The chronic condition known as sciatica is not uncommon to any professional working today, nor was it unknown to the scholars of ancient Greece. As early as the fifth century BC, sciatica was a recognized yet little understood “malady” of the hip. Hippocrates believed that the disorder was more common during the summer and autumn months and treated the condition using massage, rest, and “piped-in” music.
Today, sciatica is better understood, yet it has created a daunting legacy; it is a syndrome whose lifetime prevalence is as high as forty percent. Sciatica is not new to the massage therapist. In massage schools all across the country, students are introduced to the condition and taught how to treat it (think piriformis). Sciatica-related pain is a common complaint from many clients of massage therapists. Results for relief of pain from this condition in massage and other health care modalities are usually good, with one caveat: the relief usually does not last without continued treatment. Sciatica persists, year after year, sometimes decade after decade, and quality of life declines for most patients.
The traditional Cartesian view of sciatica in the medical field is that the condition is a physical process, thus treating it must entail a search for a “logical” reason. For example, for the last 70 years, a herniated disk in the lower back has been widely accepted as a likely cause of sciatic pain5 Treatment for sciatica, then, is often based on a diagnosis of a damaged disk. If a sciatic patient visits an orthopedic surgeon, she will probably order an MRI to rule out the possible involvement of a protruding disk. The medical community is gullible to “scientific evidence,” especially when it is presented in a pretty picture of magnetic imaging6 If a disk is herniated and they can see it, it must be contributing to the pain. Yet of the 1.5 million costly MRI scans performed each year, only twenty percent show a herniated disk serious enough to cause sciatic pain5 Also, spinal MRI scans show that most people without back pain have disk bulges.7
The Cartesian “look for one thing” view often blindly carries over to the massage therapist. For example, the common place to look for dysfunction in a massage treatment is the piriformis muscle. This is not a bad place to start, as piriformis syndrome, a term that describes dysfunction in this small muscle, could be causing the sciatic pain. If we trace the path of the sciatic nerve as it comes out of the sacrum, it passes just under the piriformis muscle, and the peroneal part of the nerve may perforate the muscle itself.10 Massaging this muscle can be of great help in releasing its hold on the nerve, but a larger question is how long will it last? What if the client was taught how to maintain her own dysfunctions?
Clinical Flexibility and Therapeutic Exercise (CFTE) is a modality derived from traditional kinesiology (the study of muscle movement) and biomechanics. CFTE consists of an entire set of exercises done in a specific order to open soft tissue and restore range of motion (ROM). Unlike many massage modalities, CFTE is rooted in kinesiology, so its approach is often very new to many professionals. It essentially utilizes ROM, something that every therapist should be familiar with. But it also involves a philosophy that is outside of Cartesian thought; instead of focusing on one thing, the entire body is considered in every treatment. Also, the sciatic patient becomes involved with her own treatment by learning exactly what needs to be done to help it.
To perform a CFTE treatment on the lower extremities, an isolation belt, which resembles a car seat belt, is used over a 3-inch hip pad to help isolate structure. For example, to treat areas that might be affecting sciatica, the belt is placed over the anterior superior iliac spine (ASIS). This keeps the ischial tuberosities down on the table, and stabilizes the hip completely, allowing for specific isolation of muscle tissue. There are over 50 different CFTE movements for the hip, all of which specifically isolate areas of injury. Treatment does not cease at the clinic; patients are educated and are always involved in their recovery. Under the philosophy of CFTE, sciatica becomes a very manageable dysfunction that does not have to be life debilitating.
For more information, visit Timothy Agnew’s Web site at www.stretchme.com. References for this article are available by request.