Wednesday, December 07, 2011

Treating Sciatica and Herniated Disc with Advanced Clinical Massage Techniques

Through my personal wellness journey which started way back on April 10, 1987 when I originally became involved in the diet and nutrition industry, I am lucky enough to have met some very inspiring people which have in turn helped me to affect people's lives for the better.  Two people in particular should be given a special mention, they are Megan Mari and Rachel Fairweather from the Jing Institute of Advanced Massage Training in Brighton, England, where I have spent 2011 training in Advanced Clinical Massage and am now able to offer the treatments which can greatly help with issues detailed in the article below.

While in Brighton in November, I was given a copy of a magazine article on sciatica and herniated disc treatment by Rachel, which I am thankful to Angela from for allowing me to reproduce here.

Body and Mind Studio

Here is the article reproduced from the Feb/Mar 2010 edition:-

Treating Sciatica
and herniated disc with advanced massage techniques 

'Sciatica is a symptom not a diagnosis'. Over the length of my bodywork career, I have collected a number of great 'soundbites' about massage; pithy little quotes that encapsulate great principles or ideas in a few words. I remember scrawling 'sciatica is a symptom not a diagnosis' on my notes many years ago when dozing off during a neurology lecture and it pops into my head every time I treat a client with this condition.

Quite simply, the term sciatica indicates that there is inflammation of the sciatic nerve. In this sense, it is NOT a diagnosis, as we still do not know the cause of the irritation and inflammation. Being informed about the possible causes can help us to carry out an accurate assessment and provide relief for this common and debilitating condition.

What is the sciatic nerve?

If you are ever lucky enough to have the question "What is the longest and thickest nerve of the body?" in a pub quiz you can be confident that the answer is the sciatic nerve. The sciatic nerve measures just under an inch in width, similar to the diameter of your finger and runs from the lower spine, through the pelvic area, and down through the hip and back of the leg.

The sciatic nerve performs two basic functions:

1. Sensory: It sends signals to your muscles from the brain.
2. Motor: It collects sensory information from the legs and passes this back to your brain.

Signs and symptoms of sciatica

If the sciatic nerve gets compressed in any way it can cause the common symptoms of sciatica which include:
  • shooting pains from the buttock, down the leg
  • tingling, or pins-and-needles sensations in the legs and thighs
  • a burning sensation in the thigh.
Causes of sciatica

The key to providing an effective soft tissue treatment for sciatica hinges on an accurate assessment of the causes of the nerve irritation.

Common causes for sciatic nerve compression include:
  • lumbar disc herniation
  • spinal stenosis or other degenerative conditions of the spine
  • piriformis syndrome.
Red flags

These are warning signals that the condition is being caused by something more serious, such as an infection of the spine or cancer. If your client is presenting with any of the below they would need to see their GP before treatment if they have not already done so:
  • Age of onset is less than 25 or over 55 years
  • Recent violent trauma, e.g., fall, accident
  • Constant, progressive, non-mechanical pain
  • Bilateral leg pain (numbness or tingling down both legs)
  • Drug use
  • HIV
  • Cancer or previous diagnosis or carcinoma
  • Widespread neurological signs and irritation
  • Systemically unwell
  • Recent weight loss
In addition it is extremely important to refer back to the GP is the client presents with any of the following symptoms. These may indicate that the client has severe compression of the nerve roots exiting from the base of the spine (cauda equna or 'horse's tail').

Cauda Equina Syndrome
  • Difficulty or increased frequency of urination
  • Loss of anal sphincter control
  • Saddle anaesthesia around anus, perineum and genitals
  • Weakness in one leg
I find that many massage therapists are terrified about contra indications and can actually go the other way of not providing treatment when it would be appropriate. It is important for massage therapists to realise that the red flags above are warning signals that would warrant further medical investigation. If however, the GP rules out organic causes such as tumours or spinal infection then soft tissue treatment can be highly effective.

Disc Herniation (Slipped Disc)

One cause of sciatica is a herniated spinal disc. The disc is like a water-filled spongy balloon that sits between the vertebrae and acts as a shock absorber to the normal daily forces that impact on the spine. You can also think of the disc as a bit like a jam doughnut with a spongy outer layer and a softer more liquid substance in the middle. In a disc herniation, the spongy outer layer wears down causing the inner disc material ('the jam') to leak out and harden. The spinal nerves therefore get compressed and people then experience the symptoms of pain, weakness and numbness.

How do I know if my client has a herniated disc?

