By Aleisha Theisen, PTA and NBC-HWC 
As spring approaches, many people follow the itch to start working in the garden, go hiking, or get back to their favorite warmer-weather sports. With this increased activity comes a rise in cases of sciatica, a painful condition that most often results from nerve irritation in the lower back.
Aaron Frye, FYZICAL-Forest Grove owner and a physical therapist at the clinic, treats this condition regularly. He says with the proper protocol, patients can get complete relief.
What Causes Sciatica?
Sciatica usually occurs when the sciatic nerve, which runs from the lower back down the back of the leg, becomes compressed at the lumbar spine or sacrum.
The pain is often triggered by activities involving bending, twisting, and lifting or even prolonged poor posture, such as slouching on a couch or in a lawn chair.
Common symptoms include:
- Radiating pain down the back of one leg
- Numbness or weakness in the leg
- Difficulty sitting for long periods
- Increased pain with bending or twisting motions
Some patients have no back pain, just hip and/or leg symptoms, so they may be surprised to learn the issue originates in their lumbar spine, Aaron says. If standing and walking reduce the pain, this is a strong indicator that sciatica treatment will be helpful for them.
Rarely does it occur in both legs. If it’s happening on both sides, it’s likely a different issue, such as lumbar stenosis, which would need a different type of treatment.
Common Misconceptions About Treatment
Aaron says many patients attempt to stretch their hamstrings, hips, or buttocks in hopes of relieving sciatic pain. While this might provide temporary relief, it often doesn’t address the root cause.
One of the most common underlying issues is lumbar spine derangement, often due to disc problems. To effectively treat sciatica, focusing on the lower lumbar spine is crucial.
Effective Treatment Strategies
Aaron is trained in the Mechanical Diagnosis and Therapy (aka McKenzie Method) for evaluating and treating back pain, and he’s found this to be very successful in his PT practice at FYZICAL-Forest Grove.
Many patients with sciatica benefit from postural and body mechanics training and a methodical progression of spinal extension. This progression includes:
1.) Lying face down (prone position) for 1-3 minutes: This can help reduce pressure on the nerve by positioning the spine in modest extension. If symptoms decrease or move up the leg closer to the low back, progress to #2.
2.) Propping on elbows for 1-3 minutes: This produces/encourages greater spinal extension and begins to restore the nature curve in the low back. If symptoms decrease or move further up the leg closer to the low back, progress to #3.
3.) Full lumbar extension (similar to cobra pose in yoga): Perform 10 repetitions. This produces a more aggressive realigning/reductive force. First, press upward and lock your elbows out completely, then exhale completely allowing your hips to drop/sag to provide an end-range corrective load.
A great indication that you are on the right track is if your pain “centralizes” or concentrates in the center of the lower back. It might intensify temporarily, but Aaron says this is actually a good sign. In 95% of cases where the “centralization phenomenon” occurs, the pain goes away completely.
Who is Most Affected?
Sciatica is most common in middle-aged individuals and can also affect “weekend warriors” who overexert themselves in sports or other recreational activities. Older adults tend to experience different spinal changes, such as stenosis, which can require a different treatment approach.
Empowering Patients Through Education
Aaron emphasizes patient education during his treatments, using images of the spine and muscles to help patients understand their condition. He believes empowering individuals with knowledge allows them to take an active role in their recovery. The goal is for patients to realize they can improve their pain through proper movement and strengthening and learn tools to manage the condition independently. He also often recommends the book Treat Your Own Back as a resource for self-management.
Manual Therapy and Strengthening
In addition to movement correction, Aaron may use a combination of manual therapy techniques for pain relief, such as soft tissue mobilization, joint mobilization/manipulation, and Augmented Soft Tissue Mobilization (Astym). Astym uses specialized instruments to apply gentle pressure to soft tissue, breaking down scarring and promoting regeneration of healthy tissue.
While this can provide helpful relief in the beginning of the treatment plan, Aaron says strengthening exercises are the key to long-term recovery.
Preventing Recurrence
Up to 80% of adults experience some type of low back pain, and once it occurs, they are highly susceptible to future episodes. However, research-backed strategies can reduce recurrence of sciatica by 50%.
In the case of sciatica, Aaron says the focus should be on:
- Initially avoiding bending, twisting or other movements that disrupt the low back and irritate the sciatic nerve
- Extension and strengthening of the lumbar spine
- Maintaining good posture and body mechanics
- Gradually returning to normal movements and activities
Real-World Success Stories
Aaron sees patients come into the clinic with frustrating, debilitating sciatic pain. They may be unable to sit for more than 10 minutes at a time and struggle to get good sleep. Through guided treatment their pain gradually disappears.
“Once we work on a program to stabilize their spine, they are independent and back to normal activity,” he says.
If you suspect you may have sciatica or are dealing with another type of back pain, you don’t have to sit on the sidelines this spring. Aaron and his team of PTs at FYZICAL-Forest Grove can evaluate you and create a treatment program to get you back on track and feeling better. Call 503-357-1706 to schedule your visit.
Aleisha Theisen is a physical therapist assistant and a board-certified health and wellness coach.
Disclaimer: This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.