Sciatica pain from a soft tissue perspective

While Sciatica is not the most misunderstood pathology out there it is one of the top 10 to be sure. Many times there is multiple pathologies that manifest as the same symptoms or very similar symptoms. More often than not a pain like sciatica is not just one thing but a bunch of things all put together. There is sciatica, and there is sciatic syndrome.

Lets be clear on what “sciatica” is before we go further. Sciatica is the sciatic nerve eliciting pain. Usually that is because of pressure upon it. It could be a bony structure, it could be soft tissue, it could also be fluid, or scar tissue. Under optimal conditions the body is laid out so that everything works easily. It is usually our habits, or an insult like an collision or fall can also cause this problem. Now, Sciatica syndrome is usually what most people have. A syndrome is a pattern of symptoms that mimic a particular pathology, injury or illness. In other words it looks like a horse, smells like a horse , but its a donkey! It might not be a horse but its still a pain in the butt!

So how did this happen? Well there are many ways for this to happen and i will cover just a couple of the most common soft tissue and structural ways. The human body operates best in movement and in a posture that resists gravity with the least amount of effort.We live in a society where our most common position is a static sitting position and under stress. That sitting position often puts strain on the SI (Sacroiliac) and the Gluteal area (your butt). But more specifically it strains the Piriformis muscle (band).

As you can see by the picture the Sciatic nerve goes right under the piriformis muscle. This is very deep to the skin. In some cases the nerve goes right through the muscle. But what is not widely considered is that the piriformis, both right and left are actually a single band/strap to hold the hips forward in place. Constantly sitting or in a posterior (back) hip position strains this muscles whose job it is to keep the hip forward. with that straining of the piriformis band in the back comes a shortening of the anterior hip soft tissue, specifically the quads and the Illiopsoas  (Yellow line).

When the nerve becomes irritated and inflamed due to posture then it incorporates other posterior hip soft tissue structures. Which can make it difficult at best to treat. Often time one or two of the soft tissue structures will be treated but not all. You will often see print about a piriformis stretch to help with sciatic pain. My experience is that this actually strains the piriformis structure, induces a temporary endorphin response (natural pain killers) and makes the problem worse! Not only that but deep tissue work on an already compromised and strained soft tissue structure is just sadistic in my opinion.

Sitting is not the only culprit in this equation. Often times where you stand on your feet and how you walk can contribute to the posterior hip placement.  Proper placement of the weight in the feet should be in the arch of the foot (SEE:  http://bbcfl.com/blog/walking-right-health/ ) and you should propel yourself forward from your back foot rather than pull from the front.

So Sciatic pain is not something play with. It takes experience and education to understand the structures involved and ease them, not beat them up.

If you have questions or comments i will be happy to answer and /or help you with this problem.

Categories: Massage Therapy and Bodywork.

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