Massage Tutorial: Sciatica myofascial release techniques
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- Опубліковано 4 лип 2024
- My new book is out! It's called Massage Is Weird: massagesloth.com/book/
Do you have massage clients with low back/hip pain that sometimes shoots down their leg? In this video, I review the anatomy of the sciatic nerve and the local musculature, and take you through my basic myofascial release protocol for sciatica symptoms.
Table of contents:
0:00 Introduction
0:23 What is sciatica? What are the symptoms?
0:45 Sciatic nerve anatomy
1:20 Relevant gluteal landmarks
4:38 Incorporating sciatica massage into your sessions
5:10 Undraping the hip
5:25 Working with touch sensitivy, using the "myofascial angle"
6:00 Myofascial release from superior to inferior
7:10 Working with the fascia
8:50 Including the lateral pelvis and low back
10:38 Treatment duration
11:12 Myofascial release from inferior to superior
13:15 Body mechanics for lazy myofascial release
13:40 Working with the lateral pelvis
14:40 Using open fists for myofascial release
16:00 Working with the hip rotators longitudinally
18:24 Pin and stretch for the external hip rotators (gluteus maximus, piriformis, etc)
20:00 Working with the hip in abduction
When you get clients in your massage office with low back pain, I recommend always asking about the hips. Pain and dysfunction in the two areas are tightly intertwined, and only working with the lumbar region while ignoring the hip extensors/rotators could mean ignoring the root cause of the pain.
While working with sciatica, realize that the entire posterior pelvic region could be hypersensitive. While you could treat this sensitivity as if you were dealing with trigger points, I think it's much kinder to approach it from a myofascial release perspective: Slow, using little lotion or oil, and from an oblique angle. Many clients with hypersensitivity will be able to tolerate pressure when delivered in this way.
Approach the SI joint, posterior and lateral pelvis, and upper femur from different angles, with the hip joint in different configurations. My goal during these massages isn't to "break up knots" or "strip out" any particular muscles, but rather to convince the local musculature that it doesn't need heightened tone/spasm, and to slowly desensitize the region. While disc dysfunction may be present, I find that working with the descending soft tissue can reduce sciatica symptoms effectively.
Let me know what you think, and if you have any tips of your own! Do you work with hip flexors on all of your sciatica clients? Do you start with more direct work? Thanks for watching!
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The professionalism, the knowledge and kindness of your soul are what make these videos amazing. Thank you for sharing your passion, i truly respect your work and i get inspired every time. You make me a better therapist and i only wish to be half as good as you seem to be.
Nice
I truly appreciate your concern for patient modesty and you are very wise to keep him/her well informed regarding your proposed techniques. My sciatic pain came on me very sudden like and I had no idea that this type of massage would relief the discomfort. My silver bullet came when I climbed onto a stationary bike at my local YMCA and, presto, sciatic pain gone! I ride two to three miles a day plus my morning walk and... so far so good. Keep up the good work, sir!
I really appreciate your clear explanation and attention to detail, also your knowledge, experience and professionalism. I always like to watch some of your videos when I have clients with specific issues to refresh my memory and make sure I have a clear idea of the procedure I should follow. It's the closest thing to having a live lesson! Best massage teacher ever. Thank you!
I just had a client that I worked on last night who has sciatica, and I watched your older video from a few years ago a few times for a different approach (myofascial vs. just "attacking" the gluteal muscles), and to just take notes, brush up on new ideas.
Today I noticed this video which is very recent, so I decided to watch it since I always learn something from you regardless of how many videos on the same subject you have. You mentioned many sciatica problems are due to disc compression problems, which I suspected might be the cause of my client's issue based on what I found, and more information from the client. So when you said that in this video I was like nailed it! That's the next step I encouraged my client to investigate, and pursue with the doctor/chiro, just based on my own clinical knowledge, how the body felt and responded, client feedback and other things. Whether or not that's the issue is yet to be determined, but I just was elated at the possibility of this being the culprit, and helping my client get to the bottom of her issues. It was kind of confirmation that my therapist investigation skills and knowledge was spot on!
