Sciatica and Piriformis Syndrome: How to Drastically Alleviate Your Clients Sciatica Pain

I have become very adept at massage in recent years, especially since my client load grows bigger and bigger. I have come to understand the human body in ways I never knew I would and I keep learning more techniques to help my clients, which is the basic reason I continue doing therapeutic massage today.

Through the years of massage I have learned that no one technique is better than another (at least in my experience). It is the understanding, skill, care, and proper education of the therapist that makes his or her technique affective at all.

In the case of Sciatica or Piriformis Syndrome, I have learned by combining certain Myofascia (Myofascial Release) techniques, specific Trigger Point Therapy techniques, and basic Swedish Massage techniques that I can help alleviate their pain until finally they have very little to no pain what-so-ever. I will outline what I do below, but first you must understand what Sciatica and Piriformis Syndrome is.

Sciatica

In Wikipedia, an online encyclopedia, they explain Sciatica as a "set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve itself. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.

Although sciatica is a relatively common form of low back and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms." - http://en.wikipedia.org/wiki/Sciatica

Piriformis Syndrome

Wikipedia also explains Piriformis Syndrome rather accurately. They explain that Piriformis Syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the sciatic nerve. There is no definitive way to diagnose the syndrome which may result from anatomical variations in the muscle-nerve relationship, or from overuse or strain." - http://en.wikipedia.org/wiki/Piriformis_syndrome

More Pressure is NOT Always Better

When using the techniques below, please keep in mind the comfort of the client. A lot of massage therapists (especially in the therapeutic realm) tend to "dig in" or "no pain, no gain". Even though some of the "no pain, no gain" is needed and true for your client to start their trip to balance and health recovery, sometimes pushing too hard can cause bruising. Bruising damages the underlying tissue of the area you are working on and can often create ruptured blood vessels without you knowing it. If you tend to bruise your clients, then it might be a good idea to ease up. They can get better without bruising and in my experience, they get better much quicker. Bare in mind, I have accidentally bruised a client here and there as well, so I am not exempt to my own advice.

With my clients I use the 1 - 10 pain scale. I ask them, "On a scale from 1 to 10, 10 being the most pain and 1 being very little pain, what are you experiencing right now?" If they say above a 7, then I ease up. If they say they are below a 7, such as a 3 or a 4, then it gives me plenty of room to work with. I can apply more pressure or I can spend more time on the muscle until it releases.

The Basic (Very Basic) Techniques

I am going to explain the basic techniques I use to ease up and to help heal the Sciatic or Piriformis Syndrome issue. I assume that you as a Massage Therapist know the anatomy pretty well. You should know the muscles and bones - not all of them, but most of them. If you do not, then don't worry. You can look up my other blogs to see exactly where these muscles and bones are and what they do.

Now, I will list exactly what I do, from the beginning of the session to the end of the session. I then want you to look up the other blogs that I have written and see exactly how to work on the muscles listed below. For example, the 1st thing I do is release the psoas muscle. I have explained exactly how I do this in a subsequent blog, so I have only a small summary about the psoas release below. I do this because I don't want to overwhelm you with too much information at one time. It is good to learn one thing at a time. Learn the psoas release, then the iliacus release, then the "QL" release, and so on.

The List:
Steps on How to Help Your Client with Sciatica and Piriformis Syndrome

1. Psoas Release: I use a basic trigger point release to help relax the psoas muscle. The psoas muscle is one of the most important muscles in your body. I call it the "body balancer" as it does just that. In my experience, releasing this muscle sends a gradual domino affect throughout the body, literally unwinding the body and putting it back in balance. Be careful with elderly people. The psoas is beneath the colon and too much pressure in this area for elderly people can cause the colon to bleed. You need to ease in gradually. Make it comfortable and easy for them. Go slow and most of all, remember to have to read the "Psoas" blog. It will teach you how to work on the psoas muscle properly.

2. Iliacus Release: The iliacus is the cousin, brother, sister, or whatever you want to call it, to the psoas. It does virtually the same function as the psoas. You may want to call it the psoas's assistant. I show you how to release this muscle in my "Psoas" blog. Sometimes you don't even need to work on this muscle. I always do. It's just my preference.

3. Thoracolumbar Fascia: Very simple and easy technique. I show you how to use Myofascial Release to take the fascia's strangle hold off of the underlying muscles.

4. Quadratus Lumborum or "QL" for short: Again, a basic trigger point technique where I apply pressure to three of the four trigger points in the muscle. Sometimes a "QL" release can lengthen that all too common "one leg is shorter than the other leg" problem and bring equilibrium back to the legs.

5. Sacral Iliac Joint or "SI" Joint: Another Myofascial technique (that seems more trigger point like) is used with this Joint, which is held together by very strong ligaments. I also show you some strengthening techniques that you can give to your client for this joint for their homework. Clients don't necessarily like receiving homework, but they think you are that much smarter and that much more talented as a therapist by showing them things that they can work on for themselves.

6. Piriformis (and other lateral rotatating muscles): The piriformis and lateral rotators can cause pain down the leg by being in constant contraction. The contracting piriformis can push on the sciatic nerve and cause a traveling pattern down the leg. The traveling pattern can be a burning sensation, a numbness, a pain or an ache, or such things as a "restless leg". There are two techniques that I use for this one, so be sure to read this very important muscle in the "Piriformis" blog. The piriformis, along with the psoas, can make the world of difference in getting your clients better.

7. Last, but not least, Gluteus Minimus and Gluteus Medius: These muscles can cause something called, "False Sciatica". Sometimes the "Gluts" can be the main culprit for pain going down a client's leg, so working on these two muscles can save you a lot of heartache and time. They are usually the missing link when nothing else seems to work. I explain why in the "Glut. Minimus and Glut. Medius" blog.

Subsequent Blogs and Other Blogs

Now go and have fun with the information that I have in my other blogs. Use the techniques, but please don't think they are "The Technique" that can save your massage career or are the only ones to use. They help me and many other professionals. I have learned them from books, from incredible massage therapists, and, oddly enough, from my clients. I have also taught these techniques on a one on one basis with other therapists.

You can put these techniques in any routine that you have. What has happened to me, when I put these techniques into practice, was a huge influx of clients. My name got out. I was helping people in ways that I never knew I could. I actually have to turn some clients down and tell them that I'm all booked up. Not all the time, but it does happen.

All in all, thank you for reading and don't forget, I have many other ways to help many other chronic and acute syndromes, symptoms, and issues that come up in every day massage life. Keep coming back as I will be sharing more and more as life and the pursuit of knowledge continues.

Brandon Ellis, LMT #12645

*The techniques and excersises on this page are for information only. They are not to replace any medical diagnosis, medical advice, or medical routine necessary for your health or for your client's health.