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Sciatica Treatment with Manual Techniques, Stretches, and Exercises: The Chiropractic Perspective

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What is sciatica?

Sciatica refers to the symptoms caused by impingement of the sciatic nerve. This nerve travels from the lower back down through each leg to the feet. When compressed, it becomes inflamed, causing pain and discomfort. With noninvasive treatment, sciatica can typically resolve within a few weeks, but some severe cases require surgical management.

While there are many treatments available for sciatica, studies show that chiropractic treatment can effectively manage symptoms and address the underlying causes of sciatica. One clinical trial showed a 72% success rate in the chiropractic treatment of sciatica. Chiropractic treatments use many of the same principles as PT and OT: manual techniques, stretching, and strengthening. Let’s take a look into these sciatica treatments with examples for your clients.

Sciatica overview

After more than a year of the COVID-19 pandemic, many of us are adjusting to more sedentary lifestyles. Several have begun working from home or spend more time on their screens. Some have had to change their fitness routine. Unfortunately, this increase in sedentary lifestyles can also lead to increased sciatica cases. In fact, sedentary lifestyles and jobs that involve a lot of sitting are among the most significant risk factors for sciatica pain.

We are all familiar with the trademark sciatica signs and symptoms. Burning or shooting pain running from the lower back down through the leg is a classic indicator. Pain generally centers on the back of the leg or buttock and only affects one leg. Pain levels and type can vary, from a dull ache to a debilitating burning sensation. Other symptoms include:

  • Numbness
  • Tingling
  • Muscle weakness
  • Pain that worsens when seated
  • Burning sensations along the back of the leg
  • Bowel and bladder dysfunction (rarely)

Sciatica can affect people of any age, but most cases are in those between the ages of 30-50. Other risk factors include those who live a sedentary lifestyle or sit for long periods at a time.

Since sciatica is a form of radiculopathy, a lumbar herniated disc is usually to blame. Some research shows that a lumbar herniated disc causes up to 90% of sciatica. This compression can come from internal or external factors. Degenerative changes such as diabetes or age, a sedentary lifestyle, or physical labor with poor ergonomics can be to blame. This compression can also be caused internally by bone spurs on the spine or the pressure caused by pregnancy.

Treatment Methods for Chiropractic Sciatica Care

Stretches and exercise are often the most effective methods to address sciatica pain. However, chiropractors may also use other treatments to increase the effectiveness of the exercises. For example, ultrasound treatments can help to decrease inflammation and improve circulation in the affected areas. Hot and cold packs can also relieve pain, and the use of NSAIDs can address pain and swelling. TENS units may also help to manage the symptoms.

Chiropractors can provide an additional level of care by performing spinal manipulations and adjustments. By correcting the placement of the spine, chiropractors relieve the pressure on the sciatic nerve. Sometimes this can provide instant relief of pain. Over time, chiropractic adjustments restore the correct position of the lumbar vertebrae and correct the herniated discs that cause sciatica.

Stretches for chiropractic sciatica treatment

By mobilizing the areas surrounding the impingement, stretches can provide instant relief of pain. In addition, increasing the range of motion of the lower back, hips, and thighs can prevent further injury.

The piriformis and hamstring muscles are the most influential muscles in sciatica pain. By relieving any tightness of these muscles, sciatica symptoms can be decreased or even eliminated.

The Sciatic Mobilizing Stretch is specifically designed to release these muscles. With the patient supine, slowly bring the affected knee to the chest. Using one hand to stabilize the hamstring area, gradually straighten the leg. Once the knee is extended, bring the leg toward the patient into hip flexion, within their tolerance. Maintain this position for 20-30 seconds. Remind the patient to breathe deeply during stretching. Repeat this range of motion exercise with both legs, two to three times.

The Supine Piriformis Stretch provides further deep tissue relaxation. With the patient supine, bend their knees and place their feet flat on the bed or plinth. Cross the legs, placing the affected ankle over the other knee. Keep the affected foot flexed. Keeping the ankle placed on the knee, slowly bring the knee toward the chest. Once the patient feels a stretch or you encounter resistance, hold that position for 15-20 seconds. Remind the patient to breathe deeply during stretching.

To increase the depth of the stretch, keep the affected leg perpendicular to the body while it is stretching. Repeat this range of motion exercise with both legs two to three times. This stretch is also known as a “Figure Four Stretch.”

Exercises for chiropractic sciatica relief

To decrease the excess pressure placed on the spine, we need to increase the strength of the supporting postural muscles. As a result, any core or postural strengthening exercises can be used in sciatica treatment. These offset the load placed on the herniated disc and prevent further damage from poor posture or ergonomics.

