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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

Therapeutic Breast Massage

Breast massage can be a contentious issue amongst therapists. Some promote that there potential health benefits through lymphatic drainage; others are less enthusiastic about any advantages of performing breast massage. Some are concerned about the personal nature of any Sydney massage that involves touching of breast tissue; others are more relaxed.

However, it must be mentioned that professional associations have policies regarding breast massage. For example, the Australian Association of Massage Therapists offers a policy development document on this issue at http://membership.aamt.com.au/lib/Journals/Summer06/AAMTbreast.pdf.
Within this document they state:

Massage therapists must recognise, accept and respect the right of every individual client to choose whether they wish to decline breast massage …..
Even when agreement with the client for the breasts to be included in a treatment is granted, it is entirely inappropriate and completely unnecessary to provide disproportionately prolonged massage to the area and that that the client is free to revoke that consent during the massage.

AAMT suggest that massage of the breast tissue is currently practiced in modalities of Manual Lymph Drainage, Lymphodema, Lomi Lomi and post surgical breast augmentation and when specifically prescribed by a Medical Practitioner. During a standard remedial or relaxation massage then there is no reason for the breasts to be massaged and the ATMS policy is that mammary glands should not be massaged and only professional techniques should be applied to surrounding tissues.

This last point can cause a little confusion from massage recipients though. For example, the pectoral muscle groups are often indicated when people have tension in their neck and shoulders. Tightness in the upper back muscles is often the result of excessively hypertonic pectoral muscles bringing the shoulders forward. Therapists may often feel that lengthening these muscles of the upper chest is important for improved posture yet to access these muscles then the therapist needs to work close to breast tissue.

Massage for the pectoral musclesThe picture to the right on this page of this page demonstrates a therapist performing a remedial massage technique on the pectoral region. It is easy to image that, on women with a larger bust, performing such a stroke for the pectoralis major and pectoralis minor muscles would be extremely difficult without touching breast tissue.

But this stroke would not be applying massage to the breast itself.

  
Therapists do need to be mindful of such strokes, explaining why they need to work in this area and soliciting permission from the client before commencing. The client also has the right to request the therapist stop should they ever become uncomfortable about the nature of the touch. Some therapists may ask the client to hold their breast to provide a physical barrier between the therapist’s hand and the breast.

As mentioned above breast massage in Sydney is not permitted within a remedial or relaxation massage. I have included the technique (with client permission) during Lomi Lomi massage. Within a traditional Lomi Lomi massage then including massage to the breasts is considered to be a normal part of the routine and whilst there is obviously no muscles within breast tissue, there are claims that it can reduce pain and stress in the chest.

TMJ Pain?
Try Massaging your Pterygoids

You may be surprised if you were told that the hardest working joint in the body is the jaw or the temporomandibular joint (TMJ). It is virtually constantly working when talking, chewing, grinding and clenching and there are estimates that it moves more than a couple of thousand times every day. It is no surprise then that some of the muscles used to move the joint can become a little overworked and sore.
Often the result can be what is referred to as TMJ dysfunction which can manifest itself in a number of different ways. These include
Massage for TMJ dysfunction

  • headaches
  • dizziness
  • soreness and irritation of the eyes
  • difficulties with chewing
  • clicking/grinding jaw
  • problems with the ears including Tinnitus

The outcome is often that the TMJ dysfunction sufferer has poor quality sleep, is constantly in pain or discomfort and a general degradation of their quality of life.
It is not uncommon that these problems can be related to trigger points in the muscles that move the jaw and, although there are a number that can be affected including the masseter and the temporalis, one of the main culprits is often the pterygoid muscles. The good news is though that it is relatively easy to massage these muscles yourself so long as you know where to work.

The origin of the term pterygoid is Greek and the root of the word, pter-, refers to wing like (as in pterodactal) which is considered to reflect the shape of the muscles.

The group consists of the medial and lateral pterygoids each of which have their own recognised trigger point referral pattern.

Trigger Points and Self-Massage for Medial Pterygoid
If there are trigger points present in the medial pterygoids then the person will often have pain in the TMJ and also around the ear. It can also be difficult to swallow with pain referred to the back of the mouth. If you have restrictions in how far you can open your mouth then there is likelihood that you will have trigger points in this muscle, normally present on both sides of the head.

In order to self-massage the trigger points then you simply press up on the inside of the lower edge of the jaw using your thumb. As with any massage, then it is advisable to go gently at first as often the jaw can be extremely sensitive at these points.
The most effective way to reach the upper fibres of the medial pterygoid is through the mouth. With clean hands, reach into the very back of the mouth beyond the final molar. Work on the muscle just beyond the bony edge of the jaw (open and close the mouth to locate the muscle if required).

pterygoid sketch

Trigger Points and Self-Massage for Lateral Pterygoid
This muscle is considered by many to be the leading culprit for pain and TMJ dysfunction. For example, if you have clicking and discomfort on opening and closing the mouth then you may have trigger points in the lateral pterygoid. Constant tension in these muscles can lead to the jaw being disarticulated.
To locate this muscle, then commence just in front of the ear on the cheekbone. Press on the underside of the cheekbone whilst opening and closing your mouth. A couple of centimetres from the ear you will often hit pay dirt with a tight tender band going up under the cheek bone. This is the lateral pterygoid and gently massage this muscle until the pain and tension has reduced.

  
Any time you massage trigger points in muscle groups it is a good idea to stretch them out afterwards to enhance the relaxation of the muscle. One recommended stretch for these muscles is to open your mouth against resistance by placing your hand under your chin while you slowly open the mouth against the resistance.

Often you will need to repeat this self-massaging a couple of times a day for a number of days to completely eliminate the trigger points in the group. If you are a TMJ dysfunction sufferer though, the time taken to do this will be well worth the effort as the pain relief can be significant.

More info on pterygoid trigger point massage is available on the video below.


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