Massage Therapy and Sciatica

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, classic 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

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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
• Hamstrings
• Gemelli-obturator internus complex

More to Explore

Baselgia, L.T., Bennett, D.L., Silbiger, R.M., Schmid, A.B. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/27449322

Basson, A., Olivier, B., Ellis, R., Coppieters, M., Stewart, A., Mudzi, W. (2017). The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28704626

Bernstein, I.A., Malik, Q., Carville, S., Ward, S. (2017). Low back pain and sciatica: summary of NICE guidance. BMJ. 
https://www.ncbi.nlm.nih.gov/pubmed/28062522

Carro, L.P., Hernando, M.F., Cerezal, L., Navarro, I.S., Fernandez, A.A., Castillo, A.O. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/28066745

Cass, S.P. (2015). Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep. 
https://www.ncbi.nlm.nih.gov/pubmed/25574881/

Ellis, R., Osborne, S., Whitfield, J., Parmar, P., Hing, W. (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.
https://www.ncbi.nlm.nih.gov/pubmed/28559669

Gilbert, K. K., James, C. R., Apte, G., Brown, C., Sizer, P. S., Brismée, J., & Smith, M. P. (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.
http://www.ncbi.nlm.nih.gov/pubmed/26917940 (OPEN ACCESS)

Govea, R.M., Barbe, M.F., Bove, G.M. (2017). Group IV nociceptors develop axonal chemical sensitivity during neuritis and following treatment of the sciatic nerve with vinblastine. J Neurophysiol.
https://www.ncbi.nlm.nih.gov/pubmed/28701542

Hopayian, K., Danielyan, A. (2017). Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features. Eur J Orthop Surg Traumatol.
https://www.ncbi.nlm.nih.gov/pubmed/28836092

Jeong, U.C., Kim, C.Y., Park, Y.H., Hwang-Bo, G., Nam, C.W. (2016). The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. J Phys Ther Sci.
https://www.ncbi.nlm.nih.gov/pubmed/26957726

Lewis, R.A., Williams, N.H., ... Wilkinson, C. (2015). Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J.
https://www.ncbi.nlm.nih.gov/pubmed/24412033

Miller, T.A., White, K.P., Ross, D.C. (2012). The diagnosis and management of Piriformis Syndrome: myths and facts. Can J Neurol Sci.
https://www.ncbi.nlm.nih.gov/pubmed/22931697

Neto, T., Freitas, S.R., Marques, M., Gomes, L., Andrade, R., Oliveira, R. (2017). Effects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis. Musculoskelet Sci Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28637597

Rade, M., Pesonen, J., Airaksinen, O. (2017). Reduced Spinal Cord Movement With the Straight Leg Raise Test in Patients With Lumbar Intervertebral Disc Herniation. Spine (Phila Pa 1976).
https://www.ncbi.nlm.nih.gov/pubmed/28542104

Ropper, A.H., Zafonte, R.D. (2015). Sciatica. N Engl J Med.
https://www.ncbi.nlm.nih.gov/pubmed/25806916 

Schmid, A.B., Nee, R.J., Coppieters, M.W. (2013). Reappraising entrapment neuropathies--mechanisms, diagnosis and management. Man Ther. 
https://www.ncbi.nlm.nih.gov/pubmed/24008054 

Stochkendahl, M.J., Kjaer, P., Hartvigsen, J.,  Vaagholt, M. (2017). National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 
https://www.ncbi.nlm.nih.gov/pubmed/28429142

Urban, L.M., MacNeil, B.J. (2015). Diagnostic Accuracy of the Slump Test for Identifying Neuropathic Pain in the Lower Limb. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/26107044