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Angela´s Sciatica Course Notes
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Angela
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January 31, 2014 - 3:05 am
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Module 1 and 2

Hallo again! I find the new course about sciatica extremely instructive and interesting; you explain so clearly and with highly descriptive pictures what and where the sciatic nerve is and about the causes, symptoms and diagnostics of sciatica.

For example, I didn´t know anything about the role of the piriformis muscle, so I would like to know that when I´m practicing the lessons with a person who has no problems with sciatica and therefore doesn´t feel any pain, how exactly can I find the spot where the sciatic nerve runs under the piriformis muscle, is there any method, just out of interest? Some years ago, I also had a light sciatica problem and a massage therapist recommended me to “walk  on the buttocks” as a daily exercise to prevent that issue. I found that a little bit weird, but now with the new background you have given me about the relation between the sciatic nerve and the piriformis muscle it´s making sense! Also, now after having watched, heard and read (this is really great!) the two modules I´m not so sure any more if it really was sciatica or not because I didn´t know so much about the whole thing and nothing about the methods or tests to confirm the diagnostic of module 2. Also some people have told me about their sciatica issue, and now I´m  wondering, how did they know? So, all this knowledge about sypmptoms and causes and how to make an interview asking about the lifestyle of the client are great tools to handle the issue.

As to the exercises (straight leg lift, dorsiflexion and F.A.I.R.), does a person with sciatica always respond with pain? And if the pain is only in one single spot without radiating downwards or upwards, can it also be sciatica?And finally, if the cause of the pain is physical degeneration and there is no solution for that, can the therapist at least relieve the pain for a while?

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Shama
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January 31, 2014 - 3:41 pm
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Q: How exactly can I find the spot where the sciatic nerve runs under the piriformis muscle?”

A: You cannot find the exact spot, and you don’t need to. There is a surefire method to find the exact spot, and it’s called an autopsy, but that is a bit premature in most cases. (Just kidding)

You might be able to see it with high tech methods like a CT scan, but that is not something which we do as massage therapists. What you can do is work the piriformis muscle, i.e. stretch it, move it, relax it etc. The goal of this is to release the sciatic nerve from the squeezed position which it might be in. Even if you would know the precise location of the sciatic nerve in relation to the piriformis muscle, it wouldn’t help you much since the work with the muscle is still of a general nature. This is not something super precise like a surgical prodecure. 

You need to know that this is one of the sciatica hot spots, and why. All you can do to release it within the scope of Thai Massage will be covered in the coming modules of this course.

Q: “Some people have told me about their sciatica issue, and now I´m  wondering, how did they know?”

A: In many cases they don’t know exactly. The reason is that the term “sciatica” does not refer to a clearly defined disease, but to a number of symptoms that are are generally caused by the sciatic nerve, but not always. So when someone tells you that they have sciatica, it means that they experience pain in the lower back, butt and/or legs. However you need to know that such a pain can be caused by other factors besides the sciatic nerve being compressed, like hip joint or SI joint issues.

Q: “As to the exercises (straight leg lift, dorsiflexion and F.A.I.R.), does a person with sciatica always respond with pain?”

A: One thing which is important to understand with this whole sciatica issue is that we are dealing with probabilities, not guarantees. The answer to your question is that if the pain is caused by piriformis syndrome, then the likelyhood is high that this will show up in those tests. However if the source of the pain has nothing to do with piriformis syndrome, but is solely caused by the lower lumbar vertebrae, then it is possible that this does not show up in those tests. In this case you might get a better indication from doing palpation on the lower back. In other words you need to do both in order to narrow down the source of the problem.

Q: “If the pain is only in one single spot without radiating downwards or upwards, can it also be sciatica?”

A: The typical scenario for sciatica is that pain is referred along the path of the sciatic nerve. If pain is totally localized in one spot, then there is a good chance that you are not dealing with sciatica. However it is possible that someone has a deteriorated disk which is causing trouble all by itself. And then suddenly it impacts the sciatic nerve. Actually one of the typical symptoms of sciatica is that the pain comes and goes. It is often not a permanent and chronic pain. So what I am saying is that a localized pain might have nothing to do with the sciatic nerve today, and tomorrow it does have something to do with it.

How can that happen? For example if the disk condition is a deteriorated disk and a bone spur, let’s just say for example. This can shrink the opening where the sciatic nerve is coming out of the spinal canal and then press on the nerve. Maybe today it does not press on the nerve, but tomorrow this same person makes a sudden movement which changes the position of the sciatic nerve slightly, and now suddenly it is compressed, meaning that now there is sciatica.

