IN CLINIC: Sciatic Pain

 
sciatic pain [ sahy-at-i-kuh ]
“Condition characterized by pain going down the leg from the lower back. This pain may go down the back, outside, or front of the leg”
Here is some clinical insight for anyone experiencing Sciatic pain.  Find out how ‘D’ alleviated their sharp, stabbing hip and shooting leg pain on visiting the Functional Health Clinic (Take a Tour of the clinic)
 
Here’s the quick-capsule take-away…….. ‘Stop Chasing Pain’. I like this phrase used by Dr Perry Nicholson.  But not just in principle.  In practice too and this is a great clinical example. 
The pain (symptom, sign, feedback) is an essential piece of the puzzle, to be acknowledged and not ignored. But isn’t the be-all-end-all of things to consider in the goal of alleviating it.
 
Instead – we are much more interested in the CAUSE of the pain.
 

Presenting with Sciatic Pain

‘D’ came in to the clinic describing an 8/10 Stabbing Pain that he thought was called Sciatica.  It would shoot from his Right hip all the way down the back of his leg to behind his knee.

If he lay on the floor – he was fine, no pain.

But if he moved he risked the sudden onset of sciatic pain.

Most aggravating and guaranteed to cause the debilitating shooting pain was on a movement of extension.  For example, on getting up out of a chair, reaching up above head and being upright.

In addition he had a constant dull ache in his Lower Back and Right Hip which he rated 5/10.

Sciatic Pain Onset

4 days ago ‘D’ had a full day of heavy lifting.  A whole day of lifting and carrying logs! 

Certainly physically challenging – yet not necessarily an unusual task for ‘D’ to perform and something he had done many times before, being a very active person.

Did his back ‘go’ and sciatica pain begin when he heaved up a heavy log?

Nope.

In fact, that evening he felt fine.  Just a “little achey”.

Did it gradually build up?

Nope.

Next day he was up and moving around.  Just a ‘little tight’.

The sudden onset of the sharp, stabbing, shooting pain was actually when he coughed!

The next two days of 10/10 pain left ‘D’ managing his pain lying on the kitchen floor with pain killers!

Sciatic Pain

On Reflection

On reflection, ‘D’ described that he’d actually felt some mild back discomfort and tightness had been building up over the last few weeks.

Prior to that he’d been experiencing ‘bad backs’ for the last 20 years or so, but just managing them himself.

He was a little perplexed at how he could do all that heavy lifting and be fine, yet a cough caused such an injury.

There are a myriad of possible answers here. I offered up quite a simple one.

Two Types of Stabilisers

When we are performing whole body, global movements such as lifting heavy items – the brain and body are quite aware of the task at hand.  It’s not a complicated puzzle for it to work out.

They know that it must be strong and stabilise itself in order to not get injured.  Or at least minimise the risk of injury.

In such an activity there will be a fundamental use of gross (major) stabiliser muscles to protect joints and structures such as the spine, pelvis, shoulders, knees etc.

(Ideally there will also be a subtle and fine stabiliser action going on beneath the surface too.  But we’ll come to see what happens when this is not happening).

Under such load – the brain does not need convincing that these areas require extra support and protection.  Especially if – for the last 20 years – all these muscles, joints, tissues and structures have been feeling the stress, strain, load and imbalances.

It is in fact likely that many of these gross stabilisers and primary muscle groups have been quite over-worked to perform all these tasks in the face of a couple of decades of compensation patterns, inhibited muscles, weaknesses, imbalances, asymmetries.

Furthermore, Pain can inhibit the more subtle stabilisers.  The Inner Unit is much more finely tuned and subtle in creating stability for spinal segments, through the pelvis and hips, across the shoulder girdle through the neck around the jaw and cranium etc.

If they are weak, shut-off or inhibited, then the body will compensate. It will try to protect these areas with other muscle groups and connective tissues. 

Especially when the task so obviously demands protection. 

Even if it is a compromise. 

Now – The ‘cough’ is an interesting onset.

Consider that prior to the cough, whilst sitting quietly, thoughts meandering, enjoying a cuppa, the brain is unlikely to be perceiving any threat of load, stress and strain.

There is no apparent threat to injury.

There is no heavy lifting task to perform.

