SCIATICA

One of the most common problems we see at the clinic is people of all ages presenting with what they ‘believe’ is sciatica. I say believe to be as often it’s a catch all term used to describe pain running down the buttock, back of thigh and calf and sometimes to the feet and toes. Many people arrive at the clinic saying their GP has told them they have sciatica and to take painkillers and / or an anti-inflammatory and rest. If you have lower back pain without the other symptoms its unlikely that you have sciatica.

The SCIATIC NERVE is the largest and longest spinal nerve in the body and runs from the lumbar and sacral plexuses in the lower back, branching off into other nerves which carry nerve signals to the feet .If the nerve is impinged at any point along its pathway say for example by tight muscles, it can lead to stabbing, shooting or burning pain. You may also feel tingling like pins and needles, numbness and weakness. This could be in the buttock, thigh area and back of legs right down to the toes. Sometimes these symptoms are exacerbated when moving and sometimes even coughing or sneezing.

It’s important at this stage to distinguish between what is sometime referred to as  ‘TRUE’ sciatica and ‘GENERAL’ sciatica. ‘TRUE’ sciatica is when pain and discomfort is felt without any relief whatsoever. This will include when lying down in bed or sitting, as well as when you are standing or moving around. It is almost impossible to find a position that relieves the pain. This is often caused by 

1. A bulging disc, sometimes referred to as a (SLIPPED DISC) – when the soft cushion of tissue between the bones in the spine pushes out
2. A narrowing of the foramen, the part of the spine where the nerves pass though (SPINAL STENOSIS).
3. When one of the bones in your spine slips out of position –(SPONDYLOLISTHESIS)
4. A back injury.

With ‘GENERAL’ sciatica the individual usually manages to find some sort of position that alleviates the discomfort, even if it’s temporary.

The reason I wanted to distinguish between the two is very important as this determines what treatment is most appropriate and also establishes a realistic idea of what the potential prognosis and ultimate outcome may be. (I’m going to get slightly technical here so please bear with me). As a therapist we are able to work on and have an effect upon the soft tissue i.e. the muscles and associated fascia or connective tissue, which can them have a positive knock on effect on the tendons, ligaments and associated joints. However the really important thing to remember is that if the client has’ TRUE’ sciatica we are not able to alter the fact that issues with the vertebrae and discs are probably aggravating the nerve. This ultimately may only be remedied by surgery. Usually a CT scan or MRI will identify this. An X-Ray on its own will help identify any abnormalities with bone, however will not highlight any issues with soft tissue.

DEEP TISSUES MASSAGE

Very often we receive clients who have been referred for deep tissue massage by their GP. We have many different techniques at our disposal in order to treat the condition and as usual we design the specific treatment around the individuals requirements at the time. Some of the techniques we may employ are Muscle Energy Techniques, Myofascial Release, combinations of Sports and Remedial Massage as well as some gentler options such as Hot Stone Therapy and mobilisations. The intention is to release any muscle tension or spasm which may be contributing to the condition, help with structural realignment, improve the blood flow and allow any build up of toxins to be flushed out of the body. This combined with some gentle stretches that can be done at home can lead to extremely positive results which are life changing.

STRETCHES

Some simple stretches and exercises can be done at home to help alleviate the pain from sciatica and usually you would expect to see some improvement within a two-week period, however it can take up to six weeks in some cases for everything to settle down. These should be done every day and in addition where possible, things like walking, swimming or yoga. As with any form of exercise, if you feel severe pain then stop!

1. KNEE TO CHEST STRETCH – Lie on the floor either on a carpet or mat with a pillow under your head. Bend both knees with the soles of your feet still on the ground about a hip-width apart. Keeping your upper body as relaxed as possible and your chin tucked in slightly bend one knee up towards your chest and hold with your hands for about 25 seconds. Repeat 3 times on both sides.
2. A variation of this stretch, sometimes called a SCIATIC MOBILISATION STRETCH is when you would start off in the same position but this time when you bend your knee up to your chest you hold the back of your thigh with both hands. Gently try to straighten your knee for around 25 seconds, bend your knee again and return to starting position. Repeat about 3 times with both legs.
3. LYING DEEP GLUTEAL STRETCH – Again start off in the same position on the floor, bend your right leg and rest your left foot on your right thigh. (Almost as if you are crossing your legs). Grasp your right thigh with both hands and gently pull up towards your chest, trying to keep the base of your spine on the floor. You should feel a stretch in your left buttock. Hold for about 25 seconds. Repeat 3 times with each leg.

If you have to visit a GP as nothing you are doing is helping, it’s always better to be able to tell them you have tried these things at home already, where possible.