Massage & Bodywork

September/October 2011

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VISIT ABMP.COM TO LEARN MORE ABOUT TIL LUCHAU'S SIX-PART WEBINAR SERIES TITLED "ETHICS FOR THE REAL WORLD," WHICH WILL BEGIN ON SEPTEMBER 28, 2011. You can see techniques from this column in Massage & Bodywork's digital edition, which features a video clip from Advanced-Trainings. com's Advanced Myofascial Techniques DVD and seminar series. The link is available at both www.massageandbodywork. com and the sensations of straightening the affected and unaffected legs, and to direct you to any sites of increased pain. Nerve pain typically radiates distally, so the entrapment causing pain resulting from this test is usually at the site of pain, or proximal to it.4 It makes sense, then, to start at the site of reported pain and work the nerve pathway proximally from there, retesting to track for any changes. VARIATIONS TO THE SCIATIC NERVE GLIDE TEST (NOT PICTURED) 1. Increased sciatic pain when bringing straightened leg across the body (hip fl exion and adduction with knee extension) can indicate piriformis involvement. 2. Placing the sole of the passive leg on the table by raising the knee can help differentiate between lumbar and nonlumbar tethering. Since the knee-up position decreases lumbar extension, suspect tethering at the lumbars (axial sciatica) if raising the knee on the passive side decreases pain. Use what you learn from performing the Sciatic Nerve Glide Test to choose where to work next. Myofascial techniques (such as those I'll describe in our next installment), as well as stretching the rotators, gluteus, or hamstrings, are often particularly effective ways to release the neural sheath adhesions or myofascial restrictions you've discovered with the Sciatic Nerve Glide Test. This test itself can also be helpful as a take-home client exercise to mobilize a tethered nerve. Clients should be cautioned not to do too many repetitions at one time, or to repeat the maneuver more than once per day, so as to avoid continually irritating an already infl amed sciatic nerve. OTHER CAUSES OF APPENDICULAR SCIATIC PAIN In addition to the soft-tissue impingements listed above, the following issues can also contribute to appendicular sciatic pain: • Prolonged sitting, either from direct pressure on the sciatic nerve from wallets, bucket seats, etc., or from postural strain resulting from hip fl exion contracture or posterior pelvic rolling (slumping). • Driving can increase leg tightness from pressing on the gas pedal, as well as from sitting (driving is also a risk factor for disc issues). • Hypertrophy (overdevelopment and enlargement) of the piriformis, rotators, or hamstrings, especially when combined with repetitive motions (as in prolonged exercise). • Structural and tissue changes of pregnancy and postpartum. • Direct trauma to the sciatic nerve, tumors or infections, or scarring or thickening of adjacent soft tissues. Some of the above causes suggest their own solutions, which often involve changes in activities or ergonomics. There are also many reports of appendicular sciatic relief being found in regular stretching (yoga's Pigeon Pose or Eka Pada Kapotasana, in particular), or from balanced strengthening tune in to your practice at ABMPtv 115 (strengthening abductors, for example, can counterbalance hypertoned rotators and adductors). Because appendicular sciatic entrapments are most often soft- tissue restrictions, they frequently respond quite well to focused and thorough hands-on myofascial work. In our next article, I'll describe hands-on techniques for working with the appendicular sciatic nerve entrapments you identifi ed with the Sciatic Nerve Glide Test. faculty, which off ers distance learning and in-person seminars throughout the United States and abroad. He is also a Certifi ed Advanced Rolfer and teaches for the Rolf Institute of Structural Integration. Contact him via and's Facebook page. Til Luchau is a member of the Advanced- NOTES 1 Iain D. Belth et al., "An Assessment of the Adaptive Mechanisms Within and Surrounding the Peripheral Nervous System, During Changes in Nerve Bed Length Resulting from Underlying Joint Movement," from: Moving in on Pain: Conference Proceedings—April 1995 Butterworth-Heinemann; 1st edition (December 27, 1995): 194–6. 2 A.K. Asbury and H.L. Fields, "Pain Due to Peripheral Nerve Damage: An Hypothesis," Neurology 34 (1984): 1,587–90. 3 Iain D. Belth et al., "An Assessment of the Adaptive Mechanisms Within and Surrounding the Peripheral Nervous System, During Changes in Nerve Bed Length Resulting from Underlying Joint Movement." 4 As mentioned in the text, the entrapment site is usually at or proximal to the place where pain is felt by the client. However, referral patterns are common (typically involving gluteus maximus, medius, and minimus; rotators; or hamstrings), and like other referred pain, these are sometimes unpredictable and aren't easily explainable by direct neural connections.

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