Sciatica and ART®
Sciatica – Active Release Techniques®
Dr. Sebastian Gonzales D.C., C.S.C.S., ART, Huntington Beach California
Keywords: sciatica, active release techniques, sebastian gonzales, orange, leg pain, foot pain, spinal stenosis, osteoarthritis, disc herniation, piriformis syndrome, buttocks pain, hip pain, tight hip flexors, tight psoas muscles, decrease gluteus maximus firing, lack of hip extension, dyfunctional hip extension motion pattern ___________________________________________________________________________________________________________
Sciatica: What to do if you have it
“My Doctor tells me I have Sciatica”
Why does the piriformis muscle become tight, causing sciatica?
How can I get rid of sciatica on my own?
What if my sciatica is not helped with stretching and glut firing?
“My Doctor tells me I have Sciatica”
What can cause Sciatica?
There a number of true causes of sciatica and it is critical to find out the cause to assign a proper treatment plan.The most serious cause is spinal stenosis, which is a closure of the bony canal that holds the spinal cord.This closure can be caused by osteoarthritis (degenerative disc disease) or a central disc protrusion, so you might guess this is seen more often in the older population.Patients often complain of sciatica symptoms in both legs, as well as having loss of bladder and bowel function.Regardless of the cause, this is a serious condition and surgery is a definite probability.If this sounds familiar, seek medical attention as soon as possible.
Another cause of sciatica is a disc herniation in the lumbar spine or lower back.This usually occurs in middle age people which have done a lot of bending forward in their life-time.Due to this, sciatica symptoms will be worse when bending forward and better when extending back, however a medical professional will be needed to distinguish if this is the main cause of your sciatica or not.This is probably most commonly reported cause; however, I have seen firsthand this is not the true cause in many cases of sciatica.
The most common cause and least recognized by the medical world is piriformis syndrome.This small muscle is located in the buttock region and although it seems insignificant, it is a frequent site for the sciatic nerve to become entrapment.In fact, in about 15% of the population the sciatic nerve passes directly through the muscle.I would imagine these unlucky people could get sciatic symptoms much easier than the rest, but I guess we won’t know until we can dissect a large number of living patients.Even if the nerve does not run through the piriformis muscle, it will be located directly beneath it.Due to its proximity, if the piriformis becomes tight, the sciatic nerve can be “pinched off”, becoming fixed within the muscle, which will cause leg pain in combination with lower back and buttocks pain.
Why does the piriformis muscle become tight, causing sciatica?
The main reason the piriformis can become tight is mostly due to a weakness in the main hip extensor, the gluteus maximus, which is mainly a result of sitting too much.(Please refer to another article called “Low Back Pain: What can you do about it” for more information.)When we sit a lot, the gluts are neurologically “turned off” by the brain, because they are not being used throughout most of the day.When the gluts have been “turned off”, the hip extension firing order becomes altered.The reason this is significant is because when the gluts no longer do their job, other muscles pick up the slack.Because they have to work harder and more often, they become chronically tight.A few muscles which have been identified in this situation are the low back muscles, the hamstrings and the hip external rotators, such as the piriformis.This is main mechanism by which many people end up with lower back pain and sciatica; these are also the people that end up being told they have a disc herniation as the main cause of their sciatica.
How can I get rid of sciatica on my own?
As just stated, the main cause of sciatica is usually due to tightness of the piriformis muscle, so the most logically thing to do is to decrease the tonicity of this muscle.One thing everyone can do is stretching.The basic seated version of this stretch can be found by searching the internet for a picture, but here are the basics.For simplicity sake, let’s say the right leg is the problematic leg.To stretch the right piriformis muscle while seated, place the right ankle on the left knee.Now pull the right knee upward towards the left shoulder, with both arms.This should place a stretch on the muscle; however, because the nerve maybe passing directly through the piriformis, stretching with too much intensity can be bad.Just stretch it to the point where you can feel the muscle getting tight; do this throughout the day.In addition to this stretch I recommend performing glut firing exercises, as stated in my other article mentioned previously.One glut firing exercise which should be used specifically if the patient is having sciatica is a modified pelvic bridge.The modification of the exercise is what makes it great.While performing a normal pelvic bridge, the patient should firmly hold a solid object between their knees.This will make it impossible for you to accomplish the hip extension with the help of the piriformis, targeting the gluteus maximus.One more trick is to put your hands on your gluts while performing the exercise to endure most of the work is being performed by them.Glut firing exercises are very important and underutilized in typical treatment of sciatica; they should be performed slowly and in sets of 12, at least one a day.If you experience any pain with the exercises, discontinue them and see a medical professional before continuing.
Sciatica PART 1
Sciatica PART 2
What if my sciatica is not helped with stretching and glut firing?
As stated before, stretching is the first and best thing to do for sciatica caused by piriformis tightness.If your sciatica is not revolved with home stretching and glut firing, you need Active Release Techniques® (ART®).Active Release Techniques® is a relatively new soft tissue technique which effectively treats conditions caused by chronic soft tissue tightness, such as carpal tunnel syndrome, tendonitis, tennis elbow and shoulder pain.Providers of this type of soft tissue treatment are trained to feel abnormal texture and tension within muscles, ligaments, tendons and nerves.ART® is so precise that it specially addresses over 300 soft tissue structures in the body, based upon their biomechanical actions and orientation in the body.One reason it is so effective with sciatica is because it helps remove fibrous scar tissue, which builds up within the piriformis muscle and surrounding tissues.Another reason ART® is so effective is because it utilizes a unique type of nerve flossing protocols.The Long Tract Nerve Entrapment Protocols® are so efficient at freeing up sciatic nerve entrapments that some patients have reported feeling a complete resolution of symptoms after a few minutes.Although not everyone gets these types of results, most people can feel a significant difference in 4-6 treatments.Active Release Techniques® maybe an effective way resolving sciatica, but the without the use stretching and glut firing exercises, the pain might come back.
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