The sciatic nerve is the longest and thickest nerve in the body, originating from the lumbosacral plexus and running through the pelvis and gluteal region down the back of each leg. Sciatica is pain or numbness caused by irritation or compression of the sciatic nerve, which can result from herniated discs, spinal stenosis, piriformis syndrome, or other causes that apply pressure on the nerve. Physical therapy management of sciatica focuses on reducing pain and inflammation, maintaining muscle strength and range of motion, retraining gait and sensory function, and addressing the underlying compressive cause through techniques like stretching, strengthening exercises, electrical stimulation, bracing, and manual therapy.

1. ARIJITBANERJEE
SCIATICA
ANATOMY
Sciaticnerve isthe longestandthickestnerve inthe body.Itis
the largestbranch of lumbosacral plexus.
 NERVES ROOT: L4-S3
 COURSE:Itexiststhe pelvisthroughthe sciaticnotch(the
greatersciaticforamen) alongwiththe superficial gluteal nerve,
inferiorglutealnerve andposteriorcutaneousnerveof thighand
entersthe gluteal region.Itemergesinferiorlytopiriformis
muscle anddescendsdownwardsininferolateraldirection.Asthe
nerve passesthroughthe gluteal region,itcrossesthe posterior
surface of superiorgemellus,obturatorinternus,inferior
gemellus.Thenitentersthe posterioraspectof thighbypassing
deeptothe longheadof bicepsfemoris.Inposteriorthigh,the
nerve givesbranchestohamstringandadductormagnusmuscles.
On reachingthe apex of popliteal fossaitterminatesby
bifurcatingintotwobranches- Tibial nerveandcommonperoneal
nerve.
 SENSORYSUPPLY: Nodirectsensoryinnervation.Indirectly
suppliesthe skinof the lateral aspectof leg,heel andboth
plantarand dorsal surfacesof footvia itsterminal branches.
 MOTOR SUPPLY: Itsuppliesthe musclesof posteriorthigh
and hamstringportion of adductormagnus.Indirectlysupplies
the musclesof legand footviathe terminal branches.
DEFINITION OF SCIATICA
Sciaticais a setof symptomsinwhichthe patientexperiencespainand/orparesthesiainthe distributionof the
sciaticnerve or an associatedlumbosacral nerveroot.
ETIOLOGY OF SCIATICA
It is causedbythe irritationorcompressionof sciaticnerve.
 INFLAMMATORY CAUSES
 Sciaticneuritis
 Arachnoiditis
 COMPRESSIVE CAUSES
 Compressioninthe vertebralcanal bydisc,tumour, tuberculosis
 Compressioninthe intervertebral foramendue torootcanal stenosisbecause of OA,spondylolisthesis,
facetarthropathyor tumours
 Compressioninthe buttockorpelvisbyabscess,tumour,haematoma
 Entrapmentinfrontof the sacroiliacjoint, underthe piriformis,overthe quadratesfemoris,underthe
gluteusmaximusorbetweenthe hamstringmuscles.
 Malpositionof body
 Sittingoverthe edge of hard surface (E.g.BedFrame)
 Duringpregnancyas a resultof the weightof the fetuspressingonthe sciaticnerve duringsitting.

2. ARIJITBANERJEE
PATHOGENESIS
Gradual compressionof nerve overaprolongedperiodleadstoischemiaof nerve characterizedbyavarietyof
symptomsthatdependsonthe nerve injured,site of compressionandthe durationof injury.Progressive
compressionleadstothe demyelinationof nerve thatmaycompromise the functionof normal nerve andmay
resultindistal axonal degenerationif leftuntreated.
CLINICAL FEATURE
Lowerback painusuallyaffectsone side of the body
Paininthe back of the leg-radiatingtype usuallyoriginatesinthe low backor buttockand continuesalong
the course of sciaticnerve
Painisrelievedwhenpatientlie downorwalkingandbecomesworstinstandingorsitting
Burning,tingling,numbnessalongthe backof the thighand leg
Shootingpain
Crampson prolongedstanding- neural claudication
Sensorydysfunction,paresthesiaoverthe legandfootbelow knee
Weaknessof hamstring,all the musclesbelow knee
Ankle jerkislostordiminished
Gait dysfunction
PT ASSESSMENT
 DEMOGRAPHIC DATA
 NAME
 AGE: Olderadultsabove 55 to 60 yearsare mostlyaffected.Itcanstrike evenduringchildhood.
