (posterior) side of the thigh, lower leg, and foot. Sciatica is a condition that is characterized by inflammation of this nerve.

SYMPTOMS

  • Signs of nerve damage, including numbness and/or weakness along the posterior side of the lower extremity.

  • Pain in the back of the thigh that may also travel down the leg.

  • Pain that worsens when sitting for long periods of time.

  • Occasionally, pain in the back or buttock.

CAUSES

Inflammation of the sciatic nerve is the cause of sciatica. The inflammation is due to something irritating the nerve. Common sources of irritation include:

  • Sitting for long periods of time.

  • Direct trauma to the nerve.

  • Arthritis of the spine.

  • Herniated or ruptured disk.

  • Slipping of the vertebrae (spondylolithesis)

  • Pressure from soft tissues, such as muscles or ligament-like tissue (fascia).

RISK INCREASES WITH:

  • Sports that place pressure or stress on the spine (football or weightlifting).

  • Poor strength and flexibility.

  • Failure to warm-up properly before activity.

  • Family history of low back pain or disk disorders.

  • Previous back injury or surgery.

  • Poor body mechanics, especially when lifting, or poor posture.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique, especially with posture and lifting. When possible, have coach correct improper technique.

  • Avoid activities that place stress on the spine.

PROGNOSIS

If treated properly, then sciatica usually resolves within 6 weeks. However, occasionally surgery is necessary.

RELATED COMPLICATIONS

  • Permanent nerve damage, including pain, numbness, tingle, or weakness.

  • Chronic back pain.

  • Risks of surgery: infection, bleeding, nerve damage, or damage to surrounding tissues.

TREATMENT

Treatment initially involves resting from any activities that aggravate your symptoms. The use of ice and medication may help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. A therapist may recommend further treatments, such as transcutaneous electronic nerve stimulation (TENS) or ultrasound. Your caregiver may recommend corticosteroid injections to help reduce inflammation of the sciatic nerve. If symptoms persist despite non-surgical (conservative) treatment, then surgery may be recommended.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Sciatica

Most people with sciatic will find that their symptoms worsen with either excessive bending forward (flexion) or arching at the low back (extension). The exercises which will help resolve your symptoms will focus on the opposite motion. Your physician, physical therapist or athletic trainer will help you determine which exercises will be most helpful to resolve your low back pain. Do not complete any exercises without first consulting with your clinician. Discontinue any exercises which worsen your symptoms until you speak to your clinician. If you have pain, numbness or tingling which travels down into your buttocks, leg or foot, the goal of the therapy is for these symptoms to move closer to your back and eventually resolve. Occasionally, these leg symptoms will get better, but your low back pain may worsen; this is typically an indication of progress in your rehabilitation. Be certain to be very alert to any changes in your symptoms and the activities in which you participated in the 24 hours prior to the change. Sharing this information with your clinician will allow him/her to most efficiently treat your condition.

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

FLEXION RANGE OF MOTION AND STRETCHING EXERCISES:

ExitCare Image STRETCH – Flexion, Single Knee to Chest

  • Lie on a firm bed or floor with both legs extended in front of you.

  • Keeping one leg in contact with the floor, bring your opposite knee to your chest. Hold your leg in place by either grabbing behind your thigh or at your knee.

  • Pull until you feel a gentle stretch in your low back. Hold __________ seconds.

  • Slowly release your grasp and repeat the exercise with the opposite side.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Double Knee to Chest

  • Lie on a firm bed or floor with both legs extended in front of you.

  • Keeping one leg in contact with the floor, bring your opposite knee to your chest.

  • Tense your stomach muscles to support your back and then lift your other knee to your chest. Hold your legs in place by either grabbing behind your thighs or at your knees.

  • Pull both knees toward your chest until you feel a gentle stretch in your low back. Hold __________ seconds.

  • Tense your stomach muscles and slowly return one leg at a time to the floor.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Low Trunk Rotation

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor.

  • Extend your arms out to the side. This will stabilize your upper body by keeping your shoulders in contact with the floor.

  • Gently and slowly drop both knees together to one side until you feel a gentle stretch in your low back. Hold for __________ seconds.

  • Tense your stomach muscles to support your low back as you bring your knees back to the starting position. Repeat the exercise to the other side.