Clients with acute herniated disc often present with extreme pain of sudden onset that is worse when coughing, sneezing or 'bearing down as in evacuating the bowels'. Visually their upper body may be totally shifted away from the side in pain. The following orthopaedic tests can also help determine whether your client has a herniated disc that may be causing their symptoms. If any of the tests below are positive, refer back to the client's GP for an MRI. However, it is important to realise that many of us show signs of degeneration of discs under MRI without having a corresponding pain problem so medical tests are only part of the assessment process.

1. Slump Test Procedure: Patient sitting with knee crease at edge of table and hands behind back. Direct your client to perform the following actions:

(i) Spinal Slump (as if slouching down in your desk when you were at school and wanted to be below the eye level of the teacher!).
(ii) Neck flexion (bringing head to chest as in nodding).
(iii) Knee extension (straightening leg).
(iv) Dorsiflexion may be added (pointing toes to the ceiling).

Positive sign: If symptoms are reproduced this can indicate a lumbar disc herniation.

2. Straight leg raise: Client supine. Passively flex the client's hip, with knee extended, ankle dorsiflexion can be added.

Positive sign: Reproduction of symptoms, indicates sciatic nerve involvement/neural tissue affected.

Piriformis Syndrome

Massage therapists can get extremely good results with this condition. The American College of Physicians found that the weight of the evidence-based medicine is that piriformis syndrome should be considered as a possible diagnosis when sciatica occurs without a clear spinal cause.  

This condition refers to entrapment of one or both divisions of the sciatic nerve by the piriformis muscle in the gluteal region.

Entrapment of sciatic nerve: The sciatic nerve normally runs from the anterior scarum through the greater sciatic notch of the illium, underneath the piriformis and over the top of the five deep lateral rotators. The nerve most commonly gets trapped between the inferior border of the piriformis muscle and the superior border of the sacrospinous ligament (this lies just underneath the piriformis). Cadaver dissections have also shown us that there can be considerable anatomical variations in the path of the sciatic nerve, in some cases the nerve actually running through the muscle itself.

Entrapment of superior gluteal nerve:  The superior gluteal nerve also exits through the greater sciatic notch but travels superior to the piriformis muscle on its way to the gluteals. Tightness in the superior portion of the piriformis can therefore trap the superior gluteal nerve against the sciatic notch. Symptoms usually include aching buttock pain and weakness of abductors of the hip.

  • Tight muscles due to prolonged sitting etc
  • Compression from an external structure ie: wallet in back pocket
  • Acute injury from fall or blow to buttock region
How to treat sciatica through advanced massage techniques  

Once you have ascertained the likely cause of the sciatic nerve entrapment you can provide an appropriate treatment. Entrapment by the piriformis muscle can typically be treated by soft tissue work; a lumbar disc herniation will typically need more sessions and a more gentle approach in the acute stage. Both piriformis syndrome and clients with a herniated disc who are not in the acute stage will respond well to the following treatment protocol:

Acute and chronic pain, and the appropriate use of hot and cold 

The use of hot and cold is a vital tool in the treatment of pain. It should be our first step in treatment. Basically speaking, cold therapy such as ice packs, ice massage, or cold stones are applied in the acute stages of pain. And heat, such as warm moist packs or hot stones for chronic pain conditions.

Fascia: Learning basic myofascial techniques allows you to work and relieve constrictions in the fascial system, which is often the missing link in massage work. The fascia is connective tissue that encases every structure of the body like a 3-dimensional body stocking. If there is a pull or a snare somewhere in this powerful fabric, it causes greater tightening in other areas causing great amounts of pain.

Muscles useful to treat in sciatica

The muscles most useful to treat are:
  • Erector Spinae
  • Piriformis, which when tight can often mimic 'sciatica'
  • Psoas, an anterior deep muscle
  • The Gluteus Group
  • Quadratus Lumborum. According to Travell and Simons "The Quadratus Lumborum muscle is one of the most overlooked muscular sources of low back pain and is often responsible, through satellite gluteus minimus trigger points for 'pseudo disc syndrome' and the 'failed' surgical disc syndrome'."
A stretching protocol for the piriformis, low back and hamstrings can be dramatically powerful in treating and preventing piriformis syndrome. Gentle exercise can also be helpful for the herniated disc.
Paul Hopfensperger of Body and Mind Studio is qualified to perform the above Advanced Clinical Massage techniques and many more on any area of the body where a client is suffering from pain. For more information, visit our main web page by clicking on the link below:-

No comments:

Post a comment