Massage & Bodywork

July/August 2011

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ASSESSING SCIATIC PAIN Sciatica is a real pain in the rear—not just for the individuals who experience it, but for society as a whole. Although estimates vary, studies indicate that up to 43 percent of people experience sciatic pain at some point in their lives. A 2008 meta- analysis of sciatic studies concluded that compared to low-back pain, sciatic pain is more persistent, more severe, and consumes even more health resources.1 Sciatica can also be a pain for manual therapy practitioners. Sometimes, sciatica responds quickly; other times, it seems intractable, and can even worsen in response to hands- on work. As a practitioner, how do you determine which approaches are most likely to be helpful? In the first of two articles, we'll look at straightforward and relatively reliable assessments for differentiating between two types of sciatic pain and discuss important considerations for working with the first (axial) type. The next part will describe techniques and approaches for relieving the second (appendicular) type. Much of sciatica's ubiquity and variability comes from the broadness of the term. Originally derived from "ischialgia," meaning pelvic or ischium pain, sciatica has come to mean any pain involving the lower back or buttocks that radiates down the posterior leg. For this reason, the term "sciatica" is in disfavor amongst some clinicians. They argue that sciatica is a symptom, not a diagnosis, since there are many possible causes of sciatic pain. For manual therapists, knowing how to distinguish between sciatic pain's different types will allow you to be far more effective in your work (and help you know when to refer to a specialist). One thing is common to all sciatic pain: it is nerve pain, and so it can be radiating, shooting, sharp, tingling, or numb. Sciatic pain involves an irritating mechanical force on a nerve, usually somewhere along the neurons (nerve cells) that make up the sciatic nerve. (I say "usually" because irritation of other nerves can radiate to the sciatic nerve distribution area as well.) Sciatic pain can be described as having two types, as outlined in Table 1: 1. Axial sciatica arises from compression on the nerve roots at the intervertebral foramina of nerves L1-S3.2 2. Appendicular sciatica is pain from nerve entrapment distal to the nerve roots. The first type, axial sciatica, involves narrowing of the foramina (openings between the vertebra where the peripheral nerves exit the spinal canal; Image 2). This narrowing can result from: Protruding or degenerated intervertebral discs (green) or the dura (aqua) can impinge nerve roots where they exit the spinal canal, causing axial sciatic pain. Image courtesy Primal Pictures. Used with permission. Boost your practice with ABMP's Website Builder—free for members on 111

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