Repeat __________ times. Complete this exercise __________ times per day

EXTENSION RANGE OF MOTION AND FLEXIBILITY EXERCISES:

ExitCare Image STRETCH – Extension, Prone on Elbows

  • Lie on your stomach on the floor, a bed will be too soft. Place your palms about shoulder width apart and at the height of your head.

  • Place your elbows under your shoulders. If this is too painful, stack pillows under your chest.

  • Allow your body to relax so that your hips drop lower and make contact more completely with the floor.

  • Hold this position for __________ seconds.

  • Slowly return to lying flat on the floor.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Extension, Prone Press Ups

  • Lie on your stomach on the floor, a bed will be too soft. Place your palms about shoulder width apart and at the height of your head.

  • Keeping your back as relaxed as possible, slowly straighten your elbows while keeping your hips on the floor. You may adjust the placement of your hands to maximize your comfort. As you gain motion, your hands will come more underneath your shoulders.

  • Hold this position __________ seconds.

  • Slowly return to lying flat on the floor.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Sciatica

These exercises may help you when beginning to rehabilitate your injury. These exercises should be done near your "sweet spot." This is the neutral, low-back arch, somewhere between fully rounded and fully arched, that is your least painful position. When performed in this safe range of motion, these exercises can be used for people who have either a flexion or extension based injury. These exercises may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress with the resistance and repetition exercises only as your caregiver advises.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTHENING – Deep Abdominals, Pelvic Tilt

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor.

  • Tense your lower abdominal muscles to press your low back into the floor. This motion will rotate your pelvis so that your tail bone is scooping upwards rather than pointing at your feet or into the floor.

  • With a gentle tension and even breathing, hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTHENING – Abdominals, Crunches

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor. Cross your arms over your chest.

  • Slightly tip your chin down without bending your neck.

  • Tense your abdominals and slowly lift your trunk high enough to just clear your shoulder blades. Lifting higher can put excessive stress on the low back and does not further strengthen your abdominal muscles.

  • Control your return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTHENING – Quadruped, Opposite UE/LE Lift

  • Assume a hands and knees position on a firm surface. Keep your hands under your shoulders and your knees under your hips. You may place padding under your knees for comfort.

  • Find your neutral spine and gently tense your abdominal muscles so that you can maintain this position. Your shoulders and hips should form a rectangle that is parallel with the floor and is not twisted.

  • Keeping your trunk steady, lift your right hand no higher than your shoulder and then your left leg no higher than your hip. Make sure you are not holding your breath. Hold this position __________ seconds.

  • Continuing to keep your abdominal muscles tense and your back steady, slowly return to your starting position. Repeat with the opposite arm and leg.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTHENING – Abdominals and Quadriceps, Straight Leg Raise

  • Lie on a firm bed or floor with both legs extended in front of you.

  • Keeping one leg in contact with the floor, bend the other knee so that your foot can rest flat on the floor.

  • Find your neutral spine, and tense your abdominal muscles to maintain your spinal position throughout the exercise.

  • Slowly lift your straight leg off the floor about 6 inches for a count of 15, making sure to not hold your breath.

  • Still keeping your neutral spine, slowly lower your leg all the way to the floor.

Repeat this exercise with each leg __________ times. Complete this exercise __________ times per day.

POSTURE AND BODY MECHANICS CONSIDERATIONS - Sciatica

Keeping correct posture when sitting, standing or completing your activities will reduce the stress put on different body tissues, allowing injured tissues a chance to heal and limiting painful experiences. The following are general guidelines for improved posture. Your physician or physical therapist will provide you with any instructions specific to your needs. While reading these guidelines, remember:

  • The exercises prescribed by your provider will help you have the flexibility and strength to maintain correct postures.

  • The correct posture provides the optimal environment for your joints to work. All of your joints have less wear and tear when properly supported by a spine with good posture. This means you will experience a healthier, less painful body.

  • Correct posture must be practiced with all of your activities, especially prolonged sitting and standing. Correct posture is as important when doing repetitive low-stress activities (typing) as it is when doing a single heavy-load activity (lifting).

