How to Manage Low Back Pain and Sciatica

Back pain

What is low back pain?

Low back pain is a common and often disabling condition.

Back pain can be chronic or acute in nature depending on the cause and nature of the injury.


Acute back pain can arise from a sudden injury such as an awkward bending or lifting activity which results in muscle strain or ligament sprain. This can cause an acute spasm and locking up of the low back. Often the only symptom is pain in the back, which will usually settle within a few weeks with good guidance and appropriate management.

Chronic back pain is used to describe ongoing or recurring episodes of low back pain. There are frequently several factors involved in pain which recurs or continues for more than 6 -12 weeks. Many factors can work together which may lead to changes in the structures of the spine, which may become more sensitive, and result in ongoing pain.



back pain

Common factors relating to back pain include:  frequently doing things the back isn’t fit for, stress, being run-down, poor sleep, inactivity, or simply constant muscle bracing habits which prevent the spine from moving freely.

There may be osteoarthritis of the facet joints in the spine, or signs of degenerative disc disease which is the natural wear and tear of spinal discs with age, and these structures can become painful when sensitized.



What is Sciatica pain?


Sciatica pain is a term used to describe pain that runs along the path of the sciatic nerve in the back of the leg. The sciatic nerve is the widest and longest nerve in the body. It comes from the nerves in the lower back, passing down through the buttock and into the lower leg. Typically, sciatica occurs down just one leg and is accompanied by back pain.

The pain is usually related to inflammation and sensitisation of the nerves as they exit from the lower back before they form the sciatic nerve. Once sensitised, they become very painful, and this results in muscle bracing and guarding to protect the area. Sciatica can also be accompanied by tingling, numbness, and weakness along the nerve path especially into the leg.

Sciatica may be related to a bulging or herniated disc or bone spur with stenosis (narrowing of the canal in the spine where the nerve exits). However, in many cases sciatica is not linked to nerve compression but to chemical inflammation around the nerve. A thorough examination will check the power, sensation and reflexes which will help determine if there is a mechanical compression related to your sciatica.

As outlined in a recent article in the British Medical Journal, it is often difficult to diagnose any one single cause for sciatica as some pathologies co-exist. Sciatica associated with nerve compression will present with numbness and loss of power and reflexes in the leg.

Other causes of “sciatica” can include spondylolisthesis, spinal stenosis and cauda equina syndrome. If you experience loss of sensation over the genital area and/or changes to your bladder and bowel control, it is important to seek urgent medical attention.

What can help to relieve symptoms of low back or sciatica pain?

Most cases of sciatic will settle in 12 weeks with appropriate management.

A thorough examination including a full history will help us determine and understand the factors relating to how the pain started and how it is affecting your life.  This includes your general health and sedentary and physical activities. How you perform day to day movements and any muscle weaknesses and joint stiffness will be noted along with the function of your nerves with a careful check of your power, sensation, and reflexes.

We will discuss the nature of your symptoms, and treatment options to help reduce your low back or sciatic nerve pain and help get you moving and active again. We may suggest that you seek some medical assistance to help address the inflammatory component of your pain or recommendations for further investigation.

Helpful treatment options for the acute pain period include:Back Pain Treatment

  • Ice or cold packs, to help reduce inflammation and dull the pain sensation.
  • Finding positions of comfort to relax the back and take the pressure off the sciatic nerve.
  • Gentle but purposeful exercises to mobilise and unlock the back.
  • Manual therapy techniques such as massage, joint mobilisation, and neural gliding to help relieve symptoms.

Occasionally if there is a serious loss of power and sensation in the leg, surgery may be indicated. If you have had surgery for sciatica, it is important to follow up with a good rehabilitation program.

How can exercises help back and sciatic pain?

A full rehabilitation program has been shown to be the key tool for physiotherapists in the management of low back pain and sciatica.

  1. Promoting blood flow to the area. – Gentle and progressive exercise promotes circulation and helps the healing process.
  2. Strengthen local muscles which support the spine. – This enables you to build general exercise tolerance and increase the workloads necessary to cope with daily activity.
  3. Improve soft tissue health. – Regular mobility exercises can help address coordination of muscle tension and muscle relaxation to decrease compression on the low back.
  4. Improve Nerve flow. – Exercises can also help neural (nerve) movement through the tissues to help reduce tension in the nervous system helping to reduce sciatic symptoms.

Many peer reviewed studies support exercise for treatment of back pain. These studies found:

  • An exercise program developed by a health professional can be invaluable.
  • Improving back flexibility and strength helps to lessen pain.
  • Exercise programs can lessen the behavioural, cognitive and disability aspects of back pain syndromes (2)
  • Symptoms often improve with physical activity as opposed to rest and consistent regular exercise seems to help prevent the return of symptoms. (1).
  • Exercises should be the main modality in the management of conservative treatment of sciatica. (1)

What are the best exercises for back pain?

Well that depends. There are evolving thoughts and recommendations on exercises and these all come with a variety of exercise variations.

Your exercises must be safe and you must work with a load which is right for you. The type of exercise which will work for you will be selected according to your symptoms and the progressions will be made based on your response to the exercise.

Each person has their own presentation, needs and goals. The most important factor is that you understand your pain and condition and can work with your exercise program with help from your physiotherapist.

As few as 3 exercises can start a good home exercise program and your physiotherapist will be able to get you going with “Your 3 Best Exercises “

back exercise

At Lilyfield Physio we have a highly skilled team of physiotherapists who will guide you through your recovery and help you monitor and progress how you manage load on your spine.

We shall offer you advice and give you options to find what works best for you and thus structure your exercise rehabilitation program directed at mobilising and strengthening your body. Settling your pain often starts with manual therapy and advice but the rewarding part comes with choosing the appropriate exercises and being able to progress safely and prevent further pain or injury.

1) Low back pain and sciatica: summary of NICE guidance Ian A Bernstein musculoskeletal physician and general practitioner 1, Qudsia Malik senior research fellow 2, Serena Carville associate director 2, Stephen Ward guideline development group chair, consultant pain physician 3 BMJ 2017;356:i6748 doi: 10.1136/bmj.i6748 (Published 2017 January 05)

2) Exercise as a treatment for chronic low back pain James Rainville MD, Carol Hartigan MD, Eugenio Martinez MD, Janet Limke MD, Cristin Jouve MD, Mark Finno MD

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