Massage & Bodywork

July/August 2011

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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 MASSAGEANDBODYWORK.COM AND ABMP.COM. environment, followed by cautious practice while having access to experienced supervision and advice. However, even without specialized in-person training, there is a tremendous amount of benefit that massage and manual therapists can provide. These pointers will help minimize risk to your clients who show signs of axial sciatica: 1. The safest, most universally helpful intentions for massage therapists dealing with axial sciatica are to gently ease the effects of unnecessary splinting and guarding, and to relieve the overall tension and stress of dealing with pain. Relaxation and calming approaches, as well as work around the lateral hips, shoulders, and neck, are especially helpful. 2. Work slowly. If you do deep work, proceed very gradually, noting your client's response between sessions. If there is a persistent increase in pain after your session, work less deeply next session, and/or in different places. What may feel good on the table may worsen the symptoms when upright, so if possible, ask your client to sit or stand partway through your session to check in about pain level, and adjust or redirect your work accordingly. 3. Use your client's own gentle active movements, rather than passive moving, stretching, or positioning. Use your client's comfort as a guide. Painful work is not helpful with inflammatory conditions such as sciatica, so your clients should be instructed not to push through their pain. Find a level of depth and pressure that allows your client to relax into the work. 4. Especially in sciatica and other nerve issues, the point of greatest pain is often the place that is least in need of direct, deep pressure. Because tissues are already inflamed or unstable in the spot of pain, direct work may worsen the symptom later. Instead, ease the body around the most painful areas. 5. Avoid any techniques that apply longitudinal compression or shearing forces (listhesis) to the spine, such as some seated techniques or passive stretches. Also, use caution with positions or techniques that twist the spine, which can narrow the foremen around an already crowded nerve root (twists can also relieve compression, but use them cautiously). 6. It is a good idea for your client with acute axial sciatic signs to be under the care of a spine specialist such as an chiropractor, orthopedist, physical therapist, or other rehabilitation specialist. If you suspect undiagnosed lumbar disc issues (for example, if your client feels a worsening of sciatic symptoms with the SLT), be sure to refer your client to a qualified medical specialist for an evaluation and possible rehabilitative work. Don't hesitate to get supervision or advice from a mentor as well. Even with this long list of cautions, don't be discouraged. Remember that your work can dramatically help someone with axial sciatic pain. Relaxing and calming are always helpful, and easing the overall patterns of guarding and stress from chronic pain can be a godsend for someone with unrelenting sciatic pain. Often, axial sciatica is accompanied by appendicular sciatica as well. In contrast to the bone-to-bone or disc- to-bone compression of axial sciatica, appendicular sciatica entrapment is typically related to the soft tissues, which respond readily to direct manual therapy. We will examine this second type of sciatic pain, and describe hands-on approaches for working with it, in our next installment. Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is also a Certified Advanced Rolfer and teaches for the Rolf Institute of Structural Integration. Contact him via info@advanced-trainings.com and Advanced-Trainings.com's Facebook page. Til Luchau is a member of the Advanced- NOTES 1. There is wide variation in sciatica prevalence estimates: "sciatica prevalence from different studies ranged from 1.2% to 43%." This same meta-study concludes that "[sciatica] is more persistent and severe than low-back pain, has a less favorable outcome, and consumes more health resources." K. Konstantinou and K.M. Dunn, "Sciatica: Review of Epidemiological Studies and Prevalence Estimates," Spine 33, no. 22 (October 15, 2008): 2464–72. 2. The sciatic nerve itself has components from nerves L4–S3; however, impingements of L1–L3 have been observed to cause sciatic-type symptoms as well. J.P. Valat et al., "Sciatica: Best Practices," Research in Clinical Rheumatology 24, no. 2 (April 2010): 241-52. 3. As mentioned by Jim Donak and Tom Myers in an August 2010 Facebook discussion, accessed May 2011, www.facebook.com/topic. php?uid=120301201315055&topic=181. 4. Although there are differing opinions about the significance of sciatic pain in the lower leg, respected physician and pain researcher Nikolai Bogduk says, "The only pain that has ever been produced experimentally by stimulating nerve roots is shooting pain in a band- like distribution. There is no physiological evidence that constant, deep aching pain in the lower leg arises from nerve root irritation." Nikolai Bogduk, Clinical Anatomy of the Lumbar Spine and Sacrum, 4th ed. (London: Churchill Livingston, 2005). Thanks to Australian Rolfer Colin Rossie for this reference. 5. W.L.Devillé et al., "The Test of Lasègue: Systematic Review of the Accuracy in Diagnosing Herniated Discs," Spine 25, no. 9 (2000): 1140–7. 6. Researchers at Cedars-Sinai Medical Center, the University of California, Los Angeles, and the Institute for Nerve Medicine in Los Angeles examined 2,239 sciatic patients (using magnetic resonance neurography) who hadn't improved with lumbar disc treatment. Results of the study confirmed that 69 percent had piriformis syndrome, while the remaining 31 percent had a combination of other nerve, SI joint, or muscle conditions. A. Filler, J. Haynes, S. Jordan, et al., Journal of Neurosurgery: Spine 2 no. 2 (2005): 99–115. Boost your practice with ABMP's Website Builder—free for members on ABMP.com 115

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