Sciatica Nerve Stretches, Protocols, and Treatments for Faster Pain Relief
By Jennifer Falzone, PT
Since starting our Advanced Physical Therapy practice in November 2022, our team (of two!) has been excited to welcome new patients into APC for all their physical therapy needs. We service all populations, from pain to orthopedic to neuro to rheumatology, and I have to say, the moment I started working with APC, I felt the integrative, collaborative approach that makes me feel confident that we can all make good decisions for our patients as a collective of pain care specialists working as a team.
The Patient Experience at Advanced Pain Care
The key that many patients are starting to realize is that it’s so much easier when you go to a clinic that has multiple disciplines all under one roof— which is exactly what makes it so rewarding to work with our patients each and every day. In fact, a pain doctor referred a patient to me who was experiencing multiple different pain points, and because of our many specialties, we were able to help him and refer him to the orthopedic doctor right on our floor. When you’re working with multiple doctors, it sometimes takes several months to get an appointment, but he was seen and treated in just two days. Today, he’s successfully undergone the surgery he needed within a much shorter timeframe than if he were to find an outside provider.
That’s Advanced Pain Care’s difference as a whole— but let’s get back to the work we’ve been so proud to do at Advanced Physical Therapy.
Related: The Many Faces of Nerve Pain
A Day in the Life
At the time of this writing, Advanced Physical Therapy includes myself and Jan (Jen + Jan!), our physical therapist assistant. Whereas some clinics will group physical therapy patients together, we work directly with each other and with our patients one-on-one to give both them and us enough time to assess their pain, provide the necessary treatment, and follow our individualized program to help them recover both in and between our sessions. No patient gets the same treatment— we stick to focusing all our attention on individualized, targeted care, so we can provide a thought-out protocol to help patients get the attention and care they need to heal faster.
What is Sciatica? & How We Work With Sciatica Patients
Before providing an initial diagnosis, we’ll first evaluate a patient on how they’re feeling. We look at the following:
- Motion: how well the vertebrae in the spine and other joints move and whether they’re experiencing anything that’s limiting their typical abilities.
- Muscle quality: how strong their back is, and how they’re being limited from their normal functions.
- Quality of movement: how much effort it’s taking them to move, what’s particularly difficult for them to do, and what’s triggering their symptoms and what’s making them better.
The basic clinical presentation of sciatica is pain starting in the buttocks, coming around the side of the hip and into the thigh, and then coming down the side of the knee and into the big toe.
One of the main reasons we see patients with sciatic symptoms is because of that muscle in your buttocks— called the piriformis— that connects from the side of the hip up into the back of your pelvis.
Your sacroiliac— or SI— joint connects the piriformis to the outside of your hip, helping your hips have rotation to the side. What’s interesting about that muscle is the sciatic nerve runs directly underneath it, which means if that muscle is in spasm or tightening, it can press on the sciatic nerve, giving you that sharp, stabbing pain that seems to knock you out with seemingly endless pain.
If we find that muscle is indeed the problem, there are a few options for fixing it: stretching, manual therapy, massage techniques, heat, ice, and electrical stimulation. How do we determine that? Through our personalized approach, examining everything from whether the patient has had back pain before, what their job is, and a slew of other important factors.
Sciatica Nerve Stretches, Treatments, and Protocols
We start every patient out with the basics, like how to maintain proper posture, and how to establish a stretching regimen. We start with the triad first, working to reduce the pain, improve their mobility, and then improve their strength:
- Electrical stimulation— the stimulation “interrupts the conversation” where the nerve is sending pain signals from your sciatic area to the brain. The process itself is a comfortable and well-tolerated modality that’s totally non-invasive for our patients; all we need is to put some small stickers over their area of pain, hand our patients their patient control so they can increase or decrease the intensity as they see fit, and let the stimulation do the rest! We also stay with our patients throughout their sessions to make sure they’re comfortable the entire time.
- Stretching— once we’ve reduced the pain (often through electric stimulation), we can move on to some gentle sciatic nerve stretches, which is, in fact, a part of the handout we provide patients. It’s very important for our patients to understand that stretching should create a slight pulling sensation— it should never feel painful.
- Education— once our patient has received the protocols they need, we always support their journey with education. We teach them about things like fat wallet syndrome, which is what happens when men carry a thick wallet in their back pocket, and then sit down on it, which throws off their posture and almost directly links to sciatic nerve issues. We also familiarize them with sleep protocols, like sleeping with a pillow between their knees on their side, as well as what shoes to wear, to get up every 30 minutes when they sit down to work, and how they can massage their back with a single tennis ball.
Related: When All Other Treatments Fail, How APC Found a Solution for Severe Chronic Pain- Check Out Stormey’s Story
Recovery Timeframe for Sciatica: APC’s Goals for Your Pain Management
With therapy in general, we say if you don’t notice an improvement within the first two weeks (4-6 sessions), we reevaluate and see if we need to request imaging or ask another specialist in our clinic.
Before and after each session, we typically track improvement by asking about their pain level. If they come in as a 9, and leave as an 8, even that small adjustment tells us that something’s working. But if they enter a 6 and you’re now a 10, we’ll seek a new direction until we find one that works.
We’re assessing every visit, every activity, and every treatment technique.
You Don’t Have to Suffer.
If you’re in one of our greater Texas areas, we’d be happy to help you out! Join us in celebrating the growth of APC through our new Advanced Physical Therapy discipline. No matter how long you’ve been struggling with pain, we’re here to tell you the pain stops here. Search for your nearest APC location here!