How Can Physical Therapy Help With a Herniated Disc and Sciatica?

If you have a herniated disc or sciatica, your first instinct may be to avoid movement.

That makes sense when certain movements hurt. But staying inactive for too long isn’t necessarily the best path back to normal activity.

For many patients, physical therapy can be an important part of conservative treatment for symptoms associated with a herniated disc or sciatica.

Physical therapy may help patients with a herniated disc or sciatica improve mobility, strengthen muscles that support the spine, address movement patterns that aggravate symptoms, and gradually return to everyday activities. Treatment should be individualized because the exercises that help one patient may not be appropriate for another. Physical therapy is also commonly used during rehabilitation after certain spine procedures when prescribed by the surgeon.

The first step is understanding what’s causing the symptoms.

What Is Sciatica?

Sciatica refers to pain or other symptoms involving the sciatic nerve or the nerve roots that form it.

Symptoms commonly affect one side of the body and may travel from the lower back or buttock into the thigh, calf, or foot.

A person with sciatica may experience:

• Sharp or burning leg pain
• Tingling
• Numbness
• Weakness
• Lower back discomfort

A lumbar herniated disc is one possible cause.

Other spinal conditions can produce similar symptoms, which is why persistent sciatica should be properly evaluated rather than treated solely based on symptoms.

How Can a Herniated Disc Cause Sciatica?

The nerves that eventually contribute to the sciatic nerve originate in the lower spine.

When disc material irritates or compresses one of these nerve roots, symptoms may travel along the nerve pathway.

That’s why someone with a spinal problem can feel pain in the leg rather than primarily in the back.

Physical therapy for sciatica therefore isn’t necessarily focused only on where the patient feels pain.

The therapist considers the spine, hips, strength, mobility, movement patterns, and neurological symptoms.

How Does Physical Therapy Help With a Herniated Disc?

Physical therapy doesn’t use one standard exercise program for every herniated disc.

Treatment should be based on the patient’s diagnosis, symptoms, functional limitations, and response to movement.

A physical therapist may evaluate posture, strength, flexibility, range of motion, walking, body mechanics, and which movements increase or reduce symptoms.

From there, an individualized treatment program can be developed.

What Types of Exercises May Be Used?

The exercises selected depend on the individual patient.

A physical therapy program may include work designed to improve spinal or hip mobility, core control, lower-body strength, flexibility, posture, and overall movement.

The therapist may also help the patient gradually return to activities that have become difficult because of pain.

One important principle is that more exercise isn’t automatically better.

The correct exercise performed appropriately can be useful. An exercise that repeatedly increases nerve symptoms may need to be modified or avoided.

That’s one reason a personalized evaluation can be more useful than simply searching online for “the best exercise for sciatica.”

Can Physical Therapy Help Relieve Sciatica?

Physical therapy may help some patients manage symptoms associated with sciatica, depending on its underlying cause.

Therapy can address mobility restrictions, weakness, body mechanics, and movement patterns that may contribute to symptoms.

The therapist can also monitor whether symptoms are improving, staying the same, or becoming more concerning.

That last part is important.

Physical therapy shouldn’t simply continue indefinitely if neurological symptoms are getting worse.

What Is the Goal of Core Strengthening?

“Strengthen your core” is common advice for back pain, but core strengthening involves more than doing abdominal exercises.

Muscles around the abdomen, back, pelvis, and hips work together to support movement.

Physical therapy may focus on improving the patient’s ability to control the trunk during everyday activities such as standing, walking, bending, lifting, and changing positions.

The exercises should progress based on the patient’s tolerance and functional goals.

Can Physical Therapy Help You Avoid Spine Surgery?

Sometimes conservative treatment, including physical therapy, can help symptoms improve enough that surgery isn’t necessary.

But it’s important not to promise that physical therapy will prevent surgery.

Whether surgery is appropriate depends on the underlying spinal condition, severity of nerve compression, neurological findings, duration of symptoms, response to treatment, and other individual factors.

Physical therapy is one part of a broader treatment plan.

For some patients, conservative care works well.

For others, persistent or progressive symptoms may require evaluation by a spine specialist.

How Long Does Physical Therapy for Sciatica Take?

There’s no single recovery timeline.

A relatively mild problem may improve more quickly than a significant disc herniation with nerve symptoms.

Recovery can also depend on the patient’s age, general health, activity level, occupation, duration of symptoms, and underlying condition.

Instead of focusing exclusively on the calendar, therapists may monitor functional improvements.

For example:

Can you sit more comfortably?

Can you walk farther?

Are leg symptoms becoming less frequent?

Is strength improving?

Are you returning to normal activities?

Progress should be measured by more than simply whether the back hurts on a particular day.

What Should You Avoid When You Have Sciatica?

This depends on what’s causing the symptoms.

There isn’t a universal list of movements that everyone with sciatica must avoid.

However, activities that repeatedly or significantly worsen radiating pain, numbness, tingling, or weakness deserve attention.

A physical therapist can help identify movements that may need temporary modification and teach alternative ways to perform necessary activities.

The long-term objective generally isn’t to make the patient afraid of movement.

It’s to help the patient return to movement safely and confidently.

