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Sciatic Nerve Pain

Background

 

  • The client is a 47-year old female with ongoing sciatic nerve pain on the left side.
  • At the time of her initial appointment, she was going to the chiropractor for the pain and taking four ibuprofen to help her sleep through the night.
  • She describes the pain as a burning sensation that radiates down the left leg.
  • She feels that certain activities such as kickboxing class and sitting for long periods of time aggravate the pain.
  • She also describes the pain as feeling “achey” in the morning when she first gets up.

Observations

  • The initial range-of-motion assessment reveals greater restriction in the left hip, especially during external hip rotation.
  • Tight bands are noted in the gluteal muscles as well, with the left side tension pattern more defined.
  • QL and erector spinae group are very tight at the low back.
  • Tight bands are also palpated in the rhomboids group on both sides of the spine.
  • Anterior and middle scalenes are tight in the neck, with a slightly exaggerated forward head posturing noted.

Treatment

 

  • The client comes in for one 30-minute (Session 2) and four 60-minute treatment sessions.
  • The first two sessions are spaced about 10 days apart, and the second and third session are spaced about two weeks apart.
  • Sessions 3, 4, and 5 are spaced about 5 days apart.
  • At the time of the second session, the low back, left side gluteal muscles and external hip rotators and left leg are the primary focus of the session.
  • In all other sessions, the left external hip rotators are focused on heavily, while incorporating work on the back and neck.
  • Chinese medical massage pressing, kneading, compression, and deep tissue techniques are applied to the back, neck, gluteal muscles, external hip rotators, and legs.
  • The primary acupressure point worked for the sciatic nerve pain is GB30 on the left.
  • Pressing and rotating into the left greater trochanter is also primary in each session.
  • Gluteal muscles and external hip rotators on the left are frictioned, holding trigger points until release.

Outcome

  • Following the second session the client is able to exercise, including attend kickboxing class, without pain.
  • She no longer needs to take pain medication at night in order to sleep.
  • With the exception of sitting for long periods of time, the discomfort in her left piriformis remains minimal over the course of the next three sessions.
  • With maintenance work, the sciatic nerve pain is limited to occasions when she engages in high impact activities, such as jumping jacks.