Hence – there would be no apparent need to protect and stabilise everywhere with the main gross stabilisers. 

Usually – if functional, these subtle stabilisers would effectively fire and protect the body if we coughed, sneezed, slipped, tripped-up, or other sudden movement.  

Typically this would protect us or significantly reduce the risk of injury.

But if they don’t fire and the sudden movement is quicker than the gross stabiliser reaction to come to the rescue……… well somethings got to give. 

So – A lumbar spine, pelvis and hip complex that is unprotected could quite easily be injured under the sudden explosive force of a cough.

Leading to imbalances, asymmetries and dysfunction.  Could this be the cause of the occurrence of a sciatic pain?

Functional Assessment

It’s ok – ‘D’ didn’t just have to sit listening to me theorise all session! 😉

We got straight into the assessment.

Without this we’d be guessing.

At this point we weren’t really that interested in whether this was or wasn’t  ‘Sciatic Pain’ or otherwise.  In fact I explained to ‘D’ that if he wanted a diagnosis of a named condition and a treatment for that named condition, that he would need to see a Medical Practitioner.

Indeed the sciatic nerve may be involved.  We’re simply more interested and concerned about why and how it is involved, if indeed it is.

Walking / Gait

The last thing we needed to do was to get the client performing loads of tests, aggravating and increasing the pain and discomfort.  Remember, they described a 8/10 stabbing pain and 5/10 constant ache in the hip.

Yet we still needed some markers of function. 

Walking back and forth the client described how it felt and I observe the movement pattern.  Their gait was relatively comfortable, but very staggered, rigid and causing a mild level of right side discomfort at the site of sciatic pain.

Clinic Space

We also looked at a simple standing forward flexion, which was relatively comfortable to perform.

And (carefully) a standing extension – of which there was zero capacity due to sciatic pain.

We chunked that assessment down and asked them to perform a simple standing arm raise up in front of them.  They could only reach up to about 80 degrees before the onset of the original right side stabbing pain.

We now have some markers. that we can come back to.

Structural Integration for Symmetry and Function

The intervention we applied for ‘D’ was a Structural Integration Technique called Bowen Technique.

In simple terms this is a fascial release therapy.

There are different approaches throughout the Bowen World and I apply that taught by Graham Pennington, with a focus on Symmetry (Movement, Tonal and Structural Symmetry).

It isn’t focussed on procedures for conditions.  This-for-that.

It’s based on the assessment identifying the primary influence on the dysfunction.

Working our way through the ‘layers of the onion’ with constant checking and guiding via the assessment.

From a practitioner’s point of view it takes the ego out of it.  We simply want to find the answers from the body and work with it to restore function.

It’s not where you think it is!

Sciatic Pain

On assessment ‘D’ presented with a primary layer of dysfunction that was coming from the Lumbar/Pelvic/Hip region.

This may appear a little obvious given that this is the general area of the constant ache and sciatic pain.

But on further assessment the key was actually on the opposite side of the pelvis to his pain.

Whilst there was a constant ache in the right hip and stabbing pain down the right leg……….It was the Left Piriformis muscle that we needed to release to improve symmetry and function in the body.

It was the opposite side to the pain that was having the greatest input on the CNS (Central Nervous System).  We simply released the tissues that were influencing the CNS to remove this key stressor and somewhat restore function.  

‘D’ got up off the couch and had a walk around, moving much quicker and with more flow and with a very slight notion of discomfort in the right side.

He reached his arms up in front to 120 degrees (pre 80deg) and was able to extend and arch backwards without any stabbing pain down his leg.

The constant Right hip ache was now rated at a 1/10 (pre 5/10) and there was no stabbing pain (pre 8/10) on the aggravating movement of getting up out of a chair.

>>>>We didn’t do a single release move on the right side of his body!<<<<

This is hugely significant given that a ‘classic’ approach to sciatic pain is to go after the same-side piriformis muscle with hammer-and-tongs!

Chasing the pain with all sorts of modalities may alleviate and improve it – But if it has not changed anything on a causal level and got to the reason why the pain occurred in the first place, then there is a great likelihood that it could return or be expressed as a different pain elsewhere!

To carry on the game of chase.

‘D’ chose not.  You can too 🙂

Jack

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