Sometimes you realize just how on your own you are in this career, so thanks for your insights and work Ian...(again). I will think of some video ideas for you!
Thanks Tori, I'm glad to be of help! And yes, ideas are always appreciated :)
I love watching these type of videos. As I too have battled with pain from my sciatic nerve due to sport training. There was a point it got so bad that I could barely walk and out of nowhere I'd get that pain down my back and leg that I'd have to take a knee, didn't matter where I was at. I took a few courses of MT in a vocational school, my teacher was amazing, just like you he was very knowledgeable. Due to that I was able to fix it, but I'm still doing sports I try to stretch & warm up well now just in case. A lot of stretches helped me and also a towel, vick's vapor rub, and a hot iron...that heat did the treat to my back, it's magical 🤗. Great video by the way!
Great stuff, Ian. I really enjoy the style of your videos. It's really helpful to see the methods "unfold" in real time, along with the discussion about the methods and what's going on anatomically. Mirror neuron's seem to take over when I go to work in the days following studying your videos, and my clients respond extremely well.
Thanks so much, Kerry!
You are a great teacher! After o binge watched your videos, I used your philosophy in a session and my client's bulged disk re aligned!
Excellent, I as a massage therapist consider my self good at eliminating sciatica pain but I know I learned more by wahtching this tutorial
So grateful for all your videos!! A video on how to deal with inflammation due to herniated discs would be so much appreciated!
Thank you so much! This is so wonderfully informative, professional and seemingly easy on a practitioner's body - what a relief. I'm excited to try these techniques! You rock, Massage Sloth.
Thanks Britt, let me know how it goes!
Omg! Great informative video! You hit all the right points. Thank you.
Thank you!Best video tutorial on sciatica!I really appreciate your work. Beautifully 🌈 done!
thank you this was what i was looking for cant wait to help my client further. also learned this but its been a while
Thank you so much for this !! I will be working on someone in much pain from sciatica…. This really helps me to pay more attention to these muscles yet not so deeply.. God Bless you and thank you 🙏🏼🍃🌸✝️
This was fantastic! Thanks so much for sharing this!:)
thank you! This is clear and thorough. great job.
Great protocol, thanks Ian. Instructive as always and it's always a pleasure to watch you delivering a treatment
I appreciate it!
@@MassageSloth Great video! Would you consider doing one regarding Torticollis pain relief? It runs in the family and I'd love to have a way to help reduce it. Also, could you tell me where you studied? I'm exploring massage therapy as a carrier option.
@@claragomezb.7849 I think that there's a lot of overlap between torticollis and "neck cricks," which I've done videos on here ua-cam.com/video/MQlPuGJdmU4/v-deo.html and here ua-cam.com/video/8XoODpmhRys/v-deo.html (that one's for self-massage on an old channel). Let me know if those seem applicable! I went to school at the Florida School of Massage in Gainesville, FL, and I honestly can't recommend it highly enough.
Great! Glad that I found this! I need to slow down! Thank you !!!
The draping is SO MUCH BETTER 👍🏾👏🏾👏🏾👏🏾👏🏾👏🏾👏🏾
Very good lesson, thank you Ian!
Such a great video. Thankyou as always. I'm having problems myself from another therapist digging an elbow into my piriformis during a class that unfortunately didn't address all the contraindications of doing something like that. Love your myofascial approach!!!!
You are awesome I do not know that much of syatic issues but I did learn it at school thanks for showing me
so useful and amazing techniques; love it. thanks.
thank you Ian, I feel the same way, we are massage therapist and the glute region is a very important part of the body because the biggest nerve can be located in the region and it can solve many lower back pain, and is connected to every day movement... but is nice to know that is only ilegal in some states... thank you one more time for all your knowledge.. your the best
Yes! Good point. It's so wrong that working on the glutes, etc would be illegal. Ridiculous!
