Conservative treatment of sciatica primarily involves physical therapy and lifestyle adjustments aimed at mitigating pain, decreasing inflammation, and enhancing mobility. Physical therapy strategically targets strengthening of the back and core muscles, boosting flexibility, and encouraging proper posture to relieve pressure on the sciatic nerve. Lifestyle interventions, including weight management and ergonomic workplace modifications, are also key to reducing spinal stress. The main objectives are to address the underlying causes of nerve irritation, enable functional recovery, and prevent future episodes.
Article Index:
Conservative Approaches
Conservative sciatica treatment typically involves non-surgical measures to alleviate pain and improve mobility. These treatments may include:
Manual therapy: A practitioner can provide exercises and stretches to help alleviate pain and improve strength and flexibility. This therapy may include myofascial release, massage, heat or cold therapy, and other techniques to reduce muscle tension and promote healing.
Osseous manipulation/mobilization: Both procedures help to relieve pressure on the sciatic nerve by improving joint mobility.
Acupuncture/Acupressure: These procedures involve inserting fine needles or applying pressure into specific points on the body to help reduce pain and inflammation associated with sciatica.
Epidural steroid injections: A healthcare provider may sometimes recommend an epidural steroid injection to help reduce inflammation and pain associated with sciatica. This could allow the patient to perform the recommended exercises and improve their sleeping patterns.
Pain medication: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce pain and inflammation associated with sciatica.
Lifestyle modifications: Making changes to your lifestyle, such as maintaining good posture, losing weight, and avoiding prolonged sitting or standing, may help to alleviate pain and prevent future episodes of sciatica.
Manual Therapy
To effectively address sciatic pain stemming from disc herniation or non-discogenic sources, a conservative treatment regimen should prioritize the following elements:
Joint function: Employing techniques such as joint manipulation or mobilization.
Soft tissue health: Utilizing myofascial release techniques.
Exercise: Concentrating on enhancing mobility, strength, and balance.
Within this approach, spinal manipulation or mobilization has been evidenced to benefit patients with back pain and sciatica due to disc herniation. Studies support its use as a valuable component of a comprehensive treatment plan, contributing to pain relief, improved mobility, and enhanced overall function (1,2,3,4).
Studies have shown that joint manipulation can elevate the Pain-Pressure Threshold (PPT), which is the least amount of pressure that elicits pain and is a useful index for assessing tenderness though not diagnostic (5). The heightened PPT following manipulation may result from various factors like shifts in b-endorphin and serotonin levels, changes in alpha motor neuron activity, or autonomic nervous system (ANS) responses; the exact mechanism remains unclear (6). Furthermore, joint manipulation not only improves PPT but also positively impacts the mechanical and neurophysiological aspects of the spine, offering relief in disc herniation cases (3).
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.
Research has shown us that when joints become immobile (as in injury or osteoarthritis), they then become subject to several physiological changes. (6)
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).
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 that targets the myofascial system, which includes fascia as well as muscles, ligaments, tendons, and other soft tissues. The goal is to release tension and reduce pain across these interconnected structures, thereby enhancing mobility and overall bodily function. It's important to recognize the integral role that addressing the entire myofascial network plays in this treatment approach.
Fascia as a Balanced Tensional Network
Fascia is often characterized as a dynamic, tension-responsive network that reorganizes its fibers according to the specific tensional needs of the area (13). In its optimal state, fascia evenly disperses forces across the body and aids in the conservation and utilization of energy for movement. Imbalances in fascial tension, however, can result in biomechanical adjustments that may cause widespread dysfunction within the body.
Fascia's Plays a Significance in Neural Communication
Research has revealed that the fascial network in the human body is equipped with sensory nerve receptors at a density ten times greater than those found in muscles, suggesting a significantly heightened capacity for neuromuscular feedback via the fascia (10).
This network is composed of various sensory receptors, such as myelinated proprioceptors including Golgi, Pacinian, and Ruffini endings, as well as unmyelinated free nerve endings (9,10,11). In conditions like sciatica, any disruption in this intricate neurological web can lead to far-reaching neurologic effects.