 GENDER:It affectsmenandwomenequally.
 OCCUPATION: It has beenshowninmachine operators,truckdrivers,andjobswhere workersare subject
to physicallyawkwardposition.
 CHIEF COMPLAIN:
Patientscomplainaboutlowbackpain,whichisusuallylesssevere thanthe legpain. Patientsmayalso
reportsensorysymptoms.
 HISTORY TAKING
 HISTORY OF PRESENT ILLNESS
The presentingsymptomsmayinvolve the low backorbuttockand continuesalongthe course of
sciaticnerve.The isvary dependingonthe causative factor.Withthe compressive factor,the onsetwill be acute.
Inflammatoryfactorshave asubacute course extendingoverdaystoweeks.
 HISTORY OF PAIN:
Painoftenhas a deep,burning,ordrawingcharacterthat may be associatedwithjabbingorshooting
pains.Paininthe back of the leg-radiatingtype usuallyoriginatesinthe low backorbuttock andcontinuesalong
the course of sciaticnerve.Painisrelievedwhenpatientlie downorwalkingandbecomesworstinstandingor
sitting.
 HISTORY OF PAST ILLNESS:
Take a note on any trauma,or spinal injurythatmaycompressthe nerve.Take a note on diabetes.
 PERSONAL HISTORY
Addictionof smoking/alcoholisnoted.
 OCCUPATIONAL HISTORY:
It hasbeenshowninmachine operators,truckdrivers,andjobswhere workersare subjectto
physicallyawkwardposition.

3. ARIJITBANERJEE
 OBSERVATION
Checkfor the attitude of the lowerlimb.
Observe forwastingof the muscles
Observe foranyskinchanges.It indicateseitherprolongedinactivityorinvolvementof fiberinthe
peripheral nerveregulatingautonomicfunction
Checkwhetheranyswellinginhe involvedareaoranygross swellingwhichmaybe relevant.
Observe foranyscars or unhealedwoundsorskininfectionsinthe limb.
 PALPATION
Checkfor the temperature (Local) overthe areaof affectionandcompare withthe normal
Palpate the edema,if present
Checkfor the tendernessoverthe areaof affection.
 EXAMINATION
SENSORY EXAMINATION
All sensorymodalitiesshouldbe tested.Includingpinprick,light,touch,proprioception,Vibration,
Graphesthesiaandtemperature.If Sensorydeficitsare detected,the extentandpatternof the lossshouldbe
determined.
MOTOR EXAMINATION
Muscle strengthshouldbe gradedbyMMT of hamstring,all the musclesbelow knee.Toexaminethe
tone,quickpassive movementisdone.The musclesbecome hypertonic.
REFLEX TESTING
The ankle jerkislostor diminished.
GAIT EXAMINATION
Ask the patienttowalka few stepsto see if nerve damage hasaffectedgaitpattern.Ataxias,high
steppinggaits,etcmaybe seen.
 SPECIAL TEST
SlumpTest
SLR Test
 INVESTIGATION
 NCVSTUDIES:
NCV testis usedtomeasure the speedof conductionof anelectrical impulse throughnerve thatmay
be sloweddown
 EMG STUDIES
It isuseful todetermine the extentandseverityof nerve lesion.
 X-RAY
X-rayof the lumbosacral spine mayevaluateforfracture orspondylolisthesis.
PT MANAGEMENT
 ACUTE PHASE: [ BETWEEN ONE AND TWO WEEKS]
GOAL INTERVENTION
RELIEF PAIN
 TENS- High TENS can be giventorelieve radiatingpains.
 Ultrasound- PulsedUltrasoundbelow 1W/cm2
canbe used.It can penetrate toloosen
adhesionsdeeplysetlike atthe hipjoint.
