Sciatica of 10 Years Relieved in 2 Treatments
Client Info
Age: 52
Occupation: Corporate Management Desk Job
Exercise / Type and Frequency: daily swimming, walking, occasional yoga
Currently Receiving Treatment from Another Health Care Providerr: Chiropractic 2 x per month
Reason(s) for Seeking Treatment: Sciatica since 10 years, but worsened in last 3 years after falling down stairs and landing on pelvis.
Associated Symptoms: Low back pain. Neck and shoulder tension since 5 years; right shoulder tension and stiff neck, with some neck tension on left
Frequency: Constant pain. Wakes up at night in pain at least 3 x per week.
Aggravation: pain worse with sitting/driving in traffic.
Radiation: Pain radiates from right buttock down leg along outer calf and foot.
Pain Scale: pelvis sacral area 6-10
Relief: Tylenol, when acute chiro gives temporary relief, forward bends feel good.
Injuries or Motor Vehicle Accidents & Dates: 3 years ago fell down stairs and landed on sacrum, also resulted in bulging discs at L4 - L5
Surgeries & Dates: none
1st Appointment
Tests:
Standing Forward Flexion: (-) produced no pain.
Supine Leg Raise Test: (+) produced pain at 60 degrees elevation in right buttock, with no radiation down the leg.
Manual direct pressure on lumbar vertebra spinous processes and transverse processes: (-) produced no pain.
Manual direct pressure on pelvis and sacrum: (+) produced pain at right and left sacroiliac joints, and right and left S2-S4.
Treatment Techniques:
Prone:
Myofascial Release of lumbar paraspinal muscles
Myofascial Release of gluteal and right and left piriformis muscles
Myofascial Release of Iliotibial Tract
Mobilization of Sacroiliac joint
Muscle Energy Technique Post Isometric Relaxation (PIR) of piriformis muscles
Counterstrain of gluteal and sacral Tender Points (Tp’s)
Supine:
Myofascial Release of Iliacus and Psoas muscles
Counterstrain of Iliacus and Psoas Tender Points (Tp’s)
Harmonic Oscillation Long lever of lumbosacral region
Result: patient reported complete relief of pain immediately following treatment.
2nd Appointment
Post-Treatment Report: patient had complete relief for two days, and woke up with pain on 3rd night. Pain same as before.
{ I explained that a condition of several years would likely take more than one treatment, which they understood. }
Prone:
Myofascial Release of lumbar paraspinal muscles
Myofascial Release of gluteal and piriformis muscles
Muscle Energy Technique Post Isometric Relaxation (PIR) of left piriformis muscles
Myofascial Release of right quadriceps
Supine:
Muscle Energy Technique Post Isometric Relaxation (PIR) of right hip in flexion with contralateral anchor on left thigh
Counterstrain Tender Points (Tp’s) of right quadriceps and rectus femoris insertion at ASIS
Harmonic Oscillation Long lever of lumbosacral region
Standing:
I asked the patient to come off the table to standing to see how they felt, and if any pain was detectable. The patient reported complete relief of pain, however after standing for a little while noted there was a hint of pain starting to come back in the sacroiliac region.
In their natural standing posture, this patient’s lumbar spine was lordotic (excessively curved). I knew that the muscle tension holding the lumbar vertebra in lordosis could be released and balanced in time with a series of treatments.
However, I decided to try a Structural Alignment Therapy Technique: I asked the patient to place a block between the shins, and a second block between the thighs. I manually and verbally adjusted their lower extremities, pelvis and lumbar spine into optimal alignment. The patient reported immediate and complete relief of the pain in the sacroiliac region.
I explained the steps again and taught the patient how to do this exercise for themselves, as a home-care exercise.
Result: patient reported complete relief of pain following second treatment, and patient continues to use the Structural Alignment Therapy Technique to self-adjust and relieve any hint of oncoming pain.
* Therapists' Note: This exercise is covered in my Structural Alignment Therapy Training, among a long list of amazingly effective exercises for various conditions. This cient has not needed any follow up appointments because she was taught how to adjust and strengthen her posture in a way that no longer causes her pain. Learn more >>
Clinical Impression
In addition to the myofascial tension and musculoskeletal imbalance resulting from the fall down the stairs, the lumbar lordosis was putting pressure on the discs and nerves, and creating increased tension on the psoas, and sacroiliac joints, resulting in compensatory muscular imbalance.
