This report discusses the rehabilitation of sciatica, emphasizing the importance of a conservative treatment approach for the acute phase and outlining various rehabilitation strategies including exercises to improve posture, strength, and flexibility. It highlights the efficacy of manual therapy techniques and lifestyle modifications in managing pain and preventing future flare-ups. The report also reviews the roles of physical therapy, neuromuscular stimulation, and traction in the treatment of sciatica.

1. Rehabilitation of sciatica
Report about
College of
Health and medical technology
Baghdad
Department of
Physiotherapy & Rehabilitation
Done by
Zaid Hjab Tawfeeq
4th
stage student
Supervised by
Zainab Ali Hussein
M.Sc. Physiotherapy, B.M. Tech.

2. 1
Introduction:
Sciatica is a common pain syndrome, considering that ∼10% of low back pain
episodes, which have a lifetime cumulative incidence of 80%, will be accompanied
by sciatica. Nerve root compression by disc herniation is regarded as the most
frequent cause of sciatica.
Sciatica is mainly diagnosed by history taking and physical examination. In
general, the clinical course of acute sciatica is considered to be favorable. In the
first 6–8 weeks, there is consensus that treatment of sciatica should be
conservative. We review and comment on the levels of evidence of the efficacy of
patient information, advice to stay active, physical therapy analgesics, non-
steroidal anti-inflammatory drugs (NSAIDs), epidural corticosteroid injections and
transformational peri-radicular injections of corticosteroid. There is good evidence
that discectomy is effective in the short term. But, in the long term, it is not more
effective than prolonged conservative care. Shared decision making with regard to
surgery is necessary in the absence of severe progressive neurological symptoms.
Sciatica is a symptom rather than a specific diagnosis. The most important
symptom is leg pain radiating below the knee and into the foot and toes. Clinical
findings of neurological deficit, such as muscle weakness and reflex changes, may
also be present. Inw90% of cases, sciatica is caused by a herniated disc with nerve-
root compression, but lumbar canal or foramina stenosis and (less often) tumors or
cysts are other possible causes.

3. 2
Rehabilitation of sciatica:
Once your acute pain improves, your doctor or a physical therapist can design a
rehabilitation program to help you prevent future injuries. This typically includes
exercises to correct your posture, strengthen the muscles supporting your back
and improve your flexibility.
Goals of Physical Therapy and Exercise in Treating Sciatica:
 Restore pain-free functional movement patterns.
 Relieve lower back, buttock, thigh, and leg pain.
 Reduce muscle spasm.
 Restore function of the lumbar spine and the sacroiliac joint.
 Improve mobility of the lower body.
 Foster a better healing environment in the lower back.
 Promote neurologic adaptations to reduce the perception of pain.
 Prevent future pain flare-ups and reduce fear associated with movement.
Common techniques:
Extension and flexion back exercises: help relieve pain by promoting movement
of the spine. Often, individuals with lower back pain and sciatica feel relief with
specific directional movement of the spine. A physical therapist typically evaluates
an individual’s directional preference before prescribing specific directional
exercises, as these are tailored to the individual patient and symptoms. These
exercises include backward (extension) and forward (flexion) bending. This
directional movement is an important component of the McKenzie Method, also
known as mechanical diagnosis and therapy (MDT).

4. 3
The McKenzie Method (mechanical diagnosis and therapy):
Is a technique that involves a series of active directional movements to identify
and treat a pain source in the spine, muscles, and/or joints? The technique
focusses on moving the radiating pain closer to the center of the body through
exercise, for example, moving leg pain closer to the spine. The theory of this
approach is that centralizing the pain indicates improvements in symptoms. The
goal is to reduce radiating symptoms originating from the spine. A therapist who
practices this technique usually has special training in the McKenzie Method.
Exercise 1 – Lying Face
Down
Exercise 3 – Lying Face
Down in Extension
Exercise 4 – Extension in Lying
Exercise 5 – extension in standing Exercise 6 – extension in lying supine
Exercise 2 – Flexion
in Standing