Fascia - A Repository of Memory
The phrase "our fascia is the repository for our body's history" (12, 13) reflects the idea that our bodies adapt structurally in response to injuries and physical forces through mechanical compensation. This adaptive process is initiated by mechanical forces that lead to transcriptional (RNA) changes, resulting in modifications to our fascial network (12).
These structural changes can cause biomechanical imbalances, fibrosis, and a thickening of tissues, ultimately affecting mobility. This fascinating concept illustrates the body's ability to record physical events and adapt at a cellular level by transcribing RNA to synthesize new proteins, effectively encoding our physical experiences into our fascial structure (12).
Motion-Specific Release
The Motion Specific Release (MSR) technique is a dynamic and patient-centered treatment modality utilized for addressing sciatica. This tailored approach takes into account the unique medical history and clinical presentation of each individual. By integrating the principles of various effective therapies, MSR transcends a one-size-fits-all method, ensuring a bespoke treatment plan that targets the specific needs and conditions of the patient.
MSR operates under the EPIC framework, which stands for Evidence-based, People-centered, Interdisciplinary, and Collaborative. This means that the approach is grounded in scientific research and tailored to the individual’s specific situation. It incorporates knowledge from multiple health disciplines, promoting a holistic and collaborative treatment strategy.
For sciatica, this could involve addressing not just the local site of pain but also considering the interconnectedness of musculoskeletal functions and how various body parts may contribute to the nerve irritation or compression causing sciatic symptoms. The goal is to restore functional movement patterns, alleviate pain, and improve the patient's quality of life by using an evidence-based and interdisciplinary method that may include joint mobilization, soft tissue work, and therapeutic exercises.
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
The Motion Specific Release (MSR) technique is a dynamic and patient-centered treatment modality utilized for addressing sciatica. This tailored approach takes into account the unique medical history and clinical presentation of each individual. By integrating the principles of various effective therapies, MSR transcends a one-size-fits-all method, ensuring a bespoke treatment plan that targets the specific needs and conditions of the patient.
MSR operates under the EPIC framework, which stands for Evidence-based, People-centered, Interdisciplinary, and Collaborative. This means that the approach is grounded in scientific research and tailored to the individual’s specific situation. It incorporates knowledge from multiple health disciplines, promoting a holistic and collaborative treatment strategy. For sciatica, this could involve addressing not just the local site of pain but also considering the interconnectedness of musculoskeletal functions and how various body parts may contribute to the nerve irritation or compression causing sciatic symptoms. The goal is to restore functional movement patterns, alleviate pain, and improve the patient's quality of life by using an evidence-based and interdisciplinary method that may include joint mobilization, soft tissue work, and therapeutic exercises.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
Revolutionize Your Practice with Motion Specific Release (MSR)!
MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.
Attend our courses to equip yourself with innovative soft-tissue and osseous techniques that seamlessly integrate into your clinical practice and empower your patients by relieving their pain and restoring function. Our curriculum marries medical science with creative therapeutic approaches and provides a comprehensive understanding of musculoskeletal diagnosis and treatment methods.
Our system offers a blend of orthopedic and neurological assessments, myofascial interventions, osseous manipulations, acupressure techniques, kinetic chain explorations, and functional exercise plans.
With MSR, your practice will flourish, achieve remarkable clinical outcomes, and see patient referrals skyrocket. Step into the future of treatment with MSR courses and membership!
References - Part 3
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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.
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.
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Akeson WH, Amiel D, Abel JF, et al. (1987). Effects of immobilization on joints. , 219, pp. 28-37.
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.
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.
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.
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.
Schleip R. (2003). Fascial plasticity— a new neurobiological explanation. Part 1. J Bodyw Mov Ther, 7(1), pp. 11-19.
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.
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.
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.
McGill, S.M. Ultimate back fitness and performance, Backfitpro Inc., Waterloo, Canada, 2004. ISBN 0-9736018-0-4. Fourth edition 2009.
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.
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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