The Sciatic Runway

How to look after the flight, fight muscles. ...when to massage, and when to stretch.

A clinical perspective of the Sciatic Nerve (SN) and corresponding chronic muscular issues.

The origin of the Sciatic Nerve

The Sciatic Nerve is the longest nerve in the body and originates from L4, L5, S1 and S2. The SN leaves the pelvis through the greater sciatic foramen, descends under the piriformis and gluteus maximus providing branches to the hamstrings before dividing at the popliteal fossa continuing as the Tibial and Common Peroneal nerves. The SN provides motor function to the hamstrings: biceps femoris, semitendinosus and semimembranosus; and adductor magnus. The tibial and common peroneal nerves innervate the plantar and dorsi flexion muscle groups of the lower limb and foot. From a sensory perspective these two nerve branches also innervate the skin of the lateral leg, heel, dorsal and plantar surfaces of the foot. (Please refer to www.physio-pedia.com/Sciatic_Nerve or teachmeanatomy.info/lower-limb/nerves/tibial-nerve for further anatomy definitions).

Common Chronic SN Issues:

Piriformis Syndrome

Rehabilitation and regeneration medical researcher Loren Fishman defines ‘piriformis syndrome’ as ‘entrapment of the sciatic nerve by the piriformis muscle.’ Symptoms include buttock pain (aggravated by sitting) tender on palpation and leg adjustment; and reduced range of motion (ROM) during straight leg raise. Pain can also extend along (the sciatic runway) hamstrings, gastrocnemius, tibias anterior; achilles tendon; tuber calcanei and adductors and flexors of the feet. Therefore activities such as driving for long periods can aggravate the SN. When the SN is aggravated chronically the muscles along the sciatic nerve become weakened. Clients describe a burning sensation down the side of the leg, the calf muscle as painful during dorsi and plantar flexion and shortened painful hamstrings when attempting to stretch.

Chronic aggravation of the SN can also lead to further issues such as:

ITB Syndrome

ITB Syndrome is a common injury of runners or cyclists and presents as tenderness at the attachment points (physio-pedia.com). However I have seen ITB syndrome present in clients who are not cyclists or runners, or people who would describe themselves as athletic.

Plantar fascitis

Plantar fascitis comprises of fibrous connective tissue originating from the periosteum of the medial calcaneal tubercle, it is important to note for therapists, that it blends with the Achilles tendon, intrinsic plantar flexion muscles and even the skin and subcutaneous tissue. The role of the “plantar fascia adds critical stability to a loaded foot.” (www.physio-pedia.com).

So how when do we massage as opposed to stretching?

I recommend the following treatment method. Begin with the piriformis muscle and gluteus maximus, that’s right, at the beginning of the ‘sciatic runway’. A cross friction technique is recommended and a study by (Kanwal, Khan, Awan et al 2018) on Stretching Exercises Versus Deep Friction Massage for the Management of Piriformis Syndrome concluded that “cross friction massage is more effective in reducing pain and improving functional abilities in patients with piriformis syndrome as compare to stretching exercises”. Moving down the sciatic runway massage the GM, piriformis, TFL, ITB, hamstrings, anterior tibial, gastrocnemeus, achilles tendon and plantar and flexion muscles of the feet. Trigger point therapy can also be included during the treatment process. The aim of using the described method and techniques is to reduce chronic tension, lengthen the muscles and encourage blood circulation to muscles, ligaments and tendons and ultimately release the plantar fascia in the feet.

Your homework: massage the lower limbs every night; piriformis stretches such as pigeon pose at least twice a week; and weekly relaxation such as meditation. In time weekly treatments can be reduced to fortnightly and so on, provided you are maintaining home practice.

When to stretch?

Stretching is only recommended when the sciatic nerve isn’t aggravated, therefore I find the best results are achieved after a massage treatment session. Once all of the muscles along the sciatic runway have been relieved and lengthened. This is important because nerves don’t stretch, it’s the muscles surrounding them that need to stretch. Hence muscle length and flexibility needs to be maintained with regular massage and muscle tone needs to be maintained with low impact exercise before a stretching session. Also make sure you have a warming up process before stretching, stretching when cold can cause more fibrous muscle tears and then of course more pain.

Emotional contribution

Another contributing factor I have noticed during treatment of SN dysfunction is emotions. In the above chronic issues I have noticed a consistent emotional factor of frustration, resentment, impatience or irritability. These emotions are consistent with the Gall Bladder (GB) meridian the offical of decision making and judgement. “The Gallbladder is like a judge for its power of discernment” (The Huangdi Neijgin The Yellow Emperor’s Classic Book of Medicine, 2700BC). Shizuto Masunaga’s GB meridian extension begins at the corner of the eye, wraps around the scapula, zigzags through the hip and also extends from the greater trochanter along the lateral side of the leg ending at the small toe. Acupressure along the GB points is also an effective treatment of the above SN issues. Maintaining the GB meridian is important for physical movement, loosening joints, muscles, alleviating headaches and releasing frustration from the body.

In conclusion massage is an effective treatment method of chronic SN issues. Cross friction massage techniques have been proven by medical researchers to be more beneficial than stretching. A holistic approach to treatment can include providing therapy for the emotional factors such as acupressure along the meridians as well. Keep your fight/flight muscles in check with regular treatment.

Figures:

‘The Sciatic Runway,’ Photo by KinKate from Pexels, modified by Fiona Scope

‘Foot Massage,’ photo by Ryan Hoyme from Pixabay

References:

Kanwal, R. Imran, J. Awan, W. A. Khan, R. Malik, S. EXERCISES VERSUS DEEP FRICTION MASSAGE FOR THE MANAGEMENT OF PIRIFORMIS SYNDROME. Vol 2 No 02 (2018): The Rehabilitation Journal

www.physio-pedia.com/Sciatic_Nerve

teachmeanatomy.info/lower-limb/nerves/tibial-nerve