Core strengthening exercises such as bridge exercises provide abdominal strengthening and a slight stretch to the back muscles. With the patient lying supine, bend the knees and place the feet flat on the bed or mat. The hands remain parallel to the body on the mat. Activating the abdominal muscles, instruct the patient to bring the hips up towards the ceiling. Hold that position for 2-3 seconds, then bring the hips back down to the mat. Patients can perform two sets of 10 repetitions each, depending on their ability.

Exercises to strengthen and stabilize the back can also provide sciatica relief. Bird dog exercises, also known as Quadruped Arm and Leg Raises, improve postural control. In a quadruped position on the hands and knees, the patient raises the opposite arm and leg into extension. Maintaining a neutral spine and abdominal contraction, the patient keeps the extended arm and leg straight and avoids pelvic tilt for 2-3 seconds. The patient can perform two sets of 10 repetitions each, depending on ability.

Sciatica treatment exercises on Eccentron

The Eccentron is an excellent tool for activating the gluteal and hamstring muscles to treat sciatica using eccentric resistance. Research shows that eccentric exercise yields 4x greater muscle activation in the lower extremities than traditional concentric exercises. Even if your client has a low tolerance for exercise, the eccentric-only contraction activates the muscle without strain on the joints and without cardiopulmonary exertion. That means you can safely use it for elderly clients and severe cases of sciatica where the muscles are tight or painful.

Home recommendations for sciatica management

Since lifestyle factors often cause sciatica, small changes at home can lead to significant improvements. In addition, education plays a vital role in the carryover of any benefits provided throughout chiropractic treatment of sciatica.

Ergonomic training can benefit patients who perform physical labor. Frequent lifting, bending, and twisting the back could lead to further injury. Train the patient in lifting with the legs and pushing or pulling to avoid lifting when possible. Remind the patient of the danger of twisting the spine when carrying a load. If standing for long periods, shift weight and alternate positions frequently.

Patients who lead a largely sedentary lifestyle also need ergonomic training. Remind the patient of the 90-90-90 rule while seated at a desk. The knees, hips, and ankles should be at a 90-degree angle to avoid unnecessary strain on the back or hips. Take breaks from sitting to move around, and change the sitting position frequently. Encourage the patient to use an ergonomic chair insert to protect the lumbar area. If the feet do not reach the floor while seated, make use of a footrest or stool.

Why chiropractic treatment for sciatica works

Chiropractic treatment for sciatica provides minimally invasive, highly effective results. It offers a holistic approach to managing sciatica pain by addressing the root cause of the symptoms. Studies indicate that active spinal manipulation in the chiropractic treatment of sciatica leads to improved outcomes and longer-lasting benefits. By combining spinal manipulation, stretches,  exercise, and patient training, chiropractic treatment relieves sciatica and prevents further injury.

 

Sydney Moninger, OTA

 

References

  1. Hochschuler, S. 2019. “Sciatica Causes”. Spine Health. https://www.spine-health.com/conditions/sciatica/sciatica-causes
  2. Yun, J. 2019. “Sciatica- A Common Pain in the Nerve for All Ages”. Hackensack Meridian Health. https://www.newswise.com/coronavirus/sciatica-a-common-pain-in-the-nerve-for-all-ages
  3. “How Chiropractic Helps Those That Suffer from Sciatica”. 2016. Gonstead Chiropractic. https://gonsteadchiropracticcenter.com/how-chiropractic-helps-those-that-suffer-from-sciatica/
  4. “Sciatica”. Mayo Clinic. 2021. https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435
  5. Axe, J. 2018. “Top 10 Benefits of Chiropractic Adjustments”. https://draxe.com/health/10-researched-benefits-chiropractic-adjustments/
  6. “Chiropractic Treatment for Sciatica”. 2021. Lake Worth Injury and Wellness. https://www.mylakeworthchiropractor.com/conditions/sciatica
  7. Santilli, V. et al. 2006. “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations”. The Spine Journal. https://www.thespinejournalonline.com/article/S1529-9430(05)00833-8/fulltext
  8. “10 Piriformis Stretches to Get Rid of Sciatica Hip and Lower Back Pain”. 2021. Rocket City Chiropractic. https://www.rocketcitychiropractic.com/10-piriformis-stretches-to-get-rid-of-sciatica-hip-and-lower-back-pain/
  9. “Sciatica Exercises: 4 Exercises for Sciatica Pain”. 2021. Spine Universe. https://www.spineuniverse.com/conditions/sciatica/exercises-sciatica-degeneratve-disc-disease
  10. “Maintaining Good Posture”. 2021. American Chiropractic Association. https://www.acatoday.org/Patients/Health-Wellness-Information/Posture