 LASER Therapy- Lowlasertherapy;spectrumat 635nm increase the circulationlocallyto
reduce muscle spasm.

4. ARIJITBANERJEE
PREVENTION OF EDEMA
Edemaoccurs due to gravitydependentpositionof limbcoupledwithlackof musculartone.
 Extremityelevationalongwitheffleurage massageisgiventodispel the edema
 Crepe bandage andelevationisalsogiventopreventedema
MAINTAIN THE PROPERTIES
OF THE MUSCLE
 Galvaniccurrentgivenas theyare of longerpulse duration.Artificiallycontracting
muscleswill ensure aproperbloodsupplyaswell ashelpinmaintenanceof excitation,
contractionand coupling.
PREVENT ANY ABNORMAL
ATTITUDE OF THE AFFECTED
PART
 Splintingorbracingmaybe necessarytopreventdeformitiesdue tostrengthimbalances
E.g. use of a plantarflexionsplinttopreventfootdrop.AFOmaybe givenforcomfortable
ambulation.
 CHRONIC STAGE:
GOAL INTERVENTION
SENSORY RETRAINING
 Sensoryreeducation- Itinclude touchingdifferenttexturedobjects,massage,vibration,
pressure,determiningjointposition,identifyingdifferenttemperature andelectrical
stimulation.Ithelpstotherapisttoretrainsensorypathwaysorstimulate unusedpathways.
Desensitization- Asnervesregenerate,the personexperiencesincreasedsensitivity
(hypersensitivity)inthe areathat hadpreviouslybeenwithoutsensation.Use agradedseriesof
modalitiesandproceduresthatproduce the leastpainful responsetothe stimuli thatproduce
the most painful response.Once the affectedareabeginstoacclimate toinitial stimulus,the
nextstimulusisincorporated.Desensitizationprogrammayprogressfromaverysoft material
stimulus(i.e.silk)toa rougher material (i.e.wool) ortexturedfabric(i.e.Velcro).
GAIT& BALANCE
RETRAINING
 It typicallybeginswiththe use of the tilttable because ithelpspreventdeteriorationin
orthostatictolerance.Thiscanalsobe started inbedby havingthe patient situprightfor
extendedperiods,astolerated.There isacardiovascularandautonomicadaptationasthe
patientisgraduallyelevatedtothe uprightposition.
 Patientsare nextallowedtostandina standingtable,whichimprovestheirmuscular
endurance andpermitsthemtoworkon othertasks. Thenthe patientisadvancedtothe
parallel bars,withthe close assistance of the therapist.
 Nextthe patientcanbe advancedto ambulationwithassistive devicesthenambulation
withoutassistivedevices.
FUNCTIONAL
RETRAINING
Lowerlimbsactivitieslike level walking,staircase climbingetc.needstobe given.
MANAGEMENT OF
UNDERLYINGCAUSE
 HERNIATED DISC MANAGEMENT- Extensionexercisesorpressupsare prescribed
 SPINAL STENOSIS MANAGEMENT- Flexionexercisesof the lowerbackare suggested.Flexingthe
lowerspine opensthe spinalcanal andallowsthe irritationtoresolve.Stretchingexercisesfor
the back are done.Forstrengtheningthe abdominal muscleshooklyingmarchandcurl ups an
be practiced.
 DEGENERATIVE DISC DISEASE MANAGEMENT: A dynamiclumbarstabilizationprogramis
recommended.Throughthisprogramthe patientfindsthe mostcomfortable positionforthe
lumbarspine andpelvisandattemptstomaintainthispositionduringactivities.When
performedcorrectly,thisexercise canimprove the proprioceptionof the lumbarspine and
reduce the excessmotionatthe spinal segments.Thisreducesthe amountof irritationatthese
segmentsrelievingpainandprotectingthe areafromfurtherdamage.
 PIRIFORMIS SYNDROME MANAGEMENT- Stretchingthe muscle,hamstringmusclesandhip
extensormusclesmaydecreasepainandimprove the ROM.Muscle energytechniquecanalso
be usedinthis case.