In this second post of the “I Love Working With” series, I want to cover something I have been dealing with since I was 22 years old. I love working with patients who suffer from sciatica because I know what the pain is like, it is pure misery. Nothing feels better than being able to help someone who is in this kind of pain, I swear I used to feel the nerve pain going down my leg in my sleep!

Usually, calls for patients suffering from sciatica start out something like this:

Patient: “Hi, I was wondering if massage can help my sciatica?”

Me: Long pause…

Maybe? Is that a good way to answer? I never know. Let me explain.

Sciatica is not really a diagnosis. It’s actually a blanket term, meaning that a person has pain in the region of the sciatic nerve that travels down the leg. The pain can be confined to the hip or lower back—but usually sciatica is marked by pain down the leg. Usually the pain is confined to one leg, but I have worked with people who suffer with it down both legs. Sciatic pain usually travels down the back or outer edge of the leg—but again, I have had people report pain down the front of the leg as well. In the worst cases, the pain from sciatica can travel all the way down to the toes.

There are quite a few things that can cause sciatica. Our “old buddy” inflammation could be a cause, and anti-inflammatories are usually indicated in this case. Lumbar issues such as spinal stenosis (narrowing of the spinal canal), degenerative disc disease (where the cushiony discs between vertebrae break down), spondylolisthesis (trying saying that three times fast) (where a vertebrae slips over another) or muscle spasms can also cause the condition. Sciatica is also pretty common during pregnancy.

So, will massage help with sciatica? Maybe. It really depends on the cause behind the pain—and how severe the issue behind it is. When I had sciatica, the cause was a lumbar spinal issue (I had two, then three, herniated discs along with spinal stenosis). All the massage in the world would not have helped me—until after I had my surgery. I was able to make a lot of headway with my massage therapist, Claire, after the surgery to quiet the muscles back down. (Note: Claire is the reason I became a massage therapist all those years ago. Thanks, Claire!) For this reason, I do not tell anyone that massage will definitely help with their sciatica. I tell them the truth, and that’s a solid “Maybe”. Massage may help with sciatica—if the cause behind the pain is muscular.

Massage can be a great place to start when it comes to beating the pain of sciatica. I tell my patients that a massage session can point them in the right direction—if the pain is muscular, usually the piriformis muscle is involved. I usually recommend a half hour targeted massage of the lower back, hip and leg(s) to release the muscular tension in the region. Then—I recommend we wait and see what happens. The body will let us know right away all that we need to know. If the pain is indeed muscular, the pain will begin to get better. The patient will make progress. I am not saying that anyone will be “healed” after only one session, but when the muscles are the cause massage will help the patient move FORWARD. That happens a lot of the time. But I would be lying if I told you that this is what happens EVERY time. Sometimes, massage doesn’t work. But—the good news is—we know it right away. When a patient has a spinal cause behind their sciatica, post-massage things just don’t change. In a few rare cases, the pain actually temporarily gets worse. The reason for the pain not getting better or temporarily getting worse after a massage when the sciatica has a spinal cause is because while it is true that the muscles surrounding the lumbar spine are tight, they are tight for a very important reason. The lumbar spinal muscles’ job in the case of a spinal injury is to SUPPORT the spine, so they will go right back to being tight after a massage. You WANT them tight in this situation, to aid with stability and to make sure further damage to the spine does not occur.

For these reasons, I believe that massage can be a great starting point for a patient who suffers with sciatica. Either massage moves you forward toword feeling better—or it shows you that something more serious is going on. It doesn’t take a series of massages to tell you this, in my opinion. We can generally tell right away what we need to do next. If the pain gets better, we perform regular massages to relax the muscles in the hip and lower back to ease the pain. If the pain does not get better, we look for a doctor or chiropractor (whatever my patient feels most comfortable with) to search and help the spinal cause. I am happy to refer a patient away from myself and to someone who can better help when the issue is spinal. The only thing I want is for my patients to feel better.

As always, I thank you for taking the time to read this blog. I’m always here if you have any questions!

—Stephanie

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