Low Back Pain & Sciatica: The Link | Massage Professionals - Institute for Integrative Healthcare Studies

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This article will highlight the relationship between low back pain and sciatica, and explore methods to aid clients with either painful condition.

The Relationship Between Low Back Pain and Sciatica

To assist clients with experiencing low back pain, it is important for a massage therapist to understand a correlating relationship between their back pain and sciatica conditions. Quite often, low back pain and sciatica conditions are related.

Defining Low Back Pain​


The lumbar spine consists of five vertebral bones. The bones in this spinal segment have larger vertebral bodies to better bear body weight. Over half of oneโ€™s weight is carried at the Lumbar 5 (L5) and Sacrum (S1) articulation. With more weight added to this vertebral joint, compressive forces also increase. A study in the Journal of Biomechanics published in 2015 showed that compression within L5-S1 increased between 46-52% with load holding tasks and 80-147% with no load in hands when body weight increased from 51 to 119 kg. (1)

With more compressive force upon the lumbar spine, muscles and surrounding structures must maintain greater integrity to withstand the increased force demand. This will strain muscles, tendon and ligaments. Both sensory and motor nerve supply may be impinged from this region. If the L5 spinal nerve becomes impinged, sensory and/or motor deficits may be witnessed within the hamstrings, knees, calves and feet.

RICE and PRICE​


Traditionally, the RICE method of injury recovery was the standard thought-process of aiding musculoskeletal pain. RICE is a mnemonic indicating Rest, Ice, Compression and Elevation as a primary means to injury recovery. Many health professionals have added โ€œProtectโ€ to create the mnemonic PRICE, as one may protect an injury with splints and bandaging efforts.

MEAT​


Presently, many health professionals have changed their view of RICE as the standard health care for injury recovery. Some suggest that gradually increasing movement as soon as possible after injury is now considered best way to improve oneโ€™s back health. The mnemonic MEAT arose from this new line of thought. This stands for โ€œMovement, Exercises, Analgesics and Treatments.โ€ The inclusion of movement prevents scar tissue from creating restrictions within the injured region as the musculoskeletal tissues heal.

Defining Sciatica Conditions​


The sciatic nerve is a large nerve stemming from the lumbar plexus of nerves.

Sciatica


The Cleveland Clinic describes that injury to the sciatic nerve itself is rather rare, however the term โ€œsciaticaโ€ generally refers to pain sensations felt originating in the low back which radiate down the legs. (2)

Many massage manuals further delineate types of sciatica. There are three main types of sciatica conditions generally presented in common massage manuals:

#1: True Sciatica features impingement of Sciatic nerve at Lumbar-Sacral plexus (L4 to S1 roots).

  • If L4 spinal nerve is impinged, sensations experienced within the medial leg-foot, loss of dorsi-flexion ankle movement, and there is reduced knee-jerk reflex.
  • If L5 spinal nerve is impinged, sensations experienced include an inability to extend great toe along with โ€œdrop footโ€ witnessed in gait.
  • If S1 spinal nerve is impinged, sensations experienced in lateral leg-foot, loss of plantar flexion ankle movement, and there is reduced ankle-jerk reflex.

#2: Piriformis Syndrome features impingement of Sciatic nerve either between Piriformis & Superior Gemellus muscles or within the Piriformis fibers itself.

#3: Pseudo-Sciatica features impingement of Sciatic nerve other than prior two locations, usually between Gluteus Maximus & Gluteus Medius muscles.

Epidemiology (Frequency)​


David Davis, et al, in his study published in StatPearls online, provides current epidemiology statistics about sciatica conditions. There is a lifetime incidence between 10-40% of general U.S. population with peak incidence witnessed between ages 40-49. Occupations which witness workers subject to awkward physical positions are most likely to acquire sciatica conditions. (3)

Classic Signs and Symptoms​

  • Lower back / Hip pain
  • Radicular leg pain
  • Burning / tingling / numbness experienced in the low back, hips and legs
  • Leg muscle atrophy / weakness experienced in the low back, hips and legs
  • Chronic gluteal pain
  • Scoliosis developing later in life
  • Reproductive organ challenges as spinal nerves S1โ€”S5 are associated with reproductive organ function

Common Causes of Either Low Back Pain and Sciatica​


The most common cause of pain in the lumbar and sacral regions is spinal nerve root impingement due to intervertebral (spinal) disc damage. A spinal disc may have one of three potential injuries.

