Leg pain, often diagnosed as sciatica, can be a painful and debilitating problem that commonly interferes with walking, standing, sitting, and sleeping. In some cases it is difficult to find any comfortable position at all. Along with pain, symptoms such as throbbing, numbness, and “pins and needles” can also be present. Adding to the frustration of these symptoms, this type of leg pain is often initiated by a seemingly routine task, or in many cases has no clear cause at all. To make matters even worse, this condition is slow to respond to traditional types of care, often creating further disappointment and aggravation.

Now for the good news: a new treatment technique known as Active Release Technique® (ART®) is proving to be a very effective method to treat many common leg problems and is helping to get those who suffer from the symptoms of sciatica back to doing their favorite activities. But before we talk about why ART® works so effectively we want to explain how sciatica symptoms develop.

As the lower five nerve roots exit the spinal column, they join to form the sciatic nerve. Sciatica refers to pain that develops as a result of compression or irritation of this nerve. The nerve roots come together to form the sciatic nerve close to the spine in the upper region of the hip and travel down the back of the leg all the way to the foot. As the nerve travels along the back of the hip, thigh, knee, and calf, it must pass between, and in some cases through, the muscles in these regions. As long as the muscles are loose and flexible and the nerve is able to freely glide along these muscles, the nerve remains healthy. However, if the nerve becomes compressed or irritated at any point along its path from the spine to the foot, sciatica pain can develop.

Sciatica refers to a group of symptoms that occur as a result of injury and irritation to the sciatic nerve. Sciatica is not a specific diagnosis and does not indicate what is causing the nerve irritation; there are many conditions that can cause the sciatic nerve to become injured. One common misconception is that sciatica always results from a disc herniation in the lower back. Although a disc herniation can result in sciatica symptoms, it is one of the less-common causes of sciatica; In fact, it is much more common for sciatica symptoms to develop as a result of problems in the muscles of the hip and leg. Because the sciatic nerve travels between the muscles of the hip, thigh, and calf, when any of these muscles become excessively tight or restricted, they can compress the nerve and prevent the nerve from gliding freely between the muscles. As this happens, the nerve becomes irritated and symptoms of sciatica develop. A complex system of muscles ensures proper movement in the hips and protects them from injury. It is not uncommon for small amounts of strain and imbalance to develop in the muscles of the hip as a result of excessive or repetitive use associated with some sports or occupations, muscle imbalances, prolonged sitting, previous injury, or lack of stretching and exercise.

Over time this strain can develop into what is known as micro-trauma. Simply stated, micro-trauma is very small-scale damage that occurs in the muscles, tendons, joint capsules, and ligaments in response to small levels of strain. Initially, micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles. Although small, this damage needs to be repaired. The body responds to micro-trauma in a predictable way: by laying down small amounts of scar tissue to repair the area. Over time this scar tissue can build up and accumulate into adhesions. As these adhesions form, they affect the normal health and function of the muscles and related joints. In fact, they can lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.

The accumulation of adhesions can also cause considerable strain and irritation to the sciatic nerve, because the adhesions restrict the normal sliding of the nerve between the muscles. Recall that the sciatic nerve passes between and through the various muscles of the hip and leg to remain healthy and must be able to freely slide between these muscles. As adhesions develop they cause the muscles to become tight and restricted, compresses the sciatic nerve, trapping it between the muscles and the muscle layers. In addition to becoming trapped by the tight muscles, as adhesions develop along the nerve’s path, the nerve can actually become stuck to the surrounding muscles. In either situation the ability of the nerve to slide is drastically compromised. When this happens the nerve is forced to stretch instead of slide, which causes the nerve to become irritated.

As the process continues, further strain is placed on the nerve and surrounding muscles, which leads to even more micro-trauma. A repetitive strain cycle begins, causing continued adhesion formation, progressive nerve irritation, and more severe nerve injury if the condition is allowed to continue.

It is possible for the sciatic nerve to become trapped and irritated at any point along its path between the spine and the foot; however, there are certain areas where the nerve is more prone to entrapment. One of the most common areas of entrapment is at the piriformis muscle, which is located deep in the back of the hip. The sciatic nerve travels directly underneath (and in some cases through the middle of) this muscle, and it is very common for this muscle to become tight and develop adhesions. When this happens it can entrap and irritate the sciatic nerve and result in sciatica symptoms. In this case, the diagnosis is piriformis syndrome.

It is also very common for entrapment to occur at the hamstring muscle, between the hamstring and adductor muscles on the inner thigh. When the nerve becomes trapped at any of these sites, pain and other symptoms can be felt along the entire nerve, not just where the nerve is trapped. This leads to what is referred to as the “Double-Crush” Syndrome, because the sciatica symptoms are generated at two entrapment sites.

How Can These Nerve Entrapments Be Corrected?

A variety of treatment methods are used to attempt to relieve sciatic pain, either alone, or in combination with other methods. Some of the more common approaches include muscle relaxants, anti-inflammatory medications, rest, heat, ice, ultrasound (US), massage, acupuncture, joint manipulation, and stretching and strengthening exercises. Most of these traditional techniques often require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause.

The main reason these approaches are often ineffective is that they fail to address the underlying muscle dysfunction and scar-tissue adhesions that develop within the muscles and surrounding soft tissue. It is these adhesions that are causing the muscles to become tight and restricted, and are entrapping the nerve and preventing the normal sliding of the nerve between the muscles.

Passive approaches such as muscle relaxants, anti-inflammatory medications, rest, ice, acupuncture, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restriction and adhesion formation. More active approaches such as joint manipulation, stretching, and exercises are often needed for complete rehabilitation of the condition and to restore full strength and function of the muscles; however, they do not treat the underlying adhesions. In fact, without first addressing the scar-tissue adhesions, stretches and exercises are often less effective and much slower to produce pain relief or recovery from sciatic pain.

artpurple-transparentART® stands for Active Release Techniques®, a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. ART® treatment is highly successful in dealing with sciatica because it is specifically designed to locate and treat scar-tissue adhesions that accumulate in the muscles and surrounding soft tissues. Locating and treating the soft-tissue adhesions with ART® allows the practitioner to:

  1. Break up restrictive adhesions
  2. Reinstate normal tissue flexibility and movement
  3. More completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain

You can think of an ART® treatment as a type of active massage. The practitioner first shortens the muscle, tendon, or ligament, and then applies a very specific pressure with the hands as you actively stretch and lengthen the tissues. As the tissue lengthens, the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar-tissue adhesions are felt, the amount and direction of tension can be modified to treat the problem area. In this sense, each treatment is also an assessment of the health of the area, as we are able to feel specifically where the problem is occurring.

An additional benefit of ART® is that it allows us to further assess and correct problems not only at the site of pain, but also in other areas of the kinetic chain that are associated with movement compensation and are often contributing to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.

One of the best things about ART® is how quickly it provides results. In our experience, sciatica tends to respond very well to ART® treatment, especially when combined with the appropriate self-directed neck-stretching exercises. Although each case is unique and several factors determine the length of time required to fully resolve each condition, we usually find that significant improvement can be gained in four to six treatments. These results are the main reason that many elite athletes and professional sports teams have ART® practitioners on staff, and why ART® is an integral part of the Ironman triathlon series.

To book an appointment to see if ART® can help with your sciatica, call our office at (248) 477- 2100.