As lower body tension can be rooted in tension in the feet it is important to work the feet prior to working deep into the legs. We start by working on the toes, aiming to release any tension held here as this may be holding or anchoring tension further up the foot. It may seem strange to start working on the foot but you will need to put this groundwork in to get the best results.
What is Sciatica?
The sciatic nerve is the longest nerve in the body and sciatica is an umbrella term given to any sort of pain that is caused by irritation or compression of the sciatic nerve.
Symptoms include leg pain, sometimes accompanied by tingling, numbness or weakness.
It originates in the lower back and travels through the buttock and down the large sciatic nerve behind the thigh and the pain can radiate down below the knee.
Sciatica is not a diagnosis in itself, it is instead a symptom of an underlying problem.
There are two main types of sciatica and knowing the difference is important.
1. ‘Axial’ sciatica is where the nerve root is impinged at the lumbar spine
2. ‘Appendicular’ sciatica is where the nerve entrapment is elsewhere in the nerve, not in the nerve
This point is really critical: because axial sciatica can be associated with spinal instability (which may well be made worse if we go powering in with indiscriminate deep work).
So in treatment of Axial sciatica our aim is simply to ease the whole-body tensing and guarding that goes with chronic pain – and of course the stress that accompanies that pain.
We are not doing deep or focused work on the lumbar nerve roots themselves. If the problem is a disc problem, a spinal problem then disc compression may be needed so the client should be referred to a chiropractor or osteopath who is trained, qualified and insured to do that compression.
Three of the main causes of Axial sciatica are:
1.A herniated disc (also known as slipped or prolapsed disc), this puts pressure on the nerve causing the sciatica symptoms.
2.The issue could also be age related degeneration in the spine, degeneration of the bones and joints leading to degenerative disc disease which irritates a nerve root and causes sciatica.
3.Lumbar spinal stenosis can cause sciatica due to a narrowing of the spinal canal
All of these problems are to do with entrapment of the sciatic nerve within the spinal structure and this needs treatment from a medical doctor, chiropractor or osteopath – it’s not something that we are going to fix by massage.
But we can, of course, address some of the muscle tightness in the rest of the body.
By contrast, Appendicular sciatica, both the root cause and our approach are different.
This is because in Appendicular sciatica, it is usually soft tissue that traps the sciatic nerve.
It can be just as painful as axial sciatica, but it will respond to soft-tissue work.
Appendicular sciatica is characterized by increased pain from sitting, stepping up stairs or steep inclines, the direct pressure of sexual intercourse in women, or with resisted active external rotation of the femur.
Sometimes the muscular tightness that is to blame can be in the lower back or in the legs – and occasionally in the feet causing problems further up the body, but the big culprit is the piriformis muscle.
In some cases someone whose bowel is distended due to severe constipation can experience sciatica as the bowel puts pressure on the nerve.
Piriformis syndrome is also a cause of sciatic pain. The pain experienced is due to the piriformis muscle compressing the sciatic nerve, such as while sitting in a car seat or running.
In the majority of cases it is likely that the piriformis muscle has simply become too tight and this puts pressure on the sciatic nerve giving the symptoms of sciatica.
If the sciatica arises from piriformis syndrome the symptoms will usually become worse after prolonged sitting, walking or running but may feel better after lying down on the back.
There is some disagreement within the medical and bodywork world as to if piriformis syndrome can be called sciatica but we have a clear precedent going back to Yeoman’s definition from 1928 describing what we now know as 'Piriformis Syndrome' as the compression of the sciatic nerve by the piriformis muscle.
Nerve entrapment by the piriformis muscle is probably the most common cause of appendicular sciatica accounting for up to 70% of these cases and there are simple tests that can be done to establish if this is the case.
As ever if your client is in any doubt they should seek a full medical opinion, this test is only one of many which can be carried out for sciatica.
Start by asking your client to sit towards the edge of a chair and lift the affected leg with the knee bent, as far towards the chest as is comfortable.
If this increases the pain it indicates that the problem is more likely to be in the piriformis, or adjacent and connected muscle groups.
When this is the case then massage deeper work is indicated in order to release the muscle tension that is putting pressure on the nerve.
Massage Treatments for Sciatica
It is important to differentiate what type of sciatica you are dealing with in order to treat correctly.
If you are in any doubt, err on the side of caution and work with the simpler and gentler treatment given for Axial Sciatica.
How we treat sciatica depends on the cause of that sciatica. If the problem is a disc problem then disc compression is needed so the client should be referred to a chiropractor or osteopath who is trained, qualified and insured to do that compression and we are only going to do more general work, leaving the area immediately around the spine alone.
1. Massage is completely contraindicated if any of the following symptoms accompany the sciatica: • weight loss or any loss of control of the bladder or bowel, the person should seek emergency medical treatment • if the pain is too severe for self-management • If the client has sudden, severe pain in their low back or leg and numbness or muscle weakness in the leg or legs.
2. If the symptoms have come on instantly after bend or stretch, where the person then can’t stand up straight or can’t walk and also gets sciatica symptoms, the sciatica is secondary to the main problem in the spine and the person needs referring to a doctor, chiropractor or osteopath for a full diagnosis and to treat the primary spinal problem. If after that treatment the sciatic pain remains, then it may be appropriate to do massage work in consultation with their spinal specialist.
3. If during your massage the pain or symptoms increases rather than decrease, then stop your treatment and refer the client to their doctor.
4. If the client has had a history of cancer within the last five years, particularly bone, sarcoma or a pelvic or bowel cancer ask them to get their doctor’s consent for treatment around the spine, sacrum and hips.
5. Other, more rare, causes of sciatica include; irritation of the nerve from adjacent bone, tumours, internal bleeding, infections, injury and for some women, pregnancy. If in doubt – get a medical opinion.
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