Sciatica is “an irritation or compression of the sciatic nerve,”i or “pain, tingling, or numbness produced by an irritation of the nerve roots that lead to the sciatic nerve. The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back.”ii
Despite the fact that lower back pain and sciatica often occur together, they have separate causes and are usually two different issues. Lower back pain is usually a muscular problem, while sciatica is a nerve problem. In fact, sciatica “is almost without exception the result of a neurological problem in the back, or an entrapped nerve in the pelvis or buttocks. Very rarely, other neurological conditions, such as multiple sclerosis or stroke, may account for it.”iii More than 5 percent of people in the United States suffer from sciatica, and each individual has a 40 percent chance of developing it at some point in his or her lifetime.iv
As stated in chapter one, the defining symptoms of sciatica are an electrical-feeling pain or tingling in the lower back or buttocks that can move down the leg as far as the toes. There might also be weakness or numbness accompanying the pain, or weakness/numbness on its own without the nerve pain.
While it might seem like it would be easy to self-diagnose sciatica, it is important that your client see a medical doctor for confirmation, since sciatica can itself be a symptom of a greater problem (and since some of the mimic disorders are also serious). The doctor will go through a number of steps to diagnose sciatica.
Physical therapy is a common first treatment prescribed by doctors for lower back pain and sciatica. It is often combined with “nonsteroidal anti-inflammatories...to reduce spasticity, help restore function, improve mobility, relieve pain, and prevent further episodes. In addition, physical therapy aims to restore, maintain, and encourage overall fitness and health.”v
Along with physical therapy, traditional Western medicine also offers medications, injections, and surgical treatment options for patients suffering from sciatica. Massage clients might be under any number of these treatments when they come to you, so be sure to get a full medical history before you begin treatment.
Acupressure and acupuncture are related modalities of Traditional Chinese Medicine (TCM). Both can be used to treat sciatica, and it is possible that your client will use one or both in their search for relief.
The main concept behind both treatments is that life energy called chi circulates through the body on meridians, which are energy pathways that resemble blood vessels or the nervous system. Chi must move through the meridians unobstructed for good health to be maintained. When the flow of chi is blocked, health issues like back pain occur.
Since a client coming for massage most likely has muscular-related sciatica, you will generally be focusing massage on the lower back (lumbar area) and the glutes/hips to target the piriformis muscles.
In addition to treatment from his or her doctor, physical therapy and alternative treatments including massage, people with sciatica can also help alleviate their symptoms at home. There are some exercises to be done and habits that can be changed to help prevent the worsening of symptoms.
There are a number of other treatment options available for clients with sciatica. Your clients should report any other treatments they are undergoing on the medical intake form they fill out when they come to see you. Some of the treatments you might encounter with your clients include: chiropractic, hydrotherapy, osteopathy, rolfing, and tai chi.
References
i Larry P. Credit, Sharron G. Hartunian, Margaret J. Nowak, Relieving Sciatica, Avery Publishing Group, 2000.
ii WebMD, “Sciatica Topic Overview,” http://www.webmd.com/back-pain/tc/sciatica-topic-overview
iii Cleveland Clinic, “Diseases and Conditions,” http://my.clevelandclinic.org/disorders/sciatica/hic_what_is_sciatica.aspx
iv Ibid
v Loren Fishman, Carol Ardman, Back Pain: How to Relieve Low Back Pain and Sciatica, Nov. 17, 1999.
FREE Massage Therapy CEU!