This is often quite a fluid situation. It is quite common that sciatic pain is triggered by some kind of movement. So the bottom line is that you cannot always totally separate a localized, non sciatic pain from a typical referred sciatic pain since one can quickly develop into the other.

Q: “If the cause of the pain is physical degeneration and there is no solution for that, can the therapist at least relieve the pain for a while?”

A: Definitely, and this is a perfectly valid treatment objective. This is used all over the medical field. It is called “managing a disease”. If a disease cannot be cured or reversed, then often all a doctor can do is making it more tolerable for the patient to endure. So there is nothing wrong with this approach. It is not a shortcoming of massage therapy or a less useful method. You need to remember that nobody can guarantee to fix every sciatic problem, no massage therapist and no doctor. Making suffering people more comfortable and relieving their pain, even if temporarily, is a totally valid treatment approach.

 

 

 

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Angela
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February 5, 2014 - 8:13 am
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First of all thanks a lot for your patience, your answers to all my questions and your detailed explanations!

Modules 3 and 4

The comprehensive treatment sounds logical and I think it is also necessary so that the client can relax which might be difficult in a too short session where only the problem spot is treated. The challenge in module 3 was using the feet because of the balance issue and because we don´t have the same sensitivity in the feet like we have in the fingers. So I was very suprised about the result – both persons I worked with liked it a lot and preferred it to the move with the hands. At the beginning I had some difficulties to find a rhythm and to work with my whole body; but once I worked that out, it felt even good for me, I really do like the foot technique! 

In module 4 I tried all the techniques on a skinny person and I was surprised that she preferred the elbow technique to using the fingertips and the forearms – maybe  in spite of her appearance she has good muscles in the back? The fingertip wiggling was fine, and she really loved the percussion!

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Shama
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February 5, 2014 - 11:34 pm
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Surprise, surprise, the foot technique works and feels good and people actually like it. Smile It’s really not that surprising if you consider that the heel is a broad soft surface, and so is every other area of the foot. Once you get the body movement and the balance worked out and you can control how much weight you put in your foot, then foot work feels perfectly good.

I am a big fan of working with body parts other than the hands since feet, forearms and knees don’t wear out as easily as hands and wrists do. 

It’s an erroneous myth that working with knees, feet or elbows is brutal and painful. If it’s done with sensitivity and good weight control, it can feel very soft and soothing.

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Angela
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February 12, 2014 - 7:02 am
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Module 5 and 6

Yes, indeed – when I started with the complete course of THM I was a little bit scared when we began to use knees and elbow techniques, especially in the back, but, like you say, with sensitivity and using your body weight instead of pressing down and the right breathing, it makes people feel so good!

In module 5 I found a little bit complicated the first move (rocking the sacrum and SI jount) because of the rhythm, it should be a natural rocking rhythm, shouldn´t it? And also I feel that I´m doing almost the same with the two arms/hands instead of rocking with one hand and leaning down with the other one – or is it a rocking move with both hands?

The forearm techniques worked out fine, also the knee techniques except the circles (like it´s not very natural for my knees to move in circles, but I´ll practice that one again).

In module 6 I like the knee techniques for the buttocks – and my partner, too – and the hamstring sequence; the thighs move so nicely and are so “handy” to work on. After the positive feed-back regarding the foot technique on the lower back I tried that as a rocking technique on the hamstrings and my partner liked it a lot! But the best was the rocking technique by lifting and squeezing and rolling/pulling! We also practiced the forearm techniques (especially the elephant walking was so welcome) and the knee technique which also felt good (well, except the circling which I don´t feel fluent).

When it came to the lower back stretch my partner was so relaxed, and I had to get her out of this state and tell her that she had to move around, so that was a bit sad … but maybe in “real life” that does not happen, because people feel pain in all this area? Or which is the nicest way to move the person around without interrupting the relaxation so much?

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Shama
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February 13, 2014 - 1:06 am
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The SI rocking technique is a little bit tricky to do. You definitely have to find the natural rhythm of your partner. Both hands are involved in the rocking, however one hand rocks with almost no pressure while the other hand is really leaning into the sacrum.

Knee circling won’t feel natural initially since nobody has ever done this in their entire life! But with enough practice it will feel like second nature, and then it will be quite easy and effective. Essentially you are training your body to move in ways with which it is not familiar at all. 

If your mat is big enough, you can move your client around without him or her having to do anything. If the mat is not wide enough or you are working on a table, then you have to ask your clients to do the moving on their own.

I have demonstrated how to move clients around in a couple of my courses. Honestly I am not sure in which ones, but I might make a short little youtube video to show how it is done. 