  1. Bulging discs Also called โ€œslipped,โ€ a portion of the spinal disc will swell and press against surrounding spinal ligaments causing an irritating compression upon neighboring spinal nerves.
  2. Herniated discs The spinal disc sprains surrounding spinal ligaments and protrudes out of its normal space within the vertebral body borders of the spinal bone causing injury to neighboring spinal nerves.
  3. Degenerated discs The spinal disc disintegrates causing the fluid core of the disc, called the nucleus pulposus, to spill into surrounding spaces and potentially injure neighboring spinal nerves.

Aside from disc projects, there are other causes of low back pain and sciatica conditions.

Other Causes of Low Back Pain and Sciatica​


Lumbar stenosis witnessing narrowing of the spinal canal, spondylosis featuring stiffening and eventual fusing of vertebral joints, and spondylolisthesis with associated spinal bone displacement may cause nerve impingement, especially at the L5โ€”S1 junction.

Additionally, dysfunction of the Sacral-Iliac joint is a potential cause of lumbar-sacral pain. The effects of pregnancy upon the female body may also contribute to creating muscle spasms of the lumbar-gluteal unit facilitating pain.

Spinal cord injury causing neurological deficits may become a complication or may be a cause onto itself.

If lumbar-sacral pain is accompanied by:

  • a loss of bladder and/or bowel function,
  • progressive lower limb weakness or numbness in the upper thighs/groin

seek medical attention immediately, as complications have arisen.

Massage Therapist Considerations​


Functionally, the sacrum acts in two significant manners.

  1. First, the sacrum acts as an anchor solidifying the vertebral column into the pelvic girdle.
  2. Second, the sacrum transfers gravitational and tension forces from the upper body to lower body.

These two functions make this bone significantly important in treating pain in the low back and gluteal regions.

Having taught in entry level education, I acknowledge that many students as well as general public members may have reservations about receiving massage near the sacrumโ€”gluteal region. Never assume client consent with this region. Always obtain informed consent prior to the session. Communicate why you intend to address this region. Help your client understand that musculature here affects pain patterns and muscles elsewhere.

A massage therapist sensitive to the connection between low back and sciatic pain will address both regions mindfully. Incorporating stretching of the low back and gluteals will be a great addition to treatments. If one is skilled in cranial sacral therapy, the sacral protocol from this work can also aid greatly.

About the Author​

Jimmy Gialelis, LMT, BCTMB

Jimmy Gialelis, LMT, BCTMB​


Jimmy Gialelis, LMT, is a national board certified clinical practitioner passionate about clients actualizing maximum health gains. A member of the Massage Therapy Hall of Fame, he contributes to the Massage & Bodywork Licensure Exam as an exam item writer. He maintains a continuing education business, Advanced Massage Arts & Education, along with his private practice studio in Tempe, AZ.
 
