Thermotherapy For Sciatica

Introduction

Do you struggle with leg pain? Do you want to find out if it’s Sciatica? In this article, we will tackle what Sciatica is and one form of therapy that may help it known as thermotherapy. So, let’s delve into this.

What is sciatica?

The term ‘sciatica’ is often used to describe leg pain, however, it is a symptom rather than a particular diagnosis.¹ It usually appears in people between the ages of 30-50 years old.² The word sciatica is often an archaic and confusing term; for the majority of clinicians, it means a radiculopathy, which involves one of the lower limbs, and is linked to disc herniation (HD) with nerve root compression.¹ However, this term is also often used to describe pain from the lower back that radiates down to the leg and can be due to other causes such as joint, ligament or disc involvement without the association of the spinal nerve root.^1,3 Further details to understand sciatica will be discussed in the sections below.

What is thermotherapy?

 Thermotherapy is a treatment that involves the application of heat to an affected area in order to improve the symptoms of a disease.⁴

The idea of using thermotherapy for sciatica can be beneficial for some individuals, as it has shown to decrease pain in other illnesses (such as in osteoarthritis).⁴ 

To further elaborate on this, the sections below will have details to shed light on this topic.

Understanding sciatica

To understand sciatica, it is essential to go through its causes and symptoms. 

Causes of sciatica

Causes of sciatica can vary and due to:^1,2,5,6

• Herniated disc: about 90% of sciatica cases are due to herniated discs with compressed nerve roots.
• Lumbar canal or Foraminal stenosis: narrowing of the spine can cause compression on the spinal nerves which results in pain.
• Tumours/Cysts: while less common than others, tumours and cysts can also be a cause of sciatica such as in a case of Granulocytic Sarcoma.
• Other: obesity, poor posture and awkward sitting positions can all promote the formation of sciatica.

Symptoms of sciatica

Now that we have addressed the causes of sciatica, it is time to address the symptoms associated with it. 

The most common symptom is a pain that radiates from the back, down below the knee and into the foot/toes.¹ There are other symptoms such as muscle weakness and altered reflexes.¹ Complications can also rise with sciatica and they can present themselves as loss of bowel or bladder functions and permanent nerve damage.² 

As any other illness, sciatica can affect our daily life; constant pain and discomfort can have a toll on someone’s mental health, as well as affect the patient’s mobility and quality of sleep. All of these can hinder someone’s ability to do day-to-day tasks such as work and socialising and can make them dependent on medication. Hence, it is important to address this issue for the patient’s well-being.

Treatments for sciatica

Treatment of sciatica can have different routes depending on the severity and cause. Some of the used treatments include:¹

1. Non-surgical treatment: in the first 6 to 8 weeks of sciatica, treatment should be conservative. However, in the presence of other aggravating factors such as infections, tumours, or osteoporotic fractures, then further investigations are required.

2. Non-pharmacological modalities: this type of modality can be summarised as:

• Patient education: providing patients with ample information regarding their case to avoid misunderstandings and provide the best recovery possible.
• Bed rest: not strong evidence is linked to sciatica specifically, however, physical activity is better than bed rest.
• Physical therapy: level of efficacy is low.
• Acupuncture, spinal manipulation, corsets, tractions: there is no evidence in literature to support these treatments and thus they cannot be recommended.
• Percutaneous electrical nerve stimulation (PENS)/transcutaneous electrical nerve stimulation (TENS): these treatments use low-voltage electrical currents for treatment. The difference between the two is that in PENS, the stimulation is done through the skin into the soft tissue using probes that are like acupuncture needles. Their efficacy levels for sciatica were also low.

3. Pharmacological modalities: the use of medications such as analgesics and non-steroidal anti-inflammatory drugs do not have a known effect on treating the cause of sciatica. However, they are useful in treating the symptoms and pain. Other medications such as epidural and transforaminal corticosteroid injections have short-term effect and low efficacy.

4.  Surgery: As you can see above, the current treatments for sciatica either provide low efficacy or are very invasive. This may not be satisfactory to the individuals suffering from sciatica, especially if they may not have as easy of an access to these treatments either. It is worth considering thermotherapy, which will be explained below.

Basics of thermotherapy

Thermotherapy refers to the addition of any substance that adds heat to the body and results in increased tissue temperature.⁷ This type of therapy can be superficial or deep, and the different modalities are listed in table 1.

In table 1, it must be noted that Thermotherapy applications methods are presented in three ways: 

• Conduction: the transfer of heat between the direct contact of two objects of differing temperatures 
• Convection: the transfer of heat through the superficial circulation of fluid/gas on the body 
• Conversion: is the changing of one energy form into another

Table 1. Characteristics of thermotherapy.⁷

Applying thermotherapy for sciatica

When choosing thermotherapy for sciatica, it is important to choose:

• the right heating source (i.e. hot packs, heating pads, warm compresses)
• proper timing
• duration of application, and
• considerations for the precautions and safety.

It is vital to consult with a healthcare professional before starting thermotherapy. This is because heat and cold can have different effects on the body as seen in table 2. Therefore, it is important to choose the right treatment for the condition at hand.

Table 2. pathophysiologic effects of hot/cold modalities.⁷

Heat therapy can be performed using hot water bottles, hot towels or electric heating pads and applied for 15-20 minutes (including breaks to avoid burning of the skin).⁸ One can apply heat therapy to warm up the muscles, then perform appropriate stretches to help relieve the compression on the sciatic nerve, followed by the application of cold to soothe the pain flare-ups.⁸

Evidential support for thermotherapy

When looking into thermotherapy, it has shown to be beneficial in pain management. For example, a study by Dehghan and Farahbod in 2014 showed that the use of thermotherapy had a positive response in terms of back pain reduction after 5 days of treatment compared to oral placebo.⁹ Another trial showed decreased pain after 8-continuous hours of heated knee wrap wear (38-40˚C) when compared to placebo.⁷ Hence, there are studies to rely on for the benefit of heat therapy when alleviating pain and the symptoms of different conditions including osteoarthritis and musculoskeletal problems.⁷ Hence, thermotherapy can bean important tool for pain management in sciatica. 

Integrating thermotherapy with other treatments

As mentioned before, one form of therapy does not seem to be effective in sciatica on its own, therefore, combinational therapy might be more effective. Other treatments that can be integrated include:^8,2

1. Mobility: stretching and movement can be beneficial for sciatica to release nerve pressure and decrease inflammation
2. Surgery: to repair herniated discs
3. Medication: management of sciatica with medications such as ibuprofen can alleviate pain even if it is short-term
4. Osteopathic manipulation

Consulting with healthcare professionals

When considering thermotherapy, it is important to consult with healthcare professionals for the proper method of application and treatment. Patients that have certain conditions such as diabetes, multiple sclerosis and rheumatoid arthritis may react negatively to thermotherapy as it can promote disease progression.¹⁰ It is wise to work with physical therapists to have your own customised thermotherapy plan, which bettersuits your body and needs.

Summary

• Thermotherapy has shown to be beneficial in reducing pain by applying heat to the area of interest 
• Heat can improve blood flow, increase metabolism, and reduce muscle spasm, all which promote healing of the tissue
• Forsciatica, heat therapy can be beneficial in reducing its associated pain
• However, it is important to note that analgesics and physical activity are also recommended for managing sciatica pain
• Sciatica stems from multiple causes so there is no clear treatment for it 
• it is worth introducing thermotherapy with a combination of other therapeutic treatments to try and improve the patient’s condition and prevent it from progressing