Very professional great information
You're really awesome .. I do some of what you do but you gave me the rest of it, thanks
It’s hard to find a good massage therapist like this
Great video...what do you suggest for the front of hip? A video of front approaches would be helpful to many. Trying to create balance and release the front hip tension, also explains pain from prolonged sitting. Thanks!
As a student., I found this very helpful
Thanks muchly,my wife gets lots of relief from this treatment.
Best massage therapist on the youtube! My girlfriend loves you and she doesn't even know it.
GREAT CLASS
we miss you. im getting withdrawels. i love your vids. xo
I'll be back :) I always go through a bit of a lull during the winter, but I always bounce back. Thanks for the kind words!
Thank you so very much!!
Thank you Ian. I'm going to try this out today. Keep them coming!
Excellent
ok its time to reappear. cant wait
You are amazing wish to learn from you
Great video! I'm loving your techniques! How about something about the hip flexors and sprains or strains?
Thanks Michele! I appreciate the suggestion. I'm currently trying to do more videos dealing with individual clients' unique massage needs, and I'd bet I could find a sprinter or crossfitter who fits that description :)
Thank you . This is so informative ! I am a pre student ( considering going to massage school so I am doing research first ) . Your voice is amazing . Have you thought of doing guided meditation videos ? You would be good at it . 🕊
Ha, that's nice of you to say :) I did a few of those some years ago: soundcloud.com/bodymindconspiracy I might give it another try one day, I'm just not sure of the right venue for it.
Awesome videos Ian!
Your voice is super soothing too ^_^
Ha! Much appreciated :)
Hi Ian (and anyone else)
Great to have this video, you teach not just a technique but a philosophy of life.
I wonder though about managing client expectation here:
If the sciatica is essentially a piriformis issue and the massage therapist identifies the tight piriformis, then fine, hopefully a few sessions of massage, perhaps with some homework stretching, will deliver relief. Job done.
But for sciatica from tighter lower back tissues or from nerve trapped between vertebrae, the prognosis is more tricky. - Ideally the sciatica would disappear of its own accord, particularly with floor exercises. Will appropriate massage accelerate this? Probably. Will a client be willing to commit to 10 sessions for a “probable acceleration” of relief? Less
likely. Is it right to offer relief in just a couple of sessions? Hmmm. How long do you work with the client before suggesting this treatment isn’t helping their particular condition?
Personally I’m loath to ask someone to come for ten sessions to help with sciatica unless they really say they feel the treatment is helping after 2-3 sessions. I would feel very uncomfortable if, after ten sessions, the client is no better, having invested so much money, time, and faith in me.
So my question is: Can you lend insights into how to manage client expectation? And from your extensive experience, would you hazard a guess as to what percentage of your sciatica clients have noticeably improved as a direct result of massage? (“Direct result” is an unfair question and subjective but it gives an indication of the likelihood of a “best case” scenario. I'd say getting up off the table and saying "wow, it's gone" qualifies as a direct result. So does disappearance of a two-year plus sciatica condition after a few weeks of massage.)
I know this isn’t an easy issue to quantify in the absence of extensive studies (as with so much massage treatment). Looking to The Sloth for guidance. Thanks.
This is a great question, and I apologize for taking so long to get to it! This is tricky, because there's really no way of saying at the beginning of treatment whether that person's unique body will respond to your massage strategy, or to massage in general. This is true not just for sciatica, but for any pain or dysfunction. As confident as I am in my ability to work with jaw pain, for instance, some clients simply don't respond to my best efforts.
It's good to keep in mind that this isn't a problem unique to massage therapists. Surgeons do hip replacements fully aware that some patients will see no improvement (or even an exacerbation) of symptoms. Psychiatrists prescribe medications which fail to produce benefits for some patients. Physical therapists often have to refer patients back to their doctor because their treatment regimen, which works in most people, just didn't work for that particular person.
