Contemporary multimodal massage therapists are uniquely suited to incorporate a number of rehabilitation strategies for sciatica based on patient-specific assessment findings including, but not limited to:
• Manual Therapy (neurodynamic mobilization, soft-tissue massage, joint mobilizations)
• Education on psychosocial factors (eg. BPS framework of pain, fear avoidance)
• Remedial Loading Programs (eg. static stretching, concentric, eccentric, isometric)
Structures to be Aware of When Treating Sciatic Pain
Sensitivities of Axons Exposed to a Pathological Environment - Neurovascular bundles may be exposed to mechanical irritation at many different points. Prolonged irritation may result in a reduction of intraneural blood flow. In turn, local hypoxia of a peripheral nerve leads to a drop in tissue pH that triggers the release of inflammatory mediators, known as “inflammatory soup”. This noxious substance can disrupt the normal function of nerves (Fisher et al. 2015). The application of specific soft tissue treatment may help to diminish intraneural edema and/or pressure by mobilizing neural tubes (Gilbert et al. 2015).
A treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. symptoms may be causes by disc herniation, spondylolisthesis or soft tissue irritation. Structures to keep in mind while assessing and treating patients suffering from sciatica may include neurovascular structures and investing fascia of:
• The piriformis
• Gluteal muscles
• Quadratus femoris
• Gemelli-obturator internus complex
More to Explore
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Baselgia et al. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Arch Phys Med Rehabil.
Basson et al. (2017). The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. J Orthop Sports Phys Ther.
Bernstein et al. (2017). Low back pain and sciatica: summary of NICE guidance. BMJ.
Carro et al. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J. (OPEN ACCESS)
Cass, S.P. (2015). Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep.
Ellis et al. (2017). The effect of spinal position on sciatic nerve excursion during seated neural mobilisation exercises: an in vivo study using ultrasound imaging. J Man Manip Ther.
Gilbert et al. (2015). Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: Implications for the treatment of neuropathic pain and dysfunction. Journal of Manual & Manipulative Therapy. (OPEN ACCESS)
Govea et al. (2017). Group IV nociceptors develop axonal chemical sensitivity during neuritis and following treatment of the sciatic nerve with vinblastine. J Neurophysiol.
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