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Angela
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February 21, 2014 - 7:01 am
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I would like to see the demonstration how to move clients around, but I´m afraid my mat is not big enough … anyway, the video would be interesting. As to the SI rocking technique, I finally worked it out! It was the angle which was wrong, and now I do like the move a lot – and my partner, too, it´s really a nice one. The knee circling goes better but still feels a little bit clumsy, I still have to work on that.

Modules 7 and 8

The spinal twist of the lower back worked fine and although I practiced it on a rather light person I felt that I could easily do it on a much heavier one, because it was no effort at all and felt good for my partner. When we did the piriformis stretch I was wondering a little bit if it was right what I was doing because my partner felt the stretch more in the line where the leg ends than in the piriformis muscle and the same happened in the pigeon pose. She is very flexible and I can bring her leg just down to the mat without any discomfort, so, is there anything wrong?

Module 8 is so useful, I´m sure we´ll make quite a good impression with all this information you give us. As to me, I´ve already started not to carry my bag always on the same side when I come back from shopping which I have done for so many years … The exercises are great, I´ve done them all to see how they feel. And I´m glad that you put the one in the sitting position where you have to pull up the hip to each side, because it´s much easier to do than the one I mentioned which is quite similar, “walking on the glutes” where you need space and a floor which is not too hard … I think it´s very true what you say, that the exercices must be as easy as possible so that people really do them. So, when you have a client with a sciatica problem – do you schedule a certain amount of sessions right from the beginning? Do you think that 3 or 4 sessions for a light sciatica problem are reasonable?

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Shama
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February 22, 2014 - 12:38 am
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I am glad to hear that you figured out the sacrum rocking technique – that’s a bit of a tricky one to get right.

People won’t always feel a stretch in the same way or in the same area, this can vary quite a bit. If someone does not have a tight piriformis, and that person is quite flexible, then they won’t feel much – if anything – in the piriformis area. However a stiff person with a tight piriformis muscle might jump out of their skin with the same technique that didn’t do anything to the other person.

Regarding scheduling – the more the better, and a regular maintenance routine would be the ideal option. But of course you will run into money issues with clients unless you are here in Thailand where you can get an hour of Thai Massage for $5.

There is no fixed number of sessions for sciatica problems. It depends on the severity of the condition and on the ability of the client to afford the sessions. If you know that the client can afford a few sessions, definitely make it clear that they should book several sessions. Sciatica is not the kind of thing that just magically disappears in one session, especially if it has been a persistent or chronic problem.

That being said, I have come across cases where one session really did the trick. That can happen if the sciatic nerve gets stuck in the piriformis area and your work just happens to release the vise grip on the nerve. 

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Angela
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March 5, 2014 - 5:27 am
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Thanks for your advices!

Module 9

In this module you mention some optional holistic methods for sciatica problems like Thai Herbal Compresses. That sounds very interesting to me, although I´ve already noticed that they are not so easily to obtain here in Mexico. And, unfortunately, through Amazon we have to pay a lot of taxes … So I was wondering if hot stones could work as well, of course, there´s no herbs, just heat, which can be favorable for some kind of pain, so what do you think?I also like the idea of using a massage hammer. Once my daughter had been treated with ultrasound and it was quite effective. Energy work like quantum touch is one of my favorites! Since you showed it to us in the complete course I´ve always practiced and used it and people liked it. As to muscle-testing, Qigong and guided visualization it also sounds very interesting, but I don´t have had any experience with that so far, but I want to look for some more information about that – like you say, it´s always good to have some additional options.

Anyway, thank you so much for all the material, the whole course is extremely instructive, and I especially appreciate the information about how to use certain movements which we already know from other courses for more special cases Smile.

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Shama
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March 5, 2014 - 12:02 pm
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Hot stone massage is definitely very useful. It is offered by quite a few of the better massage establishments here in Thailand, and they are charging a pretty penny for it! (like in three or four times as much as for Thai Massage)

Actually my wife is very good with hot stone massage. Maybe one day I will make a course about it with her. 

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Angela
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March 7, 2014 - 12:31 am
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That sounds great! Please let me know when your course is ready. Here in Mexico it is quite difficult to find a course (and a good one) about stone therapy, the material is quite expensive and the instruction leaves much to be desired according to some massage friends who have taken such a course. So I hope that day will come soon!

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Shama
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March 7, 2014 - 11:23 pm
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Maybe I will send an email around and if there is enough interest in this specialty work, I will produce the course! It will not happen very soon since I am traveling in Vietnam for a while to escape the horrible pollution in my home town of Chiang Mai during March and April due to slash and burn agricultural practices. So in other words I don’t have a recording studio while I am traveling.

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