So, from my perspective, we should do what these other healthcare providers do: Tell the client our expectations, inform them that not all cases respond to this treatment, and let them make the decision about how to proceed. For me, that sounds something like this: "Sciatica can take some time to respond to massage, so I'm interested to see how your symptoms change over the next few sessions. I expect to start seeing a reduction in low back and leg pain by the third or fourth session. If that hasn't happened, we may need to change our strategy."
If the client isn't responding after several sessions, here's what I'd say next: "We haven't seen an improvement in your sciatica symptoms so far, and I'm used to seeing some progress by now. It's possible that we'll see a response after more work, but I can't guarantee it. What are your thoughts?" Whether they continue with you or not, this is a good opportunity to encourage them to follow up with the rest of their healthcare team for further evaluation or treatment.
As far as my results with clients with sciatica, I'd say that 4 out of 5 experience a clinically significant improvement in symptoms (ranging from less pain to complete remission). Even if we can't directly impact nerve impingement, the low back and hip pain that are associated with the condition seem to respond well. Thanks for the question!
qualitysearch
Hundreds of former sciatica sufferers are already living a pain-free life thanks to these methods. So why not try it?
www.7sciatica.com/sciatica-sos-review-your-guide-to-eliminating-sciatica-pain-in-7-days-or-less-guaranteed/
I have been having issues with this region since a herniated disc about a year ago. I'm through the worst, but sitting at works brings on leg pain concentrated around the fibular head (sometimes a mirrored spot above the knee), and it's been driving me nuts.
Good Stuff.
Grt teaching
Hi Ian,
I just finished massage school last week and I just came across your videos. You got yourself a new subscriber! Can't wait to see more of your videos. By the way does anyone know where online I can practice on for my MBLEx exam that I have coming up in two weeks?
Thanks Erika! I'm afraid I don't know which MBLEx resources are better than others :/ There are some good massage therapist message boards on Facebook that will have lots of opinions on the matter, but I'm clueless here. Sorry!
Nice video, do you have any videos to show sidelying with QL Psoas and G medius? I felt I am not comfortable to go sidelying, especially try to do some range of motion for the client(draping inROM), can you make a time to show how you do the sidelying? Thx
When I'm going to be doing a lot of side-lying, especially with client movement, I like to do a short pre-massage routine while they're still clothed: ua-cam.com/video/X6ghJKqG5hk/v-deo.html It lets me work briskly, reposition them easily, and not have to worry about the drape for a while. All of that can be done while the client is draped, it's just a bit of a bother :) I definitely plan to have more side-lying videos soon though, so stay tuned!
Hi Ian like always I love your work.. but I have one question, I'm in school and I have been told that we can't undrape any part on the gluten region or touch it with our hands.. and that in some spas glute massage is prohibited.. how true is it...
Aw man, that's a bummer. Gluteus maximus and medius, the hip rotators, and the fascia that hooks in on the gluteal region are all so important for low back pain, sciatica pain, IT band pain, and lots of other issues. Not only that, glute work feels great! For me, a massage that avoids the butt (and this is pretty common) just feels incomplete. And, as someone with occasional hip problems, I really appreciate competent contact in the area.
That said: Undraping or contacting the butt might actually be inappropriate or illegal where you live. Check your local regulations. If not, I recommend working with glute massage outside of school. Don't let them prevent you from learning something so important. As you practice, stay in good communication with your client, both to make sure that the pressure/techniques feel good, but also to make sure that the draping and contact feel secure and safe.
Mozart at work; simply the best--- Hands Down.
hi ian do you have any mneumonics of your own when remembering landmarks and musvle positions?? if you have id love to hear them
I used to, but most of them are long gone :) Honestly, I remember the anatomy that's useful for me on a daily basis, and I rely on the internet to refresh my memory about the rest! My best advice for when you're first learning is to learn the landmarks and muscles on yourself, on a friend, and from a book. This gives your brain a lot of "hooks" to hang that new information on. Best of luck!
What about sciatica from pregnancy? Do you have a video on pregnancy massage sciatica work? If so I wasn’t able to find it.
