Sciatica is a named after the Sciatic nerve that is affected when someone develops a sharp nerve pain that radiates into the buttock, thigh region, or foot on one side of the body. The pain felt from a restriction or pressure on the sciatic nerve, can be rather debilitating if not treated when symptoms arise.
Anything that affects the health of the sciatic nerve increases your chance of experiencing sciatica. Age is one the biggest risk factors for sciatica because of changes in the spine that contribute to irritation of the sciatic nerve including herniated discs, bone spurs, or narrowing of the spinal cord, all in the low back where the nerve originates. A job that requires heavy lifting, days with prolonged sitting or inactivity, weak core muscles, high levels of mental stress, excessive weight around the waist, lingering back pain and smoking are some of the many reasons that someone is more likely to develop sciatica. While this list can be a bit discouraging, there are definitely things we can do to be proactive in our approach to warding off sciatica.
Massage or soft tissue mobilization as we call it in physical therapy, allows physical therapists to manipulate the soft tissue (skin, muscles, and fascia) in this case, in the distribution of the sciatic nerve to alleviate the pressure exerted on it. When muscles, like the piriformis, hold increased tension, the sciatic nerve can be compressed or restricted which can cause even more serious symptoms like weakness, numbness or tingling. Soft tissue mobilization is an important tool to promote a healthy environment for the nerve to glide through a pathway in the body.
When I first utilize massage on a patient suffering from symptoms of sciatica, I am working on calming down the nervous system, if needed. Pain can contribute to a heighten response of fight or flight that overstimulates the body and increases overall tension in the body. This increase in tension adds to the pain response a patient is experiencing. This type of massage is gentle and superficial which promotes release of endorphins that help the body feel safe to allow relaxation.
Once the nervous system is regulated, I utilize a slightly firmer, more stimulating massage technique to release histamines and improve the blood flow response to the skin in the areas of restriction. Increased circulation to an area with adhesions and high irritability will allow for new nutrients, stored in the blood, to be brought to the painful area to elicit healing.
Deep tissue massage techniques like myofascial release, trigger point release, and muscle rolling takes the massage a step further to address fascial and muscular restrictions. When a muscle is shortened, it is often tight. If the muscle is tight, it can complicate symptoms of sciatica.
As I have explained, different types of massage effect different structures in the body. It is my job, as a physical therapist, to determine what the patient’s body will respond best to each time they walk through the door!
Manual therapy through techniques like soft tissue mobilization or massage are often very effective during treatment of sciatica, but not the only treatment necessary to alleviate symptoms of sciatica for good. Active treatments like nerve glides, mobility exercises, functional biomechanics and strengthening techniques to minimize imbalances are needed to establish improved motor control and alignment within the body. With this whole body approach (versus just treating the symptoms of sciatica) the patient is much more likely to experience long lasting relief of sciatica.