Most of us have experienced low back pain at some point in our lives. But a slipped or herniated disk can result in a much more serious condition known as sciatica. Sciatica has been reported to occur in about 2.2% of the population, most commonly in people aged 25 to 45 years. Low back injury is one of the most debilitating conditions of working Americans. Sciatica is often the result of an injury to the discs in the low back. Risk factors for sciatica include age, excessive body weight, smoking, sedentary lifestyle, strenuous physical activities such as lifting, and long periods of time while driving (due to the vibration and bouncing).
What Is Sciatica?
Sciatica refers to the pain that radiates down the leg and foot, usually from a slipped disk in the lumbar region. Typically, a slipped disk, usually at L4 or S2, puts pressure on the sciatic nerve, causing numbness, weakness, and pain that travels down the leg to the foot. This can be a dull, achy pain or sharp, shooting pain and can range from mild and annoying to severe and debilitating. The term slipped disk refers to the soft, gel filled disk that separates and cushions the vertebrae. When these disks move out of position (“slip” out) it is considered a slipped disk. A herniated disk refers to a ruptured disk.
This condition may also occur as a result of the piriformis muscle putting pressure on the sciatic nerve, causing numbness and pain down the leg and foot. This is commonly known as Piriformis Syndrome. Other causes for sciatica include lumbar spinal stenosis (narrowing of the spinal canal), degenerative disc disease, and spondylolisthesis (the vertebra slips forward over the next one).
Symptoms of Sciatica
Sciatica may be acute or long-term and chronic. Up to 80% of sciatic sufferers get better on their own in about three months, but they may experience significant pain and debilitation while they suffer. The other 20% or so may experience sciatic pain ranging from two years to lifelong, chronic suffering. Symptoms include unilateral leg pain, pain radiating to the foot or toes, numbness in the same unilateral distribution, and increased pain upon raising leg or foot.
While pain medication may be prescribed, it is not uncommon for over-the-counter pain and anti-inflammatory medication to be suggested by a physician. In addition to the use of cold, heat and medication, there are stretches and exercises that can strengthen the supporting muscles and release tension in muscles that are exacerbating the pain. Massage therapy can also help sciatica sufferers, especially when the pain is the result of piriformis syndrome.
Massage Therapy Reduces Sciatic Pain
While massage therapy may not directly help in reducing sciatic pain that is causes by a slipped or herniated disk, it can be very effective in reducing pain from sciatic pain caused by the piriformis. The piriformis is the largest of six deep rotator muscles between the sacrum and the greater trochanter in the buttocks. It attaches inside the rim of the sacrum and runs laterally to the top of the greater trochanter. The piriformis is a powerful lateral rotator for the leg and, when tight, can cause misery from trigger points and by entrapping the sciatic nerve.
Using deep pressure, usually with the elbow, to release trigger points in the piriformis may significantly relieve sciatic pain. Stretches to lengthen the muscle and ice to reduce inflammation also help in reducing pain caused by the piriformis.
There are also trigger points in the gluteal muscles that may refer pain around the sacrum, low back and legs. Trigger points in gluteus maximus may refer around the sacrum and greater trochanter, while trigger points in the gluteus medius may refer pain around the sacrum and across the low back. Gluteus minimus trigger points can refer pain down the leg.
Releasing the quadratus lumborum can be a challenge as it is not easily accessible and can be extremely painful when the trigger points here are active. Approaching from the side allows the massage therapist to get under the erector spinae muscles to apply friction and release trigger points in quadratus lumborum.
Finally, trigger points in the psoas muscle may refer pain into the low back on the same side of the body. This muscle can be very difficult for massage therapists to access, especially if the client is very tight or the muscles are tender. These trigger points can be found deep in the abdomen, and many clients feel vulnerable when their massage therapist tries to access these points. Find the anterior superior iliac spine (ASIS) with one hand and the belly button with the other. The trigger point is halfway between these two landmarks. Have the client lie on their back with knees slightly to the opposite side. Placing an extra pillow or bolster under the knees helps to release the tension on this muscle so that you can better access it. If you feel a pulse while trying to locate this point, move slightly lateral as you may be on the descending aorta.
Stretches to Relieve Sciatic Pain
Stretching may be too painful if you are experiencing acute sciatica, but for chronic sciatica pain and to prevent recurring sciatica, stretching may be helpful. When stretching, hold each stretch for about a minute while taking slow deep breaths to allow muscles time to relax and release.
3 Piriformis Stretches
Stretches for the piriformis include placing the foot on the outside of the opposite knee while lying down. Then grab the raised knee and pull across the body until there is a stretch felt deep in the gluteal.
For a deeper stretch, raise one knee, then place the other foot on the knee. Reach through your legs, grabbing behind the knee to pull both up toward the chest. Again the stretch should be felt in the gluteal area.
A final stretch for the piriformis is what is known as the Pigeon pose in yoga. Begin kneeling on all fours, then pick up your right leg and move it forward so your left leg is lying on the ground almost flat. Your right foot should be in front of the right knee while the knee leans to the right. With left foot all the way back behind you (with top of foot on the floor), shift right foot to left side of left knee. Slowly lower yourself until you feel the stretch deep in the right gluteal. You can stay there with your upper body supported on your hands, or if you can, lower the upper body until you are resting on your elbows. If that is comfortable, try to lower the upper body until you press your forehead to the floor.
Other muscles that should be stretched if you are experiencing sciatica are the hamstrings, the quadriceps and the lumbar muscles.
Stretch the hamstrings by leaning forward with knees slightly bent. Relax and try to extend the stretch a tiny bit with each deep breath until you are touching your toes. This also stretches the lumbar region.
The classic “runner’s stretch” is great for quadriceps. While standing, grab a chair or wall for aid in balancing, then lift a foot and grab your “shoelaces” with the hand on the same side. Again, hold for about a minute, increasing the stretch a bit with each breath.
Quadratus Lumborum Stretch
Finally, to stretch the quadratus lumborum muscle deep in the lumbar, begin on your hands and knees. Stretch out your hands until your arms are straight out in front and your forehead is near or on the floor (Child’s pose in yoga). Then walk hands to the left, bending at the waist. Hold for a minute when you feel the stretch deep in the right side of your waist. Then move your hands to the right, and hold when you feel the stretch deep in the waist on the left.
Strengthening Exercise for Abdominal Muscles
The abdominal muscles are critical in maintaining the integrity of the lumbar region. Abdominal strengthening exercises will aid in stabilizing the low back, reducing risk of damage to the disks and irritation to the sciatic nerve.
One great exercise for stabilizing the low back is straight leg raises. If your back is compromised or your abdominals are weak, begin by lying on your back with one leg raised with knee bent, then lift the other (straight) leg up for the count of ten. Switch legs and repeat on the other side. When you are ready to increase the difficulty level, place hands under either side of the sacrum with your abdomen “hollowed” out and low back pressed to the floor to protect the lower back. Lift both straight legs up for the count of ten.
While sciatica is usually self-resolving, it can also be a seriously debilitating condition. Helping clients understand what is happening and what is causing their pain is an important part of helping them recover. As massage therapists, we can teach our clients how to stretch to minimize sciatic pain and help our clients remain pain free.