How often do you recommend doing this? Several times a week?
it actually worked almost total relief
Great to hear!
I have spent months investigating treating pain from hip flexor muscles naturallyyyy aand discovered a fantastic resource here twitter.com/fa3ad4f67c23bc958/status/794458642376368128 Massage Tutorial Sciatica myofascial release techniques
+Seng Voleak hhs
Are you still pain free?
This is some good stuff! I've always work with the sciatica nerve all the time, and usually how I work it is I put my elbow deep into the glue where the sciatic nerve runs, would you say that's a method they all teach us as Massage Therapists that is not appropriate for the body? I believe it's very damaging but at the same time brings good results to the clients... What do you think Ian? Let me know!
I think that a properly applied elbow could certainly offer relief! My preference would be to start with broader tools at a less direct angle, but there are many ways of approaching pain and dysfunction successfully.
Ah OK, I always wondered if it was a good technique, although it always tired me out while using my technique, I wanted to use something a little less harsh for some of my clients that can't take the elbow, this is perfect! Thanks for your reply Ian 😊
Where do I go for treatment like this?
Help me please this is awesome
ok thats enuf slothin - ready for some new vids!!!!
Haha, sorry about that... soon! Sometimes I need mental health breaks, and this one has lasted a bit longer than usual :)
what if it is too painful for them to lie down? it would be hard to doit sitting up. what u think..?
A distinct possibility! If that's the case, I'd switch to side-lying massage with a nice thick pillow between the legs (or under the top leg if they're rolled forward). This lets them stay in a curled-in position while I work, which tends to be much more comfortable for people with high hip tension/sensitivity. The different leg movements would have to be adapted to the new angle, but I feel like most could translate with a little experimentation.
I do not have any pains, but my heel is a bit numb, and I walk with a slight limp. What do I do? The doctor said that all the discomfort will go away, but it is now 7 months.
Sorry to hear that, Deborah! Massage may help, but this sounds like a job for further testing and rehabilitation. I recommend returning to your doctor, and possibly getting a second opinion if they won't take any steps toward getting you better. Best of luck!
Hey,
When doing these massages, would it make a difference if you use oil or not?
I like to use a little jojoba oil, but many myofascial release practitioners go without any sort of oil or lotion. It depends on how slowly you want to work, and whether you get better results using different speeds. I find that my Swedish-ish myofascial release is effective while being less tiring for my body than orthodox MFR.
Anyone giving sciatic massage in mumbai
As a massage therapist I use my forearm and elbow on clients. I now have sharp pain in my deltoid. when I raise my arm over my head it kills me. I palpate the muscle and rotate it in different positions what else can I do to relieve the pain?
Pain that seems centered in the deltoid (especially the anterior delt) can be referred from the rotator cuff muscles. I'd recommend getting work done on all your shoulder girdle muscles frequently, and considering a movement/exercise program that will get those same muscles moving in lots of ways. A well-qualified trainer might work, but if all movements cause pain, or if your pain worsens or persists, this might be a job for a physical therapist. Best of luck!
That's what I thought as well the rotator cuff. I also sleep on my stomach.
i had surgery between L4 and L5 pinching nerves that run in my left leg and left leg went completely knumb and couldnt walk. once i had surgery knumbness went away
Rghjfg
5:25 massage tutorial starts here
I've been through 4 session with my licensed therapist. But it was done through machine and not manually. Is it effective? I'm still in pain
You might give hands-on massage a try, especially with an experienced therapist with a lot of continuing education under their belt. They'll be able to work with the hip in ways that others wouldn't, and will be more versatile than massage gun or automatic implement. I'd also recommend seeking physical therapy if you haven't done so. A combination of getting massage while implementing a customized stretching and strengthening program can accomplish a lot! And if your pain persists or worsens, do keep pursuing this with your medical team, there are lots of potential avenues of relief.