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  39. DareDevil:
    366 ARIA WELLNESS โ™ฅ๏ธโ™ฅ๏ธADDRESS: 360 HWY 7, UNIT #6, RICHMOND HILL,647-222-5683 โ™ฅ๏ธโ™ฅ๏ธ(PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Beautiful Girls : New young RMT student Helen, Fun girl Apple, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! SPECIAL PROMO 30 MINS 2 GIRLS $70 ๐ŸŒน๐ŸŒน**TODAY'S PICKS OF THE DAY ARE ๐Ÿฌ๐Ÿญ APPLE AND HELEN๐Ÿฌ๐Ÿญ**
  40. Soul Relax Spa:
    โœจ Looking for a relaxing escape? โœ… Click Here Meet๐ŸŒธCarly๐ŸŒธBrandy๐ŸŒธKellyCall us today for the best treatment and service experience. Click on our Username and FOLLOW US for updates ! Call now โ˜Ž 289 - 298 - 5662โ˜Ž๏ธ Your ultimate relaxation awaits! โœจ
  41. Spa in Markham:
    GOLDEN FS โ€“ 8380 Kennedy Rd ๐Ÿ“ž 905-258-0777 / 416-688-6886 ๐Ÿ‡ญ๐Ÿ‡บ VANESSA, ๐Ÿ‡ป๐Ÿ‡ณ JULIE (2PM), ๐Ÿ‡จ๐Ÿ‡ด MEGAN (8PM), ๐Ÿ‡ป๐Ÿ‡ณ KELLY, ๐Ÿ‡ฎ๐Ÿ‡ณ SONIA (8PM), ๐Ÿ‡ป๐Ÿ‡ณ JESSIE ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookinggoldenlove
  42. FLOWER Spa - BLUEXADO | Thornhill | VAUGHAN:
    BLUEXADO FS โ€“ #06-1102 Centre St ๐Ÿ“ž 416-357-9797 / 416-678-8668 ๐Ÿ‡ป๐Ÿ‡ณ CICI, ๐Ÿ‡ป๐Ÿ‡ณ AMY, ๐Ÿ‡ป๐Ÿ‡ณ SHERRY ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingbluexadolove
  43. FLOWER Spa โ€“ PINK | Scarborough | TORONTO:
    PINK FS โ€“ 3300 McNicoll Ave ๐Ÿ“ž 416-299-5515 / 416-817-3839 ๐Ÿ‡ฎ๐Ÿ‡ท ELINA, ๐Ÿ‡ต๐Ÿ‡ญ MADY, ๐Ÿ‡ธ๐Ÿ‡ฌ CANDY, ๐Ÿ‡ป๐Ÿ‡ณ NANCY ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingpinklove
  44. SpringGreen.:
    Today we have 5 girls on downtown Toronto 72 gerrard st west๏ผš๐Ÿ’‹๐Ÿ’‹ New girl Hitti very young๐Ÿ’‹๐Ÿ’‹Lisa- Tanned Spanish beauty with large melons and a fun booty too minica- exotic goddess with a gymnasts body and corresponding flexibility Jennifer- Exotic beauty with... Call and text 647 891 0699 ask question :heart4 :heart4 :heart4
  45. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
  46. AliceSpa:
    3 Sexy Young Girls Today at Alice Spa. Open 10am to 9pm : CLOUDIA (12pm-9pm): is Vietnamese, young, petite 5'2" & 96 Lbs, B Cup, best rim deep bbbj cim. $40 Room Fee + $80 (incl bbbj & fs). +$20 for rim/cim. Excellent open minded services. SKY (10:30am-9pm): is Part time girl from Indonesia, petite 5'2", B Cup, 100 Lbs, long black hair, new to the biz.Young, fresh/cute, pretty, submissive, slim tiny waist, fair skin. bbbj
  47. ForeverWarden:
    Monday at ๐Ÿซฆโค๏ธ๐Ÿ”ดโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ 2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Bella, Yumi & Cindy. Bella is around 5โ€™3โ€ with a thin to medium build, C Cups, and a pleasing personality. She can offer dfk, bbbj and cfs as well as a good massage experience. Yumi is a young half Chinese / /half Korean very sexy & slim beauty, can do bbbj cim, excellent services...
  48. HolidaySpa:
    Monday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: AMY, FIONA & CINDY. AMY is an attractive young lady with larger breasts and a nice bottom. She has outstanding oral skills, and is very popular. Donโ€™t miss out on her special skills! FIONA is a slim hottie with long dark hair, great melons and ass, and nice services. CINDY is slim
  49. SugarLoveSpa:
    Monday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: ANA, CHRISTINA, MIA, TIFFANY & VIVI. 1270 Finch Ave W (at Keele St), Unit 18. North York, ON โ˜Ž ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฏ๐Ÿฒ๐Ÿฑ-๐Ÿฎ๐Ÿฒ๐Ÿด๐Ÿด โ˜Ž ANA is a young, short and sweet lady, 5โ€™1 & 105 Lbs, very tight, with a small to medium booty. Ana is a versatile honey who provides great massage, & can accommodate your needs. CHRISTINA is Spanish, C Cups, 5'3", tall & nice curves, very open mind
  50. bnwellness_wilson:
    We have 4 young girls are working today, young pretty Lily 25โ€™s with curve body and flirty Ivy 36DD with curly body 30โ€™s open mind, young sweet popular Michelle 26โ€™s with curve body open mind and cute GFE Ella are providing deep tissue massage, pls call 4163985777 book appointment and walk in always welcome,back entrance and parking available, 350 Wilson Ave North York
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