Sciatica is inflammation of the sciatic nerve. Pain usually originates in the lower back or hip & travels down one side of the posterior thigh & leg, but both sides may be affected. Massage has been found to improve function & reduce symptoms in persons with lower back pain.
Most often, sciatica is a symptom of another condition involving the sciatic nerve rather than its own diagnosis. Sciatica may be caused by bulging or herniated discs, spinal stenosis (narrowing of the spinal canal), bone spurs, spondylolisthesis, trauma, poor posture, tumors, or a combination of these. In men, a common cause is keeping their wallet in a back pocket, which compresses the sciatic nerve.
Piriformis syndrome is another possible cause. In approximately 15% of the population, the sciatic nerve passes through the piriformis muscle rather than anterior to it (1), increasing the likelihood of piriformis syndrome & resultant sciatica. In some cases, the cause of sciatica is unidentified.
Radicular pain that originates in the lower back & radiates into the buttocks and thigh is the hallmark symptom of sciatica. Neuropathy & paresthesia are common. The affected person may experience muscle weakness & have difficulty walking. The area may also be tender to the touch.
Initial treatment is usually conservative & may include the use of ice, massage, ultrasound, & medications (analgesics, anti-inflammatories, skeletal muscle relaxants). Physical therapy & chiropractic procedures, along with back & abdominal exercises, are often helpful. A medical procedure called an epidural injection is another option & involves injecting a corticosteroid medication into the affected area. Surgical approaches are indicated if conservative measures fail or if motor or sensory deficits are significant.
Massage Therapy & Sciatica – Massage needs to be modified according to the cause. For example, if the cause of sciatica is a herniated disc, massage may need to be postponed if pain is severe. If the cause is piriformis syndrome, massage is indicated. Use deep effleurage & friction over the femoral attachment & along the length of the piriformis. This includes the lateral sacral border & just medial to the greater trochanter. Clients with sciatica are prone to additional nerve injury at pressure points (e.g., behind the knee, front of the ankle). For this reason, use a soft rather than stiff bolster in these areas. View this video for technique recommendations for clients with lower back pain. View this video for technique recommendations for massage over the buttock area.
Massage reduced subacute & chronic lower back pain & improved trunk flexibility & function (2-4). Massage also decreased depression, anxiety, & improved sleep in people with lower back pain (2, 3). Furthermore, massage increased levels of serotonin & dopamine, indicating improved mood (2). The American Massage Therapy Association issued a position statement in 2012 that massage can be effective in reducing lower back pain (5).
Articles and Journals Referenced:
- Simons D, Travell J, Simons L: Myofascial pain and dysfunction: the trigger point manual. (1999). Ed 2, vol 2, Baltimore, Lippincott Williams & Wilkins.
- Field, T., Hernandez-Reif, M., Diego, M., Fraser, M. (2007). Lower back pain and sleep disturbance are reduced following massage therapy. J Bodyw Mov Ther. 11(2), 141-5
- Hernandez-Reif, M., Field, T., Krasnegor, J., Theakston, H. (2001). Lower back pain is reduced and range of motion increased after massage therapy. Int J Neurosci. 106(3-4):131-45.
- Preyde, M. (2000). Effectiveness of massage therapy for subacute low-back pain: A randomized controlled trial. CMAJ. 162(13):1815–1820.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.