I have treated many patients presenting with symptoms of sciatic pain. They have come to me with severe limps and on one occasion a lady came so doubled up with pain that her husband had to carry her into my treatment room, and she could only lie in a foetal position on the treatment couch. The patient history, examination and treatment in most cases follows the same procedure.
Most cases of sciatic pain emanates from one of three areas:
- the lower back or lumbar region of the spine (L4/L5)
- the sacroiliac (SI) joint in the pelvis
- the piriformis muscle in the buttock
I observe the person when entering my treatment room, how they move and how they hold themselves. I talk with the patient to determine the possible cause of their sciatica. Was it the result of a sudden action, i.e. lifting and twisting, coughing or sneezing? Or did they slip and fall or jump down, e.g. from the cab of a lorry? Did the pain come on slowly and increase over a period of time, e.g. whilst sitting for an extended period on a long car drive or flight? Have they had any surgery to the lower back or replacement joints, hip or knee?
If I am comfortable the root cause of the pain is one of the three areas mentioned above before starting any treatment I explain to the patient the procedure that I follow and why. I believe it is important for people to have a full understanding of what is happening, as in my experience it helps their healing. I always ensure I have consent before proceeding with any treatment.
- Palpation – Gently feeling along the spine and the line of the sciatic nerve to identify the most sensitive points of nerve irritation.
- Reduce inflammation – With ice cubes massage the most sensitive areas nerve irritation with ice to reduce inflammation. The reason for this is two-fold:
- When the nerve is inflamed it is usually the outer sheath of the nerve that swells causing pressure and pain. By applying ice you can reduce the swelling and relieve some of the pressure.
- Using ice cubes allows you to pinpoint sites of irritation more accurately. When the nerve is deep tissue such as in the gluteal area you can use more than one ice cube to get deeper into the tissue (caution – never use more than two ice cubes so as to avoid ice burn).
- Heat – I apply heat in the form of wheat bags along the spine and the line of the sciatic nerve to relax the muscles and infuse the area with blood to encourage healing.
- Massage – Whilst the heat is working for me, I massage the leg of the affected side to relax the muscles completely. Once this is done, I remove the wheat bags and gently massage the affected area and along the spine.
- Mobilisation – Once the patient is relaxed I mobilise with traction of the hip joint and gently mobilise the lower back and SI joint.
On completion, in most cases the patient is more relaxed and feels less pain. I then supply the patient with a Sciatic Pain Relief Cushion and advise them to use it all the time whilst sitting to minimise pressure on the sciatic nerve. Usually a follow up appointment is beneficial to keep the recovery moving in the right direction.