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Sciatic pain
So funny, when clients come to see me, they tend to have a lot of the same kind of issues going on. First people came for chronic neck pain, now they all come with one form of sciatica or another. I have been performing a lot of AIS stretching and deep tissue to release the periformis muscle as well as the glutes. I even read to release some of the abdominal muscles. I have done all of this on this one client and still I am having difficulty having lasting results. I know I will loose her as a client if she doesn't start seeing more results. I know it has something to do with the psoas muscles because she complains of the hips and lower back pain. At first I felt the tight glutes on the left side. Now I am having problems identifying the problem areas. I am not find tightness. What would you think? any ideas?
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Replies to This Discussion
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Permalink Reply by Dennis Hoover on
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I would release the psoas muscles. My old NMT teacher made us all learn that muscle. I also had sciatic issues, and it wasn't until a therapist worked on my psoas did it finally release. If the psoas tight, it will twist up the lower spine and pinch the sciatic nerve, which is what happened to me.
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Permalink Reply by Cindy Ballis on
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Hi Desiree
I would love to send you information regarding the Sacro Wedgy® - lifting the sacrum will help the piriformis and psoas relax. I've had a number of therapists over the years be able to take clients to the next level using this. Feel free to call anytime - I'll try my best to help.
Cindy
1-800-737-9295
www.sacrowedgy.com
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Permalink Reply by Donna Whitton on
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It looks like you're getting very sound advice from other MT's; however, I'd like to add the possibility of a tight/out-of-place SI joint and/or lumber spine. I've found that if a problem like this is chonic or isn't showing lasting results with cotinuous massage that is normally effective it's probably time to refer them to a good DC. Just let them know how important it is for them to continue massage to help future adjustments to be most effective and long-lasting.
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Permalink Reply by Janelle K on
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With the sciatica.. I use a trick I learned with Orthopedic massage and Prenatal massage. I teach my client so if they have someone at home.. they can teach them really quick to do between sessions, or whenever it is irritated.
I have the client lay in a fetal position on their bed or on my table. Then make sure the back is straight. Put one hand on the knee with the weight of a dime (very lightly).. have the client push their knee and leg towards your hand with the weight of a dime. Have them hold it for 10 seconds, then have them relax 5 seconds. Have them do this with a series of 3-5 times. Then do it on the other side as well. This will relieve the sciatica impingement.
All my clients compliment on that. When doing a massage.. I do a pin and stretch with my elbow in the piriformis (in the glutes) and pulling the foot towards the glutials.
If you need any other help.. let me know.. I am here to help!
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Permalink Reply by Tabitha Page on
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Depending on how long you have been seeing your client, you might want to consider a referral her to a physician. It could be a disc issue.
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Permalink Reply by Jerry Hesch, MHS, PT on
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Henry,
I enjoyed your thoughtful post.
Re your hip, there is some very encouraging research re mobilization as being very effective for hip OA. Not manipulation, but lower force, longer duration as practiced by some specially trained Physical Therapists. You can do aliterature search. Also, by profession you spend a lot of time with hips flexed. It would be relevant to test hip extension range of motion, in prone, knee flexed to 90 degrees, passively tested by someone else. Usually a restriction responds readily to 2 minutes of gentle stretch adding anterior glide to proximal femur. Also clear pelvis, SIJ's, and articulations in the foot and ankle, because a sub-talr restriction (treatable) can have distal effects, which are magnified. Research will also bear out the probability of weak hip abductors, poor endurance as well.
Hope this is helpful.
Jerry Hesch, MHS, PT www.heschmanualtherapy.com
www.heschmethod.com
Henry Hardnock said:I would check the QL, psoas, piriformis and sacrotuberous ligament on the same side the pain is. also check the tensor fasca latae on the same side for trigger points. its referral pain pattern is into the hip. the QL's referal pain is also into the hip.
if the QL is short it could be creating a "C" curve., when there is a curve the vertabra rotate and possibly impinge on the nerve roots in particular L4, L5. a short psoas can also contribute to a "C" curve ( be careful how you treat the psoas, unless you are really familiar with working through the intestines to get to the psoas you could cause damage) the piriformis originates on the anterior surface of the sacrum if it is short it can cause the sacrum to rotate and as we all know irritate the sciatic nerve. contract relax stretch works well on the piriformis.
Other possiblities on muscle pain or what may seem like muscle pain could be viseral problems manifesting as muscular pain. an example: kidney problems may create low back pain and the left shoulder jaw , pec pain may be heart problems.
I would also quiz the client about their occupation. if they sit alot, compression on muscle tissue is another form of injury. it shuts off blood and lymph supply and can cause an irritated sciatic nerve. proper posture when sitting is important. proper pillow bolstering will help them sleep at nite. in short unless they correct what is causing the problem it will be on going no matter how much work you do. also how old is the client there could be some osteoarthrits going on which causes sciatic like pain, I know from personal experience, I have it and it hurts just like sciatica, and i'm not that old. (at least I dont think so anyway LOL)
I started haveing pain and thought is was sciatica, i had all the symptoms and tightnessess in the hip and when i got work done especially when they tried to stretch all associated muscles it really aggrivated the pain and didnt help. finally i had xrays done and took them to a radiologist client of mine and low and behold thats whats going on. oddly enough i had talked to him one day he came in for therapy and he told me with out looking at xrays that that was probably what it was.
in a nut shell hope this helps Henry
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Dear Desiree Glolub:
It is of interest that much of the information focuses our attention on the piriformus and glutes as well as the SIJ.
Here is a new test:
Landmark the ASIS to ASIS. Next have your patient stand with the feet in a closed position. Have the patient perform hip ABD at increments of 25 cm or 1 foot or 6 inch as you wish. Note how the one ASIS moves relative to each other.
In most with low back pain or pelvic pain, you will find that the two do not remain level. The right will move inferior to the left in the vast majority of people with LBP.
I find most patients have a distinct muscular problem which is not being treated due to present test methods. Present tests distract us.
Once you have done this contact me.
Best regards,
E L.
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E Liepert said:Dear Desiree Glolub:
It is of interest that much of the information focuses our attention on the piriformus and glutes as well as the SIJ.
Here is a new test:
Landmark the ASIS to ASIS. Next have your patient stand with the feet in a closed position. Have the patient perform hip ABD at increments of 25 cm or 1 foot or 6 inch as you wish. Note how the one ASIS moves relative to each other.
In most with low back pain or pelvic pain, you will find that the two do not remain level. The right will move inferior to the left in the vast majority of people with LBP.
I find most patients have a distinct muscular problem which is not being treated due to present test methods. Present tests distract us.
Once you have done this contact me.
Best regards,
E L.
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