Sciatica

I think everyone I know at some time has experienced a form of low back pain, mostly centered around the sacrum and hip bones, the sacro-iliac joints, with pain radiating downward through the backside and into the thighs and calves.  This radiating pain is often suddenly sharp and can be so severe it puts us down and out for days waiting for recovery.

The cause of such a horrible pain arises from pressure or compression on the sciatic nerve, the longest nerve in the body that runs from the lower spine through the pelvis and gluteus muscles and angles down to the back sides of the lower legs.  With this intermittent or chronic pain, there may also be numbness and tingling in the legs, feet, and toes as nerve transmission becomes reduced.

Many causes of compression on the sciatic nerve have been identified.  One cause could originate from muscle tension, especially the piriformis muscle that originates on the side of the sacrum, crosses over the sciatic nerve as it angles across the pelvis, and attaches on the hip bone. Heavy lifting, twisting, perhaps long hours driving or prolonged positions before our computers without frequent stretching, or general overwork of the pelvic and hip muscles can generate a spasm of the piriformis and compression on the sciatic nerve.

As the sciatic nerve exits from the spinal column, any damage, wear and tear, tumors, protrusions or bulges to the discs, our shock absorbers, can reduce spinal flexibility that can lead to an irritation or pressure on the sciatic nerve root.  Spinal misalignment and stenosis, the fusing of the vertebral bones, can become an accessory to sciatic pain.

When these familiar pains remain unaddressed, the body often develops adaptive behaviors and positions to compensate for the pain and reduction of flexibility.  Over time this can lead to permanent damage to the discs, the vertebrae, and the affected nerves.  Some methods of treatments have been administering pain killing and anti-inflammatory drugs.  However, these may also have serious side affects with long term usage.  The use of heat and cold therapies may be suggested along with stretching and strengthening exercises to release spasms and ease pain symptoms.  Another therapy has been the use of anti-inflammatory steroid injections to the site, again with the potential of side effects.  In serious cases where diagnosis and testing has revealed bone or disc damage, surgery may be the recommended solution.

As complementary practitioners, the members of The Sandpoint Wellness Council (SWC) often address chronic back pain in its many manifestations.  After all, humans are active and creative beings who oftentimes use their bodies rather than machines to accomplish all sorts of heavy tasks.  Following is information from several of the SWC members and their strategies and techniques for addressing “sciatica.”

Ilani Kopiecki, BA, CMT, A Cranio-Sacral Approach

CranioSacral therapy provides a specialized approach to releasing and rebalancing the energy of the spine, as this is where our nerves exit outward to deliver our myriad nerve impulses powering our body.  This therapy gently and effectively decompresses the lumbar vertebrae, sacrum, and pelvic area enabling  any affected associated muscles and tissues to release and relax and allowing for the ache, pain, and tightness to subside, sometimes right away, and sometimes within a short period of time.  Many times with only a few sessions the pain disappears for good.  With Cranio-Sacral therapy, the client remains fully clothed.  Please visit www.upledgerinstitute.com for more information about craniosacral therapy, its applications and benefits, or call Ilani at 610-2005.

Owen Marcus, MA, A Rolfer’s Approach

Sciatica is a common problem. Studies estimate that 13% to 40% of adults suffer from it, and 1% to 5% suffer annual recurrences[1]. For more than 30 years now, sciatic pain has been a common reason why clients come to me for Rolfing.

Over the years, I’ve learned some things about sciatic pain:  whether the pain is caused by low back strain, a herniated disc, or hip muscle strain (e.g., piriformis muscle), inevitably the true source is soft tissue strain. The body’s muscles and connective tissue (fascia, tendons and ligaments) contract, pull on the skeleton, yank it out of alignment, and cause pain. This strain compresses the discs of the back, which is the major cause of sciatica. The strain can also force the muscles of the hip to contract (the sciatic nerve travels through those muscles) creating “pseudo-sciatica”.

Think of your soft tissue as leather; if it shrinks (tightens up due to injury, stress, or pain), your entire body shortens. The low back is the most vulnerable to shortening because of the large muscles and connective tissue of the deep abdomen and the back muscles.

“No matter what I do for my ‘core,’ I can’t seem to strengthen my lower back or flatten my low abdomen,” one of my clients told me. Even when she wasn’t having sciatic pain, her low back often just felt tired. No amount of stretching helped, because it wasn’t just her muscles that had shortened up; all her fascia was too tight also. After getting Rolfed, she told me: “It’s like my low back muscles woke up.” She hasn’t had any pain, and she can finally exercise some of those core muscles she had only heard about before.  Her stomach is flatter and her back is stronger.

