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Sciatica and Massage

Many people claim to suffer from sciatica but what is sciatica?

Put simply, sciatica is a pain, usually in the back of the leg caused by compression, irritation, or inflammation of the sciatic nerve. The sciatic nerves are the longest and largest nerves in the body, running down the back of each leg and are about the diameter of your thumb.

The sciatic nerve is actually composed of four or five smaller nerves that leave the spinal cord from the lower spinal column, join together and then travel down each leg. It then divides into numerous smaller nerves that travel to the thigh, knee, calf, ankle, foot and toes. When these nerves are irritated or affected by the inflammation of nearby soft tissues, then this is referred to as sciatica.

There are several reasons why the sciatic nerve could become compressed, entrapped, or irritated. In “true” sciatica, the nerve roots can be compressed by herniated, degenerated or displaced lumbar spinal disc(s). This can be exacerbated by tight muscles and soft tissues in the lower back, buttocks or leg.

sciaticaThere are also other conditions which can mimic sciatic symptoms such as Piriformis Syndrome where the sciatic nerve is entrapped by the piriformis muscle in the buttocks. Piriformis Syndrome is sometime referred to as “back pocket sciatica” as pressure on the piriformis muscle and sciatic nerve can be caused by sitting on a wallet in the back pocket of a person’s pants. Another problem that can imitate sciatic pain is trigger points in the Gluteus Minimus muscle. The trigger points in this muscle can refer pain sensations down the back of the leg along the path of the sciatic nerve and also on the outside of the leg.

People with sciatica suffer from a wide range of symptoms. The pain may come and go at different times, it may be a constant problem and then it may subside for hours or days for no apparent reason. Some people may feel only a dull ache travelling down the back into the upper leg. For others, it may be intense sharp shooting pains all the way down the leg into the foot and toes.

Many factors can influence the pain of sciatica. If the sufferer sits in one position for long periods of time then the pain can increase. Long distance drivers and computer operators are particularly susceptible. Exercising, or even simple things like walking, bending, twisting or standing up may be difficult and painful. For some, the pain may change from side to side or be present in both legs. For others, back pain may appear before the sciatica emerges. In some severe cases, sciatica can impair reflexes, or result in the wasting of the calf muscles.

Treatments for Sciatica
The medical approach to dealing with sciatica is to treat the symptoms. This may include using painkillers, muscle relaxers or anti-inflammatory drugs such as NSAIDs . Traction, physical therapy or injections directly into the nerve roots may also be used. In severe cases, Surgery (such as microdiscectomy or lumbar laminectomy) is used to help relieve both pressure and inflammation.

  
Massage Therapy
Massage Therapy and Bodywork can help Sciatica, Sciatic Nerve Pain, in particular the conditions which mimic sciatica such as Piriformis Sydrome. Massage therapy can relaxes muscles, releases trigger points and abnormal tissue adhesions, and improve posture to relieve the pressure on nerve roots and other sensitive structures.

Other Manual treatments (including physical therapy, osteopathic, or chiropractic treatments) can help relieve the pressure. Chiropractic and Osteopathic techniques are often used in conjunction with treatment by a Massage Therapist.

Use a Tennis Ball
The knots in the muscles of the hip and buttock can be effectively treated with a tennis ball. Simply lie on a tennis ball such that it presses on deep, sore points and just wait for the feeling to fade. However please be aware that the piriformis muscle is so unusually reactive and the use of a tennis ball to massage the piriformis needs to be gentle and conservative.

Jump in the Spa to Relax the Area with Heat
Whether the pain is caused by the crushed sciatic nerve itself, or just by tight muscles, the muscles need to relax. Hot tubs, with jets, are ideal for sciatica.

Check Your Posture
The types of sciatica that are related by excessive sitting may be influenced by the ergonomic design of work station and/or chair. It may be worth experimenting with your chair and the layout of your work station. A simple option is to use a timer to remind yourself to get our of your chair at regular intervals such as every fifteen-twenty minutes.

By Richard Lane

Do you cheat when you stretch your quads?

Many people “cheat” when they stretch their quads. The standard stretch for the quads that you will see many people doing is to stand on one leg and bring their foot to your butt.

However, the chances are that their alignment is such that they are not actually stretching the quads at all, but merely compensating by hip or trunk rotation.

(If you can cope with the sound of young children) The following video explains how best to perform a genuine quad stretch.

Massage and Nausea

Unfortunately an occasional side effect of massage is that you can occasionally feel a little nauseous after the massage. Whilst you will hopefully feel relaxed, looser with less muscle and joint pain, it is possible that you may just feel a little off colour for a while.

