massage and bodywork professionals

a community of practitioners

Does anyone have clients suffering with sciatica? Talk to me and tell me how and what you recommend doing for a client as such......

Views: 350

Reply to This

Replies to This Discussion

I treat/have been treating clients with sciatic nerve impingements throughout my 9 year career. It was only since I became afflicted with this condition that I understood better how to treat them.
My pain arises from a herniated disc, other clients from degeneration, severe OA, spinal stenosis, DDD or piriformis syndrome. Take many comfort measures to ease your client's pain. Chronic pain affects everyone differently, but most will appreciate extra care with proper positioning. For me, prone postioning caused more pain, as did excessive anterior pressure on my low back. Some pressure felt good on my low back, but trying to get up after my treatment was very difficult due to pain and stiffness that settled into my joints during the massage therapy treatment. Side lying treatment may be the best choice for acute/sub-acute sciatica.
You can also recommend that your clients seek out homeopathic medicine that specifically treats inflammation. I found a combination that naturally eased my pain.
Epsom salt baths take out the inflammation as well (mag. sulfate) and can be done everynight unless C.I.d ie heart disease.
Thank you for that info Luciana

Luciana Borba Johnston said:
I have lots of clients who suffer from sciatic pain...I usually release all muscles attached to pelvic girdle i.e. lats, es group and gluts especially piriformis. Also good to make sure that you do some good work on the thighs since they also attache at the pelvic girdle. If it is a muscular impingement then releasing the pelvic girdle from any tug of war that may be happening...your main culprit is usually the deep hip rotator Piriformis. Deep static compression right over that muscle works wonders...good luck :) and they may want to visit a good chiropractor right after they see you in case it is also a skeletal impingement...
OK I thank you for sharing that with me.

M Olajide said:
I treat/have been treating clients with sciatic nerve impingements throughout my 9 year career. It was only since I became afflicted with this condition that I understood better how to treat them.
My pain arises from a herniated disc, other clients from degeneration, severe OA, spinal stenosis, DDD or piriformis syndrome. Take many comfort measures to ease your client's pain. Chronic pain affects everyone differently, but most will appreciate extra care with proper positioning. For me, prone postioning caused more pain, as did excessive anterior pressure on my low back. Some pressure felt good on my low back, but trying to get up after my treatment was very difficult due to pain and stiffness that settled into my joints during the massage therapy treatment. Side lying treatment may be the best choice for acute/sub-acute sciatica.
You can also recommend that your clients seek out homeopathic medicine that specifically treats inflammation. I found a combination that naturally eased my pain.
Epsom salt baths take out the inflammation as well (mag. sulfate) and can be done everynight unless C.I.d ie heart disease.
Firstly you need to be sure of the diagnosis. Apart from a 10 - 20 % chance that piriformis may be 'split' with sciaitic nerve root passing between the fibres of such, and the possibility thereof contraction causing pain, though not necessarily.
Cadaveric studies have seen many such anomalies and the person had never complained of any pain.

Also be aware of:

Facet arthropathy. May be due to trauma or degenerative process. Complaint of low back pain with radiation into the buttocks or thighs are common. Pain does not travel below the knees. Pain is exacerbated with spinal extension, lateral bending and rotation towards the affected side, relieved with lumbar flexion. Medial branch blocks, which temporarily decrease pain are diagnostic for painful facets these blocks may be followed with radiofrequency ablation for more lasting relief.

Lumbar radiculopathy. The majority of clinically significant lumbar disk herniations occur at L4-5 and next L5-S1, causing L5 and S1 radiculopathies respectively. Test for lumbar radiculopathy with good interrater reliability include cross leg straight leg testing (best test), a positive straight leg raise at <60 degrees, unilateral leg pain worse than back pain, loss of lordosis.

Internal Disk Disruption (IDD). The intervertebral disk is a poorly vascularized tissue that tends to heal poorly. Microtrauma and annular tears may release inflammatory mediators that can aggravate local pain fibers. Risk factors include repetitive twisting motions and prolonged sitting. Diagnosis is via fluoroscopic discography followed by CT visualization.