ExitCare Image RESTING POSITIONS

Consider which positions are most painful for you when choosing a resting position. If you have pain with flexion-based activities (sitting, bending, stooping, squatting), choose a position that allows you to rest in a less flexed posture. You would want to avoid curling into a fetal position on your side. If your pain worsens with extension-based activities (prolonged standing, working overhead), avoid resting in an extended position such as sleeping on your stomach. Most people will find more comfort when they rest with their spine in a more neutral position, neither too rounded nor too arched. Lying on a non-sagging bed on your side with a pillow between your knees, or on your back with a pillow under your knees will often provide some relief. Keep in mind, being in any one position for a prolonged period of time, no matter how correct your posture, can still lead to stiffness.

ExitCare Image PROPER SITTING POSTURE

In order to minimize stress and discomfort on your spine, you must sit with correct posture Sitting with good posture should be effortless for a healthy body. Returning to good posture is a gradual process. Many people can work toward this most comfortably by using various supports until they have the flexibility and strength to maintain this posture on their own.

When sitting with proper posture, your ears will fall over your shoulders and your shoulders will fall over your hips. You should use the back of the chair to support your upper back. Your low back will be in a neutral position, just slightly arched. You may place a small pillow or folded towel at the base of your low back for support.

When working at a desk, create an environment that supports good, upright posture. Without extra support, muscles fatigue and lead to excessive strain on joints and other tissues. Keep these recommendations in mind:

ExitCare Image CHAIR:

  • A chair should be able to slide under your desk when your back makes contact with the back of the chair. This allows you to work closely.

  • The chair's height should allow your eyes to be level with the upper part of your monitor and your hands to be slightly lower than your elbows.

BODY POSITION

  • Your feet should make contact with the floor. If this is not possible, use a foot rest.

  • Keep your ears over your shoulders. This will reduce stress on your neck and low back.

ExitCare Image INCORRECT SITTING POSTURES

  • If you are feeling tired and unable to assume a healthy sitting posture, do not slouch or slump. This puts excessive strain on your back tissues, causing more damage and pain. Healthier options include:

  • Using more support, like a lumbar pillow.

  • Switching tasks to something that requires you to be upright or walking.

  • Talking a brief walk.

  • Lying down to rest in a neutral-spine position.

ExitCare Image PROLONGED STANDING WHILE SLIGHTLY LEANING FORWARD

When completing a task that requires you to lean forward while standing in one place for a long time, place either foot up on a stationary 2-4 inch high object to help maintain the best posture. When both feet are on the ground, the low back tends to lose its slight inward curve. If this curve flattens (or becomes too large), then the back and your other joints will experience too much stress, fatigue more quickly and can cause pain.

ExitCare Image CORRECT STANDING POSTURES

Proper standing posture should be assumed with all daily activities, even if they only take a few moments, like when brushing your teeth. As in sitting, your ears should fall over your shoulders and your shoulders should fall over your hips. You should keep a slight tension in your abdominal muscles to brace your spine. Your tailbone should point down to the ground, not behind your body, resulting in an over-extended swayback posture.

ExitCare Image INCORRECT STANDING POSTURES

Common incorrect standing postures include a forward head, locked knees and/or an excessive swayback.

WALKING

Walk with an upright posture. Your ears, shoulders and hips should all line-up.

ExitCare Image PROLONGED ACTIVITY IN A FLEXED POSITION

When completing a task that requires you to bend forward at your waist or lean over a low surface, try to find a way to stabilize 3 of 4 of your limbs. You can place a hand or elbow on your thigh or rest a knee on the surface you are reaching across. This will provide you more stability so that your muscles do not fatigue as quickly. By keeping your knees relaxed, or slightly bent, you will also reduce stress across your low back.

CORRECT LIFTING TECHNIQUES

ExitCare Image DO :

  • Assume a wide stance. This will provide you more stability and the opportunity to get as close as possible to the object which you are lifting.

  • Tense your abdominals to brace your spine; then bend at the knees and hips. Keeping your back locked in a neutral-spine position, lift using your leg muscles. Lift with your legs, keeping your back straight.

  • Test the weight of unknown objects before attempting to lift them.

  • Try to keep your elbows locked down at your sides in order get the best strength from your shoulders when carrying an object.

  • ExitCare ImageAlways ask for help when lifting heavy or awkward objects.

INCORRECT LIFTING TECHNIQUES

DO NOT:

  • Lock your knees when lifting, even if it is a small object.

  • Bend and twist. Pivot at your feet or move your feet when needing to change directions.

  • Assume that you cannot safely pick up a paperclip without proper posture.