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Sciatica Unraveled Part 3: Conservative Treatment

Updated: 1 day ago

Manual Therapy on the Hamstring Muscle

Sciatica treatment can be both effective and empowering when approached with manual therapy and lifestyle adjustments. By focusing on alleviating pain, reducing inflammation, and improving mobility, these methods offer a comprehensive path to recovery. Physical therapy is designed to strengthen back and core muscles, enhance flexibility, and promote proper posture, which collectively help to ease the pressure on the sciatic nerve. Additionally, lifestyle changes such as managing weight and optimizing workplace ergonomics play a vital role in minimizing spinal stress. The ultimate goal is to address the root causes of nerve irritation, support functional recovery, and prevent future episodes, all while fostering a proactive and positive approach to health and wellness.

Article Index:


Conservative Approaches to Sciatica

Treating sciatica conservatively often means opting for non-surgical methods that focus on relieving pain and enhancing mobility. These treatments can be both effective and holistic, encompassing a range of approaches:

  • Manual Therapy: Skilled practitioners offer a variety of techniques to ease pain and boost strength and flexibility. This includes Motion Specific Release (MSR), massage, heat or cold applications, and various methods aimed at reducing muscle tension and encouraging healing.

  • Functional Exercises: Under the guidance of a professional, patients engage in exercises specifically designed to strengthen back and core muscles, improve flexibility, and promote proper posture. These exercises are crucial for relieving pressure on the sciatic nerve and enhancing overall mobility.

  • Osseous Manipulation/Mobilization: These techniques involve precise adjustments and mobilizations of the spine and joints to improve alignment and increase joint mobility, thereby alleviating pressure on the sciatic nerve. Chiropractic adjustments or osteopathic manipulations can be particularly effective in this regard, improving joint function and reducing nerve compression.

  • Acupuncture/Acupressure: Utilizing Traditional Chinese Medicine (TCM) principles, specific points such as BL40 (Weizhong), GB30 (Huantiao), and BL60 (Kunlun) are targeted to reduce pain and inflammation associated with sciatica. These therapies involve inserting fine needles or applying pressure to stimulate these points, thereby enhancing the body's natural healing processes.

  • Cortisone Injections: These injections can be recommended by healthcare providers to significantly reduce inflammation and pain. This reduction in pain allows patients to tolerate manual therapy better and perform the necessary functional exercises.

  • Pain Medication: Over-the-counter pain relievers like acetaminophen or NSAIDs can be crucial in managing pain and inflammation. However, it's essential to follow the advice of your physician to determine what is best for your particular case, ensuring safe and effective pain management.

  • Lifestyle Modifications: Specific changes such as maintaining proper posture, achieving a healthy weight, avoiding prolonged sitting or standing, and setting up an ergonomic workspace are essential. These adjustments help reduce spinal stress and prevent future episodes of sciatica. Additionally, incorporating regular physical activity, stretching routines, and mindfulness practices can support long-term spinal health.

These comprehensive approaches aim to support your journey to recovery, promoting overall well-being and long-term health while effectively managing the symptoms of sciatica.


Manual Therapy

Joint Manipulation/Mobilization

The vast array of movements the human body can perform hinges on the integrity of its joints. For healthcare practitioners, understanding the intricate connections between joint structure and function is crucial. Joints function in a complex network, not independently, meaning an injury to one can cause compensatory biomechanical adjustments in nearby as well as far-reaching joints.

Flow Chart Explain Effect of Joint Manipulation

Research has shown us that when joints become immobile (as in injury or osteoarthritis), they then become subject to several physiological changes. (6)

Flow Chart Explaining Impact of Injuries

Alterations such as a reduction in joint fluid can diminish the space within the joint capsule, resulting in closer proximity of joint fibers. This condition fosters the formation of cross-fiber linkages and adhesions within the synovial folds of the joints, leading to weakened collagenous tissues and increasing the risk of tissue failure, even under less strain (7,8). Joint manipulation is documented to mitigate several of these adverse changes (7,8).

Chiropractic Adjustment Demonstration Video

Adjustment Demonstration

Chiropractic adjustments are a valuable intervention for chronic back pain and can be particularly effective for relieving sciatica symptoms. Patients engaging in regular chiropractic maintenance care often experience more favorable results than those who only pursue chiropractic treatments during acute episodes of sciatic pain.


Myofascial Release

Myofascial release is a therapeutic practice focused on the myofascial system, which encompasses fascia, muscles, ligaments, tendons, and other soft tissues. The aim is to release tension and alleviate pain in these interconnected structures, enhancing mobility and overall bodily function. Addressing the entire myofascial network is crucial in this treatment approach for optimal results.

Myofascial Release of the Hamstrings

Fascia as a Balanced Tensional Network

Fascia is a dynamic, tension-responsive network that adapts its fibers to meet the specific tensional needs of different areas. In an optimal state, fascia evenly distributes forces across the body, aiding in the conservation and efficient use of energy for movement. However, imbalances in fascial tension can lead to biomechanical adjustments that may cause widespread dysfunction throughout the body.

Fascia's Plays a Significance in Neural Communication

Research has shown that the fascial network in the human body contains sensory nerve receptors at a density ten times greater than those in muscles, indicating a significantly enhanced capacity for neuromuscular feedback through the fascia.

This network includes various sensory receptors, such as myelinated proprioceptors (Golgi, Pacinian, and Ruffini endings) and unmyelinated free nerve endings. In conditions like sciatica, disruptions in this complex neurological web can lead to extensive neurological effects.

