Sciatica? or is it?

People receive massages for many different reasons. In my experience, the most problem areas being encountered are either the neck or the back. Of course, some people have both.

In this article, we will talk about a very common problem: lower back pain. Lower back pain can means many things. Some can means referral pain from the kidney or other viscera(organ) damage, some from sore muscles or other problem caused by soft tissue damage, and some from a structural damage. One thing that I often heard from my clients, are the feeling of numbness and tingling down the posterior(back) side of the legs. This may be an indication of some kind of neural pain. In other word, this can be caused by the impingement of a nerve. It doesn't matter if it's caused either by hard structures or soft tissues, the pain is real and sometime can be a burden for someone to do a daily chore.

When a client claims that he/she suffers from a numbness sensation down the leg, the first questions that the therapist needs to ask the client is: where does the pain start. The answer to this question can be a very important indication of how the therapist needs to start his/her treatment.

The most common case I encountered is when a client claims that he/she has sciatica. The first question needs to be asked is: How do you know you have sciatica. Again, the answer can be very crucial.

Most cases of sciatica, the pain usually starts from the back. However, there are some cases when a client notices that the pain starts from the buttock area. In this case, it might not be sciatica. Of course, this has to be supported by positive findings of orthopedic testings, which needs to be done before start the treatment.

There is a condition which mimics sciatica, it's called false-sciatica or piriformis syndrome. When the numbness starts from the buttock down, usually it's an indication that pirifomis muscle is hypertonic(too tight). The hypertonicity of the piriformis muscle can impinge a nerve underneath the muscle.

The nerve running through piriformis muscle is actually the same nerve that can cause sciatica. However, the location of the impingement is in two totally different areas. In sciatica, the impingement location is at the nerve root, whereas in piriformis syndrome is at the buttock area, right underneath the muscle. The causes of both problems are both equally different too. In sciatica, the impingement is caused by a structural problem(spine), whereas in piriformis syndrome is caused by a soft tissue problem(piriformis muscle).

In piriformis syndrome, it's highly recommended for the therapist to do posture analysis to his/her client. The reason because the action of piriformis muscle is an external rotation of the hip(turning the hip outward). In the posture analysis, if the therapist finds that the client's hip turn too outward or if there's an unevenness between the left and the right hips, these are great indications to do the next special orthopedic testings for piriformis syndrome.

Pace abduction test and piriformis length test are just few examples of the testing which can be done very efficiently and effectively. These testings are basically doing a resisted action and stretched action of the piriformis muscles to create that sensation of numbness and tingling again. The positive finding is where both tests result in the reoccurring pain.

It needs to be reminded that this is not a diagnose. To diagnose an illness is out of a massage therapist scope of practice.