It was a beautiful, sunny afternoon at the end of the week. I was offering home visits at the time in Cheshire and Merseyside area. Perfect day to help another patient in need. She was a young female in her early 30s, complaining about acute left sciatica symptoms, going for about 3 weeks. Pain was travelling from her left buttock to the side of her left calf. Patient marked her pain 8/10. Unfortunately prescribed painkillers didn’t help, nor the exercises found on Youtube. One of her friends recommended my service to her and I was able to book her in the same week.
Consultation and initial findings
After setting up my equipment we went through a standard procedure of consultation. Interview first. I needed to know how the pain started, when it hurts the most, how is her day to day functioning, quality of sleep, any injuries in the past, stress levels, what does she do for living etc. Interview gave me already some directions what the problem might be, but we needed to confirm that with physical assessment – posture, range of movement in the joints and palpation (I was looking for tender areas of the body).
Patient was presenting a slight torsion of the pelvis where right illium was tilting anteriorly (forward), whilst left posterior (backwards). We performed Laseque test to see if there is potential irritation in the roots of the sciatic nerve. Both legs were flexing equally, so most likely there's no irritation on the roots. These days when we say “sciatica symptoms” it doesn’t necessary might originating from the room of the sciatic nerve, but might be coming from a pressure on the nerve as it’s travelling down the leg or it might be imitated most commonly by active trigger points in the gluteal muscles. In this case after palpation examination and looking for the trigger points in the gluteus minimus muscle, we were able to reproduce the pain by pressing on the muscle – BINGO!
The treatment
Now we know that we have to improve the blood flow to the area and reduce the activity of the trigger point. However this is just the effect of what was happening at work. Favouring one leg when standing up and not distributing the weight evenly when lifting the boxes in the warehouse where she was working. So I have educated patient on changes she has to implement on daily basis. We also seen a torsion of the pelvis which meant we also had to work around deep muscles around the spine, hip flexors and gentle stimulation around neck area at the end of the session to stimulate the proprioceptors telling the brain where she was in space.
Patient was very good during her session and despite going through some painful moments, she generally felt relief after her first session. Patient was prescribed her daily exercises and we decided we will meet again in 7 days.
Report after first visit
When I came back after a week, patient reported that symptoms where more bareable, pain was not travelling to her calf anymore but only was in her buttock. Patient marked her pain on scale 5/10. Sleep was better and work was a bit easier too. But it wasn’t perfect yet. What was the most interesting was that patient reported she did not experience any headache since her last visit.
- Oh, you didn’t mention anything about headache on your consultation. - I said.
- Well, I was only thinking about problems associated with my leg mainly – she replied - But I was experiencing regular headaches, few times a week for about… Probably around a year. Sometimes they were more intense or sometimes less… But I didn’t not have any since you last came.
I am aware of course of myofascial connections through the body and the topic of headaches and migraines was always one of my favourite. Personally I was experiencing regular migraines as a young adult – mainly associated to stress and my adventure with sports. In my world when it comes to headaches and associated trigger points we mainly think about the muscles around the neck and shoulders, but I didn’t really do enough around that area on her last visit to have a very good effect on that. It was one of those experiences where as a therapist you see a practical application and a proof on what you’ve learned as a student. In this case long muscle chains starting around the pelvis and having an effect muscles on the neck.
I have seen this particular patient only one more time to establish correct muscular tension around her pelvis and neck and patient was pain free. Next time when I’ve met the lady was after she gave birth to her first child couple of years after, but generally she was in good shape and she was still performing her short stretching routine to make sure she can withstand challenges of her work.
To sum it up
Not everyone with sciatica symptoms improve so quickly, but in my experience it is not the most complicated problem that can occur in our body, and with the right exercises and treatment like trigger point therapy, deep tissue massage, myofascial release or even sports massage patient can get pain under control fairly quickly. This patient was young, was following my advice accurately and the pain was present only for few weeks. Usually the longer the problem is, the longer it takes to help with sciatica.
So if you have started to experience some pain around your buttock and travelling down the leg, firstly you try to stay active and move. But if the pain is not improving or even getting worse after around 2-3 weeks, it worth to seek for professional advice.
If you live in the south of Liverpool around Mossley Hill or Allerton we are next door!
Mateusz “Matt” Ciesielski Pain Relief Therapy 07784751656 hello@painreliefliverpool.com
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