Sciatica -- A Real Pain in the Butt!

Treating Sciatica with Massage (from Fall 2007 YBIH Newsletter, lead article)

Pain caused by irritation of the sciatic nerve -- commonly known as sciatica -- is perhaps one of the most common (and painful!) complaints I hear in professional massage practice. Most of us, at one time or another, have suffered the pain of "sciatica." It can range from nothing more than a mild tingling down the back of the thigh, calf or foot, or it may be an agonizing pain that makes it hard to walk, move, sit, stand, or even lie down comfortably.

The sciatic nerve at its largest point is a bundle of nerves about the thickness of your thumb. It starts in the lumbar spine, navigates its way through the buttock muscles, down the back of the leg, and branches out at the knee to also include entire lower leg. Impingement of the sciatic nerve can occur at nearly any point along its length, but most commonly happens either as a result of a bulging or ruptured spinal disc (true sciatica), or from muscular tightness in the buttock -- particularly of the piriformis muscle, under or through which the nerve travels. Sciatica-like symptoms caused by tightness of the piriformis is more accurately called "piriformis syndrome."

Any time you suspect that you have sciatica, it is important to see your doctor to rule out disc impingement. If your pain is caused by a ruptured disc, then massage is unlikely to help very much, other than to help you relax (which ain't bad!). Medical intervention in the form of anti-inflammatories, steriods, chiropractic care, rest, ice, and even surgery all may be preferred initial methods of care that your doctor will discuss with you.

If your doctor rules out a disc problem as the cause of your pain, you can then explore the possibility of it being due to muscular tension, especially from tightness in the lower back, buttocks and hamstrings. A combination of massage, trigger point therapy, and active assisted stretching is particularly well suited to treat this type of dysfunction. In fact, even if it IS a disc problem, massage may still be able to help keep your body from creating bigger problems caused by compensatory measures that can cause muscular and postural imbalances throughout the entire musculo-skeletal system.

How can massage possibly alleviate sciatica, if sciatica is an irritation of the sciatic nerve? What can a massage therapist do for nerve irritation?

Well, going back to the basic anatomy lesson above, because the sciatic nerve travels under and through the thick muscles of the buttocks (remember the piriformis?), it is an easy target for compression. Some common culprits include sitting on your wallet, poor posture, tight belts or pants, and sports-related injuries, all of which may cause the nerve to become irritated and/or can encourage the formation of painful trigger points in the muscle.

A massage therapist will usually begin with a hands-on assessment of the entire low back, buttock and hamstrings. Often low back muscles are also involved, so treatment should include warm-up work in that general area, too. Every body is different, but much of the work at this point will commonly be focused on the piriformis, starting with its attachment along the sacrum. As the work gets deeper, clients will often register a "that's where it hurts" sentiment, particularly as the trigger points in the piriformis and surrounding muscles are identified and released. I find that it is also very important to work on loosening the hamstrings, calf and lower back muscles in order to effect the most relief.

Oftentimes I will put clients into a side-lying position in order to reach the affected area from different angles to achieve maximum release. In addition, with some clients it may be advisable to also do some work in releasing the illiopsoas group, the muscles deep in the abdomen that assist in posture and hip flexion. Often these muscles become extremely tight as a compensatory response to back pain, so releasing these muscles -- while sometimes quite a slow and uncomfortable process -- can provide tremendous relief for the client.

Other extremely valuable treatments for this type of pain can be chiropractic care and acupuncture, and, ideally, I will often refer clients out for co-treatment. I work the muscles, the chiro adjusts the bones, and the acupuncturist opens the energy pathways. And, once the pain subsides, a regular stretching routine (yoga can be great!) may also help speed recovery, improve flexibility, maintain progress between sessions, and prevent re-injury. Clients benefit greatly from this type of combined, holistic approach, and will often find long-lasting relief from sciatic pain and discomfort.

So, if ever you find yourself being told by a doctor that you have sciatica, know that you have some excellent options. Track down a massage therapist, chiropractor, and/or acupuncturist near you and get to the root of the problem. Your body will be back in harmony in no time!

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*[Note: From personal experience, I would urge you to get a second and even third opinion if your doctor recommends surgery. In many cases, even ruptured discs can have a way of working themselves out over time. In my (non-medical) opinion, surgery should really be a last resort, and only contemplated when (a) the problem is causing a serious muscular deficit in the lower extremeties (such as a "drop foot"), or (b) if the pain has lasted an extremely long time and other less invasive methods have not worked. Also, if your back condition is accompanied by loss of bowel or bladder function, this must be considered an emergency situation and you should seek medical assistance immediately.]