When Should Physical Therapy Be Stopped for a Spine Evaluation?

Physical therapists are an important part of conservative spine care, but they also need to recognize when symptoms may require additional medical evaluation.

Contact your physician or spine specialist if symptoms are worsening rather than improving, particularly if you develop increasing numbness or weakness.

Prompt medical evaluation is important for symptoms such as:

• Rapidly progressing muscle weakness
• Significant difficulty walking
• Loss of bowel or bladder control
• Numbness around the groin or saddle region
• Severe symptoms following significant trauma

These symptoms shouldn’t simply be treated with additional exercises.

What Happens if Physical Therapy Isn’t Relieving Sciatica?

Persistent symptoms don’t necessarily mean surgery is the next step.

They do mean the condition may need to be reassessed.

A physician may reconsider the diagnosis, perform another examination, review imaging, order additional testing when appropriate, or discuss other nonsurgical treatment options.

When symptoms remain significant despite appropriate conservative care, referral to a spine specialist may help determine whether another treatment approach should be considered.

Can Physical Therapy Help After Spine Surgery?

Yes, when recommended by the surgeon.

Physical therapy can play an important role in rehabilitation after certain spine procedures.

The timing and type of therapy depend on the surgery and the patient’s individual recovery.

Postoperative rehabilitation may gradually address walking, mobility, strength, body mechanics, endurance, and return to everyday activities.

The therapist works within the restrictions and progression established by the surgeon.

Is Physical Therapy Different After a Microdiscectomy?

It can be.

A microdiscectomy may be performed to remove disc material that’s compressing a spinal nerve.

After surgery, rehabilitation needs to respect healing tissues while gradually restoring function.

Depending on the surgeon’s recommendations and patient’s progress, therapy may eventually focus on mobility, strength, movement mechanics, and a safe return to work or recreational activities.

Patients shouldn’t assume they can immediately return to their previous exercise routine simply because the nerve pain feels better.

Recovery still requires appropriate progression.

Can Physical Therapy Be Used After Cervical Spine Surgery?

Physical therapy may also be recommended following certain cervical spine procedures.

The rehabilitation plan depends heavily on the procedure performed.

For example, rehabilitation following a cervical disc replacement may differ from rehabilitation following a cervical fusion.

The surgeon and physical therapist can coordinate the appropriate progression based on the procedure and individual patient’s recovery.

Why Is Communication Between the Physical Therapist and Spine Specialist Important?

Spine conditions often benefit from a coordinated approach.

A patient’s treatment may involve a physician, spine specialist, physical therapist, and other healthcare professionals.

Communication becomes particularly important when symptoms change.

If a therapist notices increasing weakness or another concerning neurological change, the spine specialist may need to reevaluate the patient.

Likewise, when a patient undergoes surgery, the therapist needs to understand the surgeon’s postoperative restrictions and rehabilitation goals.

The objective is the same for everyone involved:

Help the patient return to function as safely and effectively as possible.

Frequently Asked Questions About Physical Therapy for Herniated Discs and Sciatica

Is walking good for a herniated disc?

Walking may be appropriate for many patients, but activity recommendations depend on symptoms and the underlying condition. If walking significantly increases radiating pain, numbness, or weakness, discuss it with your healthcare provider or physical therapist.

Can stretching fix sciatica?

There’s no single stretch that “fixes” sciatica. The appropriate treatment depends on what’s irritating the nerve. Some stretches may help certain patients while aggravating symptoms in others.

Should I exercise when I have sciatica?

Appropriate movement and exercise may be part of treatment, but the program should match your condition and symptoms. Significant or worsening neurological symptoms should be evaluated.

How do I know if physical therapy is working?

Improvement may include less frequent radiating pain, improved mobility, better strength, increased tolerance for sitting or walking, and greater ability to perform everyday activities.

What happens if my leg numbness gets worse during physical therapy?

Increasing numbness or weakness should be reported. Progressive neurological symptoms may warrant additional evaluation by a physician or spine specialist.

Do I need physical therapy after spine surgery?

It depends on the procedure and patient. Your spine surgeon will determine whether physical therapy is appropriate and when it should begin.

Physical Therapy Can Be an Important Part of Comprehensive Spine Care

The goal of physical therapy isn’t simply to make back pain disappear for a few hours.

It’s to help patients understand how their bodies respond to movement, improve mobility and strength, regain function, and return to the activities that matter to them.

For patients with a herniated disc or sciatica, physical therapy may be an important part of nonsurgical care.

For patients who eventually require spine surgery, it may also become an important part of recovery.

And when symptoms aren’t improving—or neurological symptoms are getting worse—physical therapy can help identify when it’s time to return to the physician for further evaluation.

Physical Therapy and Spine Care at Plano Orthopedic & Sports Medicine Center

At Plano Orthopedic & Sports Medicine Center, physical therapy can be part of a coordinated approach to orthopedic and spine care.

Patients experiencing back pain, neck pain, sciatica, numbness, tingling, weakness, or other symptoms can be evaluated to determine the underlying problem and an appropriate course of treatment.

If back or neck symptoms are limiting your daily activities, contact Plano Orthopedic & Sports Medicine Center to schedule an evaluation and learn which treatment options may be appropriate for you.