For most people, this side effect of massage only last for a relatively short period. Some people will need to have a lie down and sleep. Others will drink plenty of water to feel as though they are giving their system a flush. Regardless, in the vast majority of cases, the nausea is only a transient hindrance.

Dizziness and nausea post massage
There is much discussion regarding the cause of the nausea and dizziness after a massage and it may well be the case that there are a number of different causes. One theory which is discounted by most therapists is that the nausea is caused by toxins that are release by the massage. For a discussion of this fallacy then please check out www.innerwestmassage.com.au/massage-toxins.php.
A recent hypothesis is that “Post Massage Soreness and Malaise” is the result of a mild case of Rhabdomyolysis which occurs when muscle cells are damaged and it interferes with the blood chemistry.

Personally whilst there may be some evidence to support this theory, if you follow this theory then you would agree that the deeper the massage, then the more likely you would be affected. Although this is a personal viewpoint, it doesn’t tally with my experiences.

For me nausea is more likely if I haven’t had a massage for a while and I have never noticed any correlation between the pressure/intensity of the massage and the degree of nausea experienced. I tend to subscribe to the theory of Dr Keith Eric Grant who considers that massage is about returning the body towards homeostasis and that the nausea may be the result of giving the lymphatic system a bit of a kick-along. Other therapists may argue differently to this but regardless this type of nausea post massage is very normal and not a cause for concern.

However, if you start vomiting and feel extremely dizzy post massage then that is a different kettle of fish. This happen whilst I was massaging someone a while ago and we had to stop the massage after about 20 minutes as the client was unable to continue. Although massage had only been carried out to the back, just the act of lying prone was too much for the client. Although she recovered and started to feel better once she rose from the table, this was not a normal state of affairs and seeing her doctor was the next step.

Although uncommon, one possible explanation for the extreme nausea in this case is atlantoaxial instability.

Atlantoaxial instability can be considered as a loose upper spine and is the loss of the integrity of the joint between the top two vertebrae, the atlas and the axis. For some people who may have had a neck injury or trauma, then when they move their head or neck then a bone projection (the “dens”) from the axis may effectively make contact with their brain stem. The result of this can range from mildly unpleasant through to downright dangerous.

  
Whilst massage is not necessarily precluded for people who suffer from atlantoaxial instability, extreme caution would be required. The neck can be considered vulnerable and only relatively gentle strokes should be attempted with the approval of a suitably trained diagnostic therapist. Most doctors would strongly recommend that there be no manipulation such as a chiropractic adjustment.

Although there may not have been a formal diagnosis of the condition then a massage therapist should be alert to the possibility. A client may be particularly tight high in the neck or be very guarded and protective of the way they hold their head. If any alarm bells are rung for the therapist then they back off with the intensity of their work and use the adage “too little is better than too much”.

By Richard Lane

Why Does My Neck Hurt?

Regardless of where a problem may originate in the body, the neck and shoulders are very often the manifestation of the issue.  This is true of both physical and emotional dysfunctions.

On top of the cervical vertebrae is a large roundish object which is virtually always in motion in an attempt to stay balanced and to keep the eyes horizontal.   If this object, also known as the head, is well balanced on the vertebrae then the loads on the muscles of the neck and shoulders are relatively low.   However, physical disturbances all down the body to the feet can interfere with this dynamic leading to greater loads on and tension in the muscles.  For example, a shortening of calf muscles from, say, wearing high heels, tilts the pelvis forward which alters the curvature of the spine which will impact on how the head sits.

In addition, our necks are always adjusting to any imbalances in our body.  If we sidebend to one side then there is a tendency for our neck to counteract this movement in order to keep our eyes level with the ground.

Chickens are often used to demonstrate this to great effect!

Our emotions often arise in our stomachs and we are all familiar with the sensation of butterflies or tightening in our bellies.  From there they will wind up again to our necks where the emotions can often be expressed in the form of tightening of the muscles of the neck and shoulders.  If this becomes a near constant state of tension then we can lose a degree of flexibility in our spine to create a bottleneck in the area.

  
Furthermore the complicated movements and requirements on the cervical spine and muscles can lead to problems more easily than elsewhere in the body where there is more protection and less mobility demands.

For these reasons, whenever you book in for a massage, then your therapist is likely to find restrictions and painful areas in your neck that you may not even have been aware of.  However, if you do present with a neck problem then it may very well be the case that your therapist could spend significant time working on parts of the body other than the neck if they consider that the root cause of the neck issues may not actually be with the neck.

By Richard Lane


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