by Nick Lakoff, CMT
One very common condition that I would encounter often in my massage therapy practice is Sciatica. Sciatica is nerve pain that is usually felt in the lower back, hip and towards the rear of the leg down to the calf in the more severe cases. There are two classes of Sciatica, True Sciatica and False Sciatica. True Sciatica is when the Sciatic nerve is impinged upon by bone at the intervertebral foramen. This is the passage that is created by the shape of the vertebrae’s and allows the nerve to connect to the spinal cord and branch out to the lower limbs (legs). Problems usually occur from the sciatic branches that radiate out from the fourth and fifth lumbar vertebrae’s (L4-L5) and fifth lumbar and first sacral vertebrae’s (L5-S1). This condition usually occurs from a birth defect or from trauma suffered to the spinal column. In a chronic state this condition requires medical consultation and could perhaps require a surgical intervention depending on the severity. Much more common is False Sciatica which is when the nerve is impinged upon by muscle, ligaments, connective tissue and/or fascia past the intervertebral foramen.
The pain from prolonged bouts of sciatica can be debilitating to those who suffer its effects. Medications usually have a limited effect since the pain is nervous rather than muscular. Massage Therapy’s domain being musculature, ligaments, connective tissues and fascias, it is very effective in treating False Sciatica. Some individuals sometimes unknowingly carry a lot of stress in their lower back/buttocks area causing this condition to evolve. Massaging these areas regularly can often greatly reduce pain and discomfort and sometimes completely eliminate it.
Generally speaking any type of massage can be used whether it’s Swedish, Shiatsu, Amma, Thai Yoga or other style. In my experience however Swedish has been particularly effective for my clients suffering from False Sciatica. One of the first things I do after my clients get in the prone position on the massage table is to elevate their hips up. To do this I use a folded sheet that I insert under the main sheet right under their hips. Pads or cushions can also be used but from experience I have found that this is the simplest way to do it. The sheet is about 10 inches wide and is just thick enough to reduce the stress in the lower back. This greatly facilitates my work and allows my strokes to be much more effective. From experience in cases I’ve encountered, the source of most False Sciatica pain was centered in the lower back/buttocks rather than down the legs. This is why I concentrate much more time in these areas than the legs. One common point where impingement can occur is at the site of the Piriformis muscle which is located in the center of and under the buttocks. In 10% of the population the Sciatic nerve actually passes through the Piriformis rather than under it which is much more problematic when an issue with it arises. Using a combination of over lapping and transversal cross friction movements and kneading, I seek to loosen the fascia that causes the knots applying pressure to the nerve. As well as the lower back and buttocks I take time to work around the hip area which sometimes can be responsible for the impingement. I end working each side with the legs and feet. I work both sides because very often the side experiencing the pain will be favored and the opposite leg is working harder and is in need of relief as well. Once the session completed, I carefully remove the folded sheet from under the client’s hips. Generally with this condition I often opt to assist the client in getting up from the massage table so as not to strain their lower back. At every moment in this process, I take steps to protect the client’s intimacy. Once upright I tell them to sit up straight and take a few moments before attempting to get off the table.
When seeking a massage therapist to treat your Sciatica, experience with various pathologies is a plus. Don’t be afraid to ask questions and seek a second opinion if you’re not sure. Fortunately in most cases massage cannot make things worse however most of us would like any treatment we pay for to be effective of course. Some practitioners will use products that contain Camphor or Arnica or other herbal additives that heat up tissues so be sure to mention if you have any allergies or dislike the use of these when getting a massage.
Nick Lakoff is a certified practitioner in the following disciplines: Swedish Massage, Sports Massage, Reflexology, Acupressure, Myo-Fascial Release, Massage for Pregnancy, Swedish Chair Massage, Hot Stone Massage and Reiki.