By Dorthe Krogsgaard and Peter Lund Frandsen, Denmark - June 2006
Treating sciatic pains is a true sport for reflexologists. Knowing the few most common causes, it is usually quite simple to treat. That the sciatic nerve can also be involved in knee problems, swollen legs and other leg problems is perhaps new knowledge for some – and how many reflexologists realise that the sciatic nerve is responsible for transmitting back to the central nervous system all the impulses from the sole of the foot?
Simplicity and knowledge often go hand in hand. Even though it can be straightforward to treat sciatica, it requires a good knowledge about the common causes and connections involved. Among other subjects this is included in Touchpoints workshop ”Round about: Hip, Sciatica and Knee”. In this article we will show a few important techniques to include in the treatment of sciatic pain.
Sciatica is pain radiating from the buttocks down into the leg. Somewhere along its course the sciatic nerve is entrapped, causing irritation or inflammation and thereby pain.
Slightly simplified, one can distinguish between two main causes of sciatic pains: Entrapment of the root and muscle tensions in the pelvic or gluteal regions.
Root pressure involves the spinal nerves from L4-S3. They may be compromised by a slipped or herniated intervertebral disc, which is most commonly seen in the 30-50 age group.
Entrapment of the nerve roots may also be due to arthrotic narrowing of the spinal canal itself (spinal stenosis). This is more often the case with elderly persons.
The Piriform muscle
A more common cause for sciatica is muscle tensions in the buttocks. The sciatic nerve leaves the pelvis through an opening (the infrapiriform foramen) where it shares the limited amount of space with several muscles, nerves and vessels (see figure 1). The nerve has a special relation to the piriform muscle, in some persons in actually passes right through the muscle. The piriform muscle originates on the ventral surface (inside) of the sacrum at the level of S2-S4 and attaches to the femur (greater trochanter). Tensions in this muscle can therefore very easily compress the sciatic nerve (piriformis syndrome) and cause pain. Luckily this condition is relatively easy to assess and treat.
Figure 1. The sciatic nerve in the gluteal region
Foot reflex for the piriform muscle
The reflex is treated thoroughly with slow, deep movements. It is a good idea to pay extra attention to the origin (sacrum) and attachment (greater trochanter).
See Figure 2.
Figure 2. Reflex for the piriform muscle
Nerve reflex point for the sciatic nerve
This point has a well defined location on the upper edge of the heel bone (figure 3). It should be treated using nerve reflexology technique, which is an accurate static pressure on the periost of the bone until pain in the point has vanished (max.15 seconds).
Figure 3. Nerve reflex point for the sciatic nerve
An extraordinary technique
An often amazingly effective technique with sciatica is the so called nerve mobilisation. This is a method devised by Australian physiotherapist David Butler. A stretch is applied to the nerve which can often help free the nerve from pressure and tensions which has affected it. When the nerve lies free in its surrounding connective tissue, the circulation inside the nerve is normalised (axoplasmatic flow) and its function improved.
Technique: Stand next to the table facing away from the client. Hold the client’s lower leg with the arm closest to the table. Slowly lift the client’s straight leg. It should be a passive movement without the client helping. Maintain a constant communication about any pains and as soon as the familiar sciatic pain is developing, you stop the movement and lower the leg until the pain stops. Then try to lift the leg again. Repeat this pattern 10-15 times and for each time try to go a little higher. You go – so to speak – into the pain and out again, and usually you will notice that the position eliciting pain is moving further and further up as the nerve is being mobilised. (See figure 4).
Figur 4. Mobilisation of the sciatic nerve.
Mobilising while treating
A quite unique effect can be achieved by pressing the sciatic nerve reflex point and at the same time perform the mobilisation as described above. By so doing the nerve is simultaneously being treated from the outside by stretching the tissue, and from the inside through the reflexological impulse.
In the majority of sciatica clients these techniques provide an immediate effect in the form of increased motility and pain reduction. Practically, you could start a treatment session by assessing how high the leg can be raised without pain, then do the mobilise while treating technique, then ordinary reflexology therapy – and at the end of the session, try to test the leg again. You – and not the least – the client will see an astonishing difference.
Naturally, the effect will not last after just one session, but it will help breaking the vicious circles that have maintained constant muscle tensions. And it will certainly motivate the client to do more about her/his problem.
The sciatic nerve is of course interesting because so many people suffer from sciatic pains. But for reflexologists the nerve is of particular interest, because this is the very nerve conducting all touch and pain sensations from the feet.
Each foot contains 75,000 free nerve endings registering everything we do as reflexologists. That incredible amount of information is relayed to the central nervous system via the sciatic nerve.
Therefore, it makes sense assuming that a proper function of the sciatic nerve is necessary for a good effect of reflexology, especially if you are in favour of the theories of reflexology working through the nervous system.
Nerve mobilisation: David S. Butler: The Sensitive Nervous System, Noigroup Publications, (2000).
Nerve reflexology: Touchpoint, Denmark with permission from Nico Pauly, Belgium