Physio Penrith Low Back Pain With Sciatica Treatment
Treatment of Low Back Pain with Sciatica at Sydney Muscle & Joint Physio Penrith
What is low back pain with sciatica?
Low back pain with sciatica is a very common presentation at Sydney Muscle & Joint Physio Penrith, and suggests that the patient has mechanical low back pain with irritation or compression of a nerve that exits the lumbar spine. Intervetrebral disc herniations or bulges are the most common irritators of the nerve, with lateral recess stenosis less common.
What are the symptoms of low back pain with sciatica?
Most patients complaining of having a pinched nerve and symptoms like burning pain, sharp shooting pain and numbness down the leg beyond the knee often into the calf, foot and toes. Sciatica is a form of radicular pain or radiculopathy caused by either irritation or compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signalling.
Diagnosis of low back pain with sciatica
Recent guideline based care for the management of low back pain with sciatica suggests the use of a risk assessment and risk stratification tool. At Sydney Muscle & Joint Physio Penrith our practitioners consider the use of a risk stratification, such as the STarT Back risk assessment tool. Based on this risk stratification, our physiotherapists and chiropractors will consider two options:
1. Simpler and less intensive support for people with low back pain with or without sciatica likely to improve quickly and have a good outcome (for example, reassurance, advice to keep active and guidance on self-management).
2. More complex and intensive support for people with low back pain with or without sciatica at higher risk of a poor outcome (for example, exercise programmes with or without manual therapy or using a psychological approach).
Diagnostic testing can help confirm a mechanical origin and possibly the involvement of disc or bony osteophytes. Further testing of the nerve with muscle spindle reflexes (MSR) and myotome (muscle testing) can rule in/out a radiculopathy. Regardless, treatments should target impairments related to the patient presentation.
Guideline-based treatment of low back pain with sciatica
At Sydney Muscle & Joint Clinic Penrith, our physiotherapists follow the NICE guideline for with conservative management of low back pain with sciatica. This guideline states the following when treating low back pain with sciatica:
Self-management: physiotherapists, exercise physiologists and chiropractors must provide people with advice and information to help them self-manage their low back pain with or without sciatica, including:
information on the nature and prognosis of low back pain and sciatica.
self management exercise or movement to reduce pain and improve range of motion.
encouragement to continue with normal activities.
Exercise based therapy: consider exercise programs like biomechanical, aerobic, mind–body or a combination of approaches for patients with a specific episode or flare-up of low back pain with or without sciatica. At Sydney Muscle & Joint Physio Penrith our exercise or movement techniques for low back pain with sciatica include neural or nerve stretching, McKenzie Method, strength training and aerobic conditioning.
Orthotics: do not offer belts or corsets; do not offer foot orthotics; and do not offer rocker sole shoes for managing low back pain with or without sciatica.
Manual therapies: do not offer traction for managing low back pain with or without sciatica. Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy. At Sydney Muscle & Joint Physio Penrith our physiotherapists, exercise physiologists and chiropractors we use both passive and active interventions in the treatment of low back pain with sciatica.
Acupuncture: do not offer acupuncture for managing low back pain with or without sciatica.
Electrotherapies: do not offer ultrasound; do not offer percutaneous electrical nerve simulation (PENS); do not offer transcutaneous electrical nerve simulation (TENS); do not offer interferential therapy for managing low back pain with or without sciatica.
Psychological therapy: consider psychological therapies using a cognitive behavioural approach for managing low back pain with or without sciatica but only as part of a treatment package including exercise, with or without manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage).
Combined physical and psychological programs: consider a combined physical and psychological interventions for people with persistent low back pain or sciatica:
when they are avoiding normal activities based on inappropriate beliefs about their condition or
when previous treatments have not been effective.
Return-to-work programs: promote and facilitate return to work or normal activities of daily living for people with low back pain with or without sciatica. People do better if they maintain work hours rather than taking time off.