With this shortening, your organs and back are susceptible to impairment, and so are the nerves that run out of the spine. Your discs are like jelly donuts filling in the space between the vertebrae of the back, allowing the back to bend. After years of strain, these discs flatten into pancakes and the low back shortens. (This is where we lose most of our height.) Then the compressed discs can bulge, pushing against a nerve. In the hip, the deep hip muscles can contract around the nerve.

The compounded strain over the years distorts your entire structure, forcing your bones to try to compensate, essentially mal-forming your skeleton. If your body’s entire leather suit shrinks, your skeleton does the best job it can to adjust to the decreasing space. But your nerves are very sensitive to irritation from this chronic imbalance. We can fix one part of this puzzle, but if the systemic strain remains, you will have recurring pain.

Fortunately, the whole process is reversible. Think of it like straightening out a twisted hose-you can’t just straighten out one section, you need to unwind the torque from the entire hose so it will lie flat.  To stretch out your soft tissue, so your skeleton can go back to its natural state, you have to “unwind” all the soft tissue, releasing the chronic stress and allowing your body to regain its natural state.

All your soft tissue needs releasing-right where the pain is, and throughout your entire body-for significant lasting change. There are many ways to get a release; Rolfing is just one of them.

Owen Marcus, MA Certified Advance Rolfer, www.align.org, 265.8440.

Krystle Shapiro, BA, LMT, CDT, A Massage Therapy Approach

As a medical massage therapist, I have many clients who request a massage to relieve their back pains.  My approach is to determine the recent activities and movements a client has undertaken to understand exactly which muscles have “cramped up” from what action.  Most often it is the piriformis muscle, but sometimes other low back, abdominal, or leg muscles are the source.  The pelvis is our core where upper and lower body structures attach or originate, and as we move, it receives a tremendous amount of action every day.

I utilize two basic therapeutic approaches to address sciatic pain:  muscle energy technique (MET) and positional release therapy (PRT).  Cramping or spasms become involuntary.  By applying MET, I perform with the client a contract/relax activity with the affected muscle three or four times.  This pattern informs the brain and muscle receptors that a new action is requested, that of relaxing.  It always amazes me how effective this technique is when a therapist understands kinesiology and can identify the right muscle precipitating the spasm.

PRT is similar in that it causes a renegotiation between the muscle receptors and the brain.  When we injure ourselves, the muscle receptors send the brain a signal that says “Ouch!!”  The brain then sends a chemical, surprisingly called Chemical P,  that causes a pain sensation.  This in turn causes us to protect an area that hurts.  With PRT, I find a “tender hot spot” and then move the affected limb into a position where the pain “turns off.”  With the appropriate wait time held in that special position, the muscle receptors say “Ahhh,” the brain stops sending Chemical P, and the spasm is released.  Usually any residual ache subsides within a couple of hours as the immune system carries the residue of Chemical P away from the site.  These two therapies are very effective and have enabled many of my clients to not take medications that create unwanted side effects.

Krystle Shapiro, Touchstone Massage Therapies,  208/290-6760

Mary Boyd, A Physical Therapist Approach

Leg pain may be misunderstood as there are two different causes.  In the first situation, the piriformis muscle that lies deep within the buttocks may be inflamed as a result of low back dysfunction.  This little muscle, about the size of your pinkie, lies over the sciatic nerve and often mimics true sciatica by pushing on the nerve and in turn causing pain, numbness, and tingling in the posterior leg.

In the second situation, true sciatica occurs when the nerve itself is pinched or pushed upon by one of the spinal segments in the low back, also bringing pain, numbness or tingling into the leg and foot.  It is important to understand the root cause so the treatment will be effective.  Personally, I use joint or soft tissue mobilization to treat these symptoms, working directly on the joints of L 3, 4, & 5 in patients with true sciatica or directly on the buttocks for those that have piriformis irritation.  It is also important to understand that pain that extends below the knee is considered to be more serious and more difficult to treat.

Mary Boyd, MS, PT, 208/290-5575

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[1] From Oxford Journals of the BJA.

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Resources for more info -

http://www.curezone.com/dis/1.asp?C0=299

http://www.spineuniverse.com/displayarticle.php/sciatica-treatment-3126.html

http://www.mothernature.com/Library/Bookshelf/Books/41/101.cfm

http://www.sciatica.org

http://www.mindbodysoul.tv/episodes/episode-five/sciatica