Low back pain and sciatica can be frustrating and sometimes confusing. I know when my wife was pregnant with one of our children, she experienced low back pain and sciatica. It kept her up at night, limited her movement during the day, and prevented her from doing some of the things she really wanted to do.
But, as you may know, there’s so many options out there for treating low back pain. Braces, tape, exercises, electrical stimulation…it can be difficult to know which treatment options are most effective. Hopefully, this article will shed some light on the topic. We’ll cover a little basic information about low back pain and sciatica, and we’ll also look at what the research suggests as the most effective treatment options.
About Back Pain & Sciatica
Low back pain is one of the leading causes of disability & chronic pain [1]. Back pain may present with or without sciatica, and some factors of diagnoses, like pregnancy, may cause or effect symptoms for patients experiencing low back pain with or without sciatica [2].
In fact, as my wife would attest, low back pain (LBP) is one of the most common complains of pregnant women [3]. It seems altogether common that low back pain tends to a common topic of conversation in these circles. For many patients, the pain may become so severe that it interferes with sleep, self-care, household tasks, and can cause an increased use of sick leave [1][2]. As you may know, sleep & self-care play a vital role in both physical and mental/emotional health. So anything that affects that should be addressed quickly.
Research also shows that, if left untreated, LBP can cause long-term disability and functional limitations. And, though many treatment options exist for patients experiencing LBP with or without sciatica, research suggests that patients find physical therapy valuable, especially when the treatment programs are individualized [4]. That’s what we’re all about here at ProActive. Taking a Biopsychosocial Approach helps us craft individualized treatment programs to meet our patients where they are on their unique road to recovery, rather than trying to fit them into cookie-cutter treatment protocols.
Let’s take a look at the types of treatments that the research suggests are most effective for patients experiencing low back pain, with or without sciatica.
Recommendations from Research
As with many diagnoses and problems, there’s never a one-size-fits-all treatment option, or a “magic bullet”. Low back pain and sciatica requires an intentional and individualized approach. That being said, the research points towards some treatment options that have been shown to be effective for patients experiencing low back pain. Many treatment options include some sort of exercise program, physical therapy evaluation, and activity modification. Below are couple questions answered by current research.
What types of rehabilitation interventions are recommended for patients experiencing Low Back Pain (LBP) with or without sciatica?
Even though physical therapy has been shown to help patients who have low back pain, it’s important to understand which types of treatment are most effective. Current research suggests that physical therapy treatment should include exercises to reduce pain and discomfort, techniques for improving functional spinal movement, walking and dynamic posture, and manual therapy and cardiovascular exercise [4]. That sounds like a lot. And in reality, any individualized treatment program that takes a biopsychosocial approach will include many techniques and approaches aimed at wholistic health.
That may mean that two patients with sciatica may actually have different exercises or treatment techniques included in their plan of care. One patient may do some aquatic exercises, while the other may do land-based treatment at the beginning.
One thing that is interesting from the research? Evidence suggests that early referrals to PT for acute onset sciatica & LBP improved disability and other outcomes when compared to usual care [1]. So, instead of taking a “wait and see” approach, quickly receiving physical therapy treatment can help decrease pain and prevent disability.
What about patients who are pregnant and experiencing symptoms associated with pregnancy-related LBP & Sciatica?
Like I mentioned earlier, pregnancy-related low back pain and sciatica can be a common experience among pregnant women. Here’s what one research article had to say about selecting a treatment program or strategy:
“Moderate-quality evidence that an 8- to 20-week exercise program reduced the risk of women reporting lumbo-pelvic pain” [2]. Water-based exercise programs were also shown to significantly reduced LBP-related sick leave [2].
Basically, women experiencing pregnancy-related low back pain may experience pain relief and decreased disability or limitations from a physical therapy treatment program. This therapy program will typically involve exercise-based programs to strengthen and support muscles around the low back & hips.
Here’s another quote from a research study:
“Early identification and treatment, that takes under consideration the individuality of each woman and pregnancy, provide the best opportunity for the best possible outcome.” [3]
Again, low back pain, especially during pregnancy, is too complex to be treated with cookie-cutter treatment programs. For physical therapy to be truly effective, you need to find a clinic that will complete an individualized evaluation and help you craft a personalized plan of care. This helps you address the factors that are causing pain in your specific situation.
Summary
Well, it’s no secret that physical therapy can provide great relief from low back pain and sciatica. Whether your back pain is a chronic condition, or whether it’s related to pregnancy, an exercise-based physical therapy program can help you overcome your pain and get back to the things that are important to you.
The important thing to remember is that low back pain and sciatica is not a uniform condition. Cookie-cutter treatment programs may provide some relief. But in order to really receive the benefit of treatment, you must seek out an individualized approach.
References
[1] Julie M. Fritz, Elizabeth Lane, Molly McFadden, et al. Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica: A Randomized Controlled Trial. Ann Intern Med.2021;174:8-17. [Epub ahead of print 6 October 2020]. doi:10.7326/M20-4187
[2] Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews. 2013 Aug 1(CD0011):1-00. doi: 10.1002/14651858.CD001139.pub3.
[3] Katonis P, Kampouroglou A, Aggelopoulos A, et al. Pregnancy-related low back pain. Hippokratia. 2011;15(3):205- 210. https://pubmed.ncbi.nlm.nih.gov/22435016/
[4] Boote J, Newsome R, Reddington M, Cole A, Dimairo M. Physiotherapy for Patients with Sciatica Awaiting Lumbar Micro-discectomy Surgery: A Nested, Qualitative Study of Patients’ Views and Experiences. Physiother Res Int. 2017;22(3):e1665. doi:10.1002/pri.1665