Hope that helps rather than confuses.

AJ
It did help AJ thanks

Allan J Jones said:
Firstly you need to be sure of the diagnosis. Apart from a 10 - 20 % chance that piriformis may be 'split' with sciaitic nerve root passing between the fibres of such, and the possibility thereof contraction causing pain, though not necessarily.
Cadaveric studies have seen many such anomalies and the person had never complained of any pain.

Also be aware of:

Facet arthropathy. May be due to trauma or degenerative process. Complaint of low back pain with radiation into the buttocks or thighs are common. Pain does not travel below the knees. Pain is exacerbated with spinal extension, lateral bending and rotation towards the affected side, relieved with lumbar flexion. Medial branch blocks, which temporarily decrease pain are diagnostic for painful facets these blocks may be followed with radiofrequency ablation for more lasting relief.

Lumbar radiculopathy. The majority of clinically significant lumbar disk herniations occur at L4-5 and next L5-S1, causing L5 and S1 radiculopathies respectively. Test for lumbar radiculopathy with good interrater reliability include cross leg straight leg testing (best test), a positive straight leg raise at <60 degrees, unilateral leg pain worse than back pain, loss of lordosis.

Internal Disk Disruption (IDD). The intervertebral disk is a poorly vascularized tissue that tends to heal poorly. Microtrauma and annular tears may release inflammatory mediators that can aggravate local pain fibers. Risk factors include repetitive twisting motions and prolonged sitting. Diagnosis is via fluoroscopic discography followed by CT visualization.

Hope that helps rather than confuses.

AJ
Luciana, this a very hard question to answer in short form. Whenever an area is suspected as the cause of pain, the first thing I do is 'clear' adjoining segments as being possible culprits. So, if the lumbar area is suspected, I would clear hip and lower thoracics as contributors first. There are too many differentation tests for me to list. If any of the other possible causes I listed were the cause of the pain, massage, and a lessening of the guarding effects may in fact be counterproductive.
If, after testing things were actually pointing to pirformis syndrome I would treat for just that. I like to work all Mm that may also contribute to tight piriformis, starting with furthest from my target Mm (prirformis) then work my way closer. So, biomechanically, what does piriformis actually do? At what degree of hip flexion does it do differing things? What are the antagonists? etc etc.

Again, hope this was helpful in some way.:)

AJ

Luciana Borba Johnston said:
Aj...what would be your approach in said diagnosis? I am curious....

Ella Jones-Oduntan said:
It did help AJ thanks

Allan J Jones said:
Firstly you need to be sure of the diagnosis. Apart from a 10 - 20 % chance that piriformis may be 'split' with sciaitic nerve root passing between the fibres of such, and the possibility thereof contraction causing pain, though not necessarily.
Cadaveric studies have seen many such anomalies and the person had never complained of any pain.

Also be aware of:

Facet arthropathy. May be due to trauma or degenerative process. Complaint of low back pain with radiation into the buttocks or thighs are common. Pain does not travel below the knees. Pain is exacerbated with spinal extension, lateral bending and rotation towards the affected side, relieved with lumbar flexion. Medial branch blocks, which temporarily decrease pain are diagnostic for painful facets these blocks may be followed with radiofrequency ablation for more lasting relief.

Lumbar radiculopathy. The majority of clinically significant lumbar disk herniations occur at L4-5 and next L5-S1, causing L5 and S1 radiculopathies respectively. Test for lumbar radiculopathy with good interrater reliability include cross leg straight leg testing (best test), a positive straight leg raise at <60 degrees, unilateral leg pain worse than back pain, loss of lordosis.

Internal Disk Disruption (IDD). The intervertebral disk is a poorly vascularized tissue that tends to heal poorly. Microtrauma and annular tears may release inflammatory mediators that can aggravate local pain fibers. Risk factors include repetitive twisting motions and prolonged sitting. Diagnosis is via fluoroscopic discography followed by CT visualization.

Hope that helps rather than confuses.

AJ

Reply to Discussion

RSS

© 2022   Created by ABMP.   Powered by

Badges  |  Report an Issue  |  Terms of Service