5. 4
Strengthening exercises: include bodyweight and resistance exercises to
strengthen the muscles of the abdomen, low back, hips, and legs.
 Isometric exercises involve contracting muscles without moving the joints.
Examples of isometric exercises include a plank or a bridge hold. These
exercises can help strengthen muscles when symptoms are more acute.
 Isotonic exercises include the contraction of a muscle to resist a constant
load, such as resistance bands and weight training, to help increase muscle
strength through constant resistance to specific motions.
Functional retraining includes reintroducing movements, such as lifting, carrying,
and bending or squatting. The use of proper technique and healthy movement
patterns are incorporated to reduce pain and prevent re-injury.
Nerve glides (nerve mobilization) involves active or passive techniques on a
symptomatic nerve when it is placed into and out of tension to facilitate
movement and reduce symptoms.
Joint mobilization is a manual therapy technique in which the therapist applies
pressure to a joint to mobilize it and produce a therapeutic effect.
Joint manipulation is a manual technique in which the therapist applies a quick,
thrust force at the end range of motion of a joint to promote pain relief and
restore normal movement.
Dry needling is a technique in which a certified healthcare provider uses a small
needle to target a trigger point in a muscle. This technique is performed to
release hyper-irritable and/or hyper-contracted muscle tissue to reduce pain.
Muscle energy technique is a form of manual therapy that involves the patient
performing gentle muscle contractions in conjunction with the therapist moving
the painful joints through a specific range of motion. This technique may help
reduce pain and restore function.
Myofascial release and soft tissue mobilization include the therapist using their
hands or an instrument to mobilize the tissues in the lower back, hips, or legs to
treat fascial (underlying soft tissue) restrictions and decrease muscle tension or
spasm.

6. 5
Posture and Lifestyle Modifications for Sciatica:
In addition to physical therapy and exercise, committing to correct and
ergonomically supported posture while sitting, standing, and walking is essential
in treating and preventing sciatica. Daily routines, such as following ergonomically
safe lifting techniques and using good sleep postures are also important to follow.
Activity is more effective than bed rest:
When sciatica is severe, patients may find the pain hard to bear and may need to
rest a day or two. However, resting for more than a couple of days is generally not
advised, as prolonged rest or inactivity can increase pain and lead to
deconditioning. Regular movement is important to allow the flow of healing
nutrients to the injured structures that cause pain.
While physical therapy is usually elective, meaning that it is the individual’s
decision to participate or not, it is typically an essential component of resolving
the signs and symptoms and aiding in the long-term prevention of sciatica.
Physical Therapy Aids and Passive Techniques for Treating Sciatica:
Heat and Cold Packs
Heat packs may relieve pain by reducing muscle stiffness. The heat from these
packs helps dilate blood vessels, improve blood flow, and reduce muscle tension.
Using a heat pack may help promote relaxation and prepare for a physical therapy
appointment.
Cold packs may relieve pain by causing a numbing effect. These packs typically
constrict the blood vessels beneath the skin, helping to reduce pain and swelling.
Cold packs also slow down the chemical reactions that cause inflammation and
pain.
Transcutaneous Electric Nerve Stimulation (TENS)
A TENS unit applies electric current directly to sensory nerves, creating a tingling
sensation that may reduce the feeling of pain. When used in conjunction with
physical therapy, a TENS unit may help reduce acute lower back pain. This
reduction in pain may help improve a patient’s tolerance for active movements
that facilitate healing.

7. 6
Neuromuscular Electric Muscle Stimulation
Neuromuscular electrical stimulation using different wavelengths and amplitudes
is a therapeutic method of inducing muscle contraction. In certain cases, when
nerve involvement is severe and a patient is unable to voluntarily contract
muscles in their hip or leg, or muscle contraction is weak, electrical
stimulation can help facilitate these contractions to improve function.
Electric muscle stimulators are available in different forms, including machines
with electrodes that are taped to the body, or smaller devices that are placed
directly on the body. A computer or hand-held remote helps to adjust the
frequency and intensity of electric current that is passed.
Traction
Mechanical traction gently pulls the vertebrae apart to relieve the compression of
spinal tissues. In treating sciatica, traction of the lumbar spine can help:
 Temporarily widen spaces in the intervertebral foramina to relieve
compression of the spinal nerves
 Provide muscle stretch to relieve spasm
 Relieve pressure on injured discs, reducing nerve symptoms
A therapist may apply traction manually or use mechanical traction, where the
patient lies on a table and is secured using a harness or straps. The therapist
usually determines the type and amount of force to be used. The tension may be
increased gradually and is usually followed by a period of relaxation.
M. traction

8. 7
References
1- Patrick C. A. J. Vroomen, Marc C. T. F. M. de Krom, Patty D. Slofstra, and J. Andre
Knottnerus. Conservative Treatment of Sciatica: A Systematic Review. Journal of Spinal
Disorders. December 2000. Vol. 13, No. 6, pp. 463–469.
2- Jean-Pierre Valat, Ste´phane Genevay, Marc Marty, Sylvie Rozenberg, Bart Koes.
Sciatica. Elsevier. Best Practice & Research Clinical Rheumatology 24 (2010) 241–252.
3- Margareta C Nordin, Federico Balagué. Exercise may be beneficial for patients with
chronic severe sciatica who would normally qualify for surgery. Evidence-Based
Medicine. 2012; 37:531–42.
4- Kim EJ, Choi YD, Lim CY, Kim KH, and Lee SD. Effect of heating and cooling combination
therapy on patients with chronic low back pain: study protocol for a randomized
controlled trial. Trials. 2015; 16:285.