RNA Diagram

Fascia - A Repository of Memory

The phrase "our fascia is the repository for our body's history" encapsulates the concept that our bodies structurally adapt to injuries and physical forces through mechanical compensation. This adaptation begins with mechanical forces triggering transcriptional (RNA) changes, leading to modifications in our fascial network.

These structural changes can result in biomechanical imbalances, fibrosis, and tissue thickening, ultimately impacting mobility. This intriguing idea demonstrates the body's ability to record physical events and adapt at a cellular level by transcribing RNA to synthesize new proteins, thereby encoding our physical experiences into our fascial structure.


Motion-Specific Release

Motion Specific Release (MSR) is a dynamic, patient-centered technique designed to effectively treat sciatica. This personalized approach considers each individual's unique medical history and clinical presentation. By integrating principles from various therapies, MSR goes beyond a one-size-fits-all method, creating a customized treatment plan tailored to the patient's specific needs and conditions.

For sciatica, MSR addresses not only the local pain but also the interconnectedness of musculoskeletal functions. It considers how various body parts contribute to nerve irritation or compression causing sciatic symptoms. The goal is to restore functional movement, alleviate pain, and improve the patient's quality of life through an evidence-based and interdisciplinary method, incorporating joint mobilization, soft tissue work, and therapeutic exercises.

Sciatic Nerve Release Video
Click Image to Watch Video

Eliminate Your Sciatic Nerve Pain

In this video, Dr. Abelson demonstrates some of the Motion Specific Release (MSR) procedures we use to release the Sciatic Nerve. Symptoms of sciatica can be caused by disc herniation, foraminal stenosis, spinal stenosis, or entrapment of the sciatic nerve. Fortunately, most cases of Sciatica do NOT require Surgery, as long as no red flags are present.


Conclusion - Part 3

Sciatica treatment can be both effective and empowering when approached with manual therapy. By focusing on alleviating pain, reducing inflammation, and improving mobility, these methods offer a comprehensive path to recovery. Functional indiviudalized exercise program strengthens back and core muscles, enhances flexibility, and promotes proper posture, collectively easing pressure on the sciatic nerve. Additionally, lifestyle changes such as managing weight and optimizing workplace ergonomics play a vital role in minimizing spinal stress. The ultimate goal is to address the root causes of nerve irritation, support functional recovery, and prevent future episodes, fostering a proactive and positive approach to health and wellness.


References - Part 3

  1. Snelling NJ. Spinal manipulation in patients with disc herniation: a critical review of risk and benefit. Int J Osteopath Med 2006;9:77–84.

  2. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J 2006;6:131–137.

  3. Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther 2004;27:197–210.

  4. Lisi AJ, Holmes EJ, Ammendolia C. High-velocity low-amplitude spinal manipulation for symptomatic lumbar disk disease: a systematic review of the literature. J Manipulative Physiol Ther 2005;28:429–442.

  5. Akeson WH, Amiel D, Abel JF, et al. (1987). Effects of immobilization on joints. , 219, pp. 28-37.

  6. Woo SL, Matthews JV, Akeson WH, et al. (1975). Connective tissue response to immobility: correlative study of biomechanical and biochemical measurements of normal and immobilized rabbit knees. , 18(3), pp. 257-264.

  7. Coronado RA, Gay CW, Bialosky JE, et al. (2012). Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis. , 22(5), pp. 752-767.

  8. Degenhardt BF, Darmani NA, Johnson JC, et al. (2007). Role of osteopathic manipulative treatment in altering pain biomarkers: a pilot study. , 107(9), pp. 387-400.

  9. Mitchell JH, and Schmidt RF. (1977). Cardiovascular reflex control by afferent fibers from skeletal muscle receptors. In: Shepherd JT, et al, eds, Handbook of physiology, Section 2, Vol. III, Part 2. Bethesda: American Physiological Society, pp. 623-658.

  10. Schleip R. (2003). Fascial plasticity— a new neurobiological explanation. Part 1. J Bodyw Mov Ther, 7(1), pp. 11-19.

  11. Van der Wal J. (2009). The architecture of the connective tissue in the musculoskeletal system: An often-overlooked functional parameter as to proprioception in the locomotor apparatus. In: Huijing PA, et al, eds. Fascia research II: Basic science and implications for conventional and complementary health care. Munich: Elsevier GmbH.

  12. Chen C, and Ingber D. (2007). Tensegrity and mechanoregulation: from skeleton to cytoskeleton. In: Findley T, and Schleip R, eds. Fascia research. Oxford: Elsevier, pp. 20-32.

  13. Findley T, and Schleip R. (2009). Introduction. In: Huijing PA, Hollander P, Findley TW, and Schleip R, eds. Fascia research II. Basic science and implications for conventional and complementary health care. München: Urban and Fischer.

  14. McGill, S.M. Ultimate back fitness and performance, Backfitpro Inc., Waterloo, Canada, 2004. ISBN 0-9736018-0-4. Fourth edition 2009.

  15. McGill, S.M. Low back disorders: Evidence based prevention and rehabilitation, Human Kinetics Publishers, Champaign, IL, U.S.A., 2002. ISBN 0-7360-4241-5, Second Edition, 2007.

  16. Lori A, Boyajian-O’ Neill, et al. Diagnosis and management of piriformis syndrome:an osteopathic approach. J Am Osteopath Assoc Nov 2008;108(11):657-664



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Photo of Dr. Brian Abelson

Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.


MSR Instructor Mike Burton Smiling

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