Sciatic Nerve Neuralgia.

Sciatic nerve neuralgia is considered to be one of the most difficult abnormalities of the support and movement system. Clinical expressions of sciatic nerve neuralgia include sharp pain irradiating to the lower extremities which increases during any of the patient’s attempts to move and of course limited range of motion on all axes and planes. Usually, when a patient appears at the doctor’s office with such a difficult clinical picture, in addition to prescribing painkillers, anti-inflammatory drugs, and/or utilizing injections, the doctor will usually refer the patient for radiological examination. Today, the most common radiological examinations are the MRI and/or CT scan. In many cases, MRI test detects bulging and/or herniation of discs. If symptoms are not alleviated in a period of a few weeks due to conservative methods of treatments (above mentioned oral or injected medication) consideration will be given to surgical intervention. The problem is that in many cases, this difficult neurological picture is not the result of the disc herniation, but is actually the result of piriformis muscle syndrome.

Anatomy of the Piriformis Muscles
The Piriformis muscle originates from the anterior surface of the sacrum and inserts into the greater trochanter. It shares the passage through the greater sciatic foramen with several important nervous and vascular structures including nerves which provide innervation to pelvic inner organs, the gluteals, and the lower extremities. The piriformis muscles can accumulate tension to the point that they will start compressing/ impinging sciatic nerve and awaking in some cases intolerable pain in the buttocks and lower back with irradiation to the extremities.

Sciatica nerve neuralgia can be the result of compression of the S1 spinal nerve as well as due to the compression of the sciatic nerve by over-tensed piriformis muscles. If patients with symptoms of sciatica have the ability to bend forward without awaking pain, most likely the sciatica neuralgia is the results of piriformis muscle syndrome.

The Causes for Accumulation of Tension in the Piriformis Muscles
1. Due to spondylosis, including herniation of disc, spinal nerves can be irritated (please do not confuse irritation of the spinal nerve with compression of the spinal nerve.) Irritation of the spinal nerves that provide innervation to the piriformis muscles (S1 spinal nerve) will cause a gradual accumulation of tension in these muscles, to the point that they will compress the sciatic nerve.
2. Physical overload of the muscles such as vigorous exercise, job performances that put too much static load on the piriformis muscles, hormone changes, exposure to toxins, physical and/or psychological trauma, etc.

Once, I presented to a group of doctors on medical massage and I mentioned the importance of medical massage treatment in cases of sciatic nerve neuralgia. I also pointed out that in many cases, herniation of the intervertebral disc does not play the main cause for this difficult pathology. One of the young doctors who attended my presentation said to me “According to you, many spinal surgeries are performed unnecessarily,” to which I replied, “This is true.” This young doctor asked me the following question: “How can I explain that after surgery this terrible irradiating pain to the extremities disappeared?” I replied, “Under total anesthesia, all muscles drop any tension they were holding. Thus, if the cause of this neurological picture was over-tensed piriformis muscles, the post-anesthesia patient experiences immediate relief from the shooting pain to the lower extremities. Massage therapy procedure in cases of sciatic neuralgia is directed at reducing the tension in piriformis muscles, which in turn will impinge/compress nerve less, as well as to eliminate trigger points that possibly can be developed on the pathways of sciatica nerve and branches. The protocol of massage therapy that I offer you was initially developed and proposed by professor Popelansky , MD. As I mentioned before, spondylosis, including degenerative disc disease, herniation of disc, spondyloarthritis, etc, can irritate the spinal nerves and cause reflexively increased tension in piriformis muscles and others. Therefore, it is very important to start treatment of sciatica neuralgia from the lumbar spine area, sacro-iliac crest region. The proposed segment-reflex massage will not only cause reduction of tension in the piriformis muscles before we even begin working on them, but also will increase arterial blood supply to the region. It is very important to place a pillow under the stomach of the client (as he/she lays face down). Pillow should be located on the projection and level of lumbar spine to prevent hyperextension and possible protective contraction phenomenon of the muscles at the time of applying moderate pressure on the lumbar spine region.