@@MassageSloth Thank for the immediate response. God bless your blog
How about for someone with hip replacements? Any considerations
Great question. My answer: Every client with a hip replacement will have their own comfortable range of motion, and they'll be able to guide you. Their hardware will allow a decent amount of rotation and flexion/extension, just like any other hip joint, but many people with a total or partial hip replacement will have sensitivity in certain parts of their range. Rather than thinking of "a hip replacement can't go outside this arc," think "how can I explore this client's comfortable range of motion?" By staying within their currently comfortable range while offering massage, you can decrease pain and tension, and even (in my clinical experience) increase ROM without having to challenge the outer edges of comfort.
hi ian i have a client in morning who landed hard on his coccyx 15 months ago he has been to chiropractors physical therapist now he is trying me what muscles would you do hope u can help
I think that the techniques in this video would be pretty darn useful. Coccygeal pain can be referred from the muscles that connect nearby. While you can't work directly with the pubic floor muscles, working on and around the sacrum could do a world of good. Best of luck!
Massage Sloth poor guy he shuffled in . thx for advice i did just that . did a lot from ur gluteal vid i think it helped a great deal he messaged and said he feels freer and that he was making another appointment once he back from holidays. cheers xo
That's excellent, congrats on the successful session!
Are you using any lubricant here, or is it done with dry hands?
Ooh, sorry about not making that more clear. Any time you see me gliding, I tend to have a little bit of jojoba oil on the skin. All of these can be done without lubricant and at a much slower pace, however.
Can you massage when laying on their side as well
Jose y delia sandoval you sure can! It is called “side-lying” .
Where are you ? Omg I have been suffering for a decade
I need this kind of massage asap.
Plus bruh has a nice tan. I know vitamin D/ the sun can help chronic pain too at least thats what Ive read.
Can sciatica pain travel up through the front thigh area, near the testicles?
Body Bliss I think so. I had some clients say they feel it around their inner thigh
Wondering the same
My client is rather on the large side and struggles to get on the couch and cannot lay flat on his abdomen, any ideas?
This is a job for side-lying massage! Have your client lie on the couch with a pillow under his head and a body pillow under his arm and upper leg. From there you can use techniques from this video: ua-cam.com/video/JEVpPsZmL7c/v-deo.html (and taking a class devoted to the subject would be an excellent idea)
what is it called when the pain appears to come from the groin (and sometimes the knee) and shoots down the front of the leg? It's like an ice pick in the groin. Full disclosure I have osteoarthritis in the joints. The pain is usually brief. It occurs sometimes when I stand from a sitting position, try to turn over in bed or bend down to pick up something from the floor. Most times if I sit down and stand up again it resolves. Or sometimes if I turn my foot in it resolves. The most painful is when I bend down, and there is no place to sit-down and stand up. Its very painful to move. It's almost impossible to put any pressure on the effected leg and I am unable to lift the leg without great pain. If you could help me articulate this, so I could tell the doctor or give a suggestion on what type of doctor I should see to help resolve this. Or perhaps it cannot be resolved, I asking for suggestions.
My recommendation would be to see your primary care physician for assessment, and to ask for a referral to a physical therapist. When talking to your doctor, the explanation that you provide above will do nicely. While these pain presentations might seem weird and possibly unrelated to us, they won't be new or unusual to any doctor worth their salt. The PT will likely be very familiar with the pattern of pain and dysfunction, and will be able to get you started on a stretching and strengthening regimen tailored to you. Best of luck!
thank you SO MUCH for your response! I will get an appointment next week.
How do you work this area with undergarments on?
Without the ability to glide, I'll do my best to approximate slow progress by doing static compressions that gradually travel across the relevant tissue, through the drape. For example, I'll sink two fists in near the ischial tuberosity (the sit bone) and traction that tissue superiorly, holding for several seconds (or longer, if it feels important for the client's pain). I'll reposition my hands just superior to there, add that superior traction again, hold, reposition, etc. Sometimes I skip around rather than trying to approximate linear progression, it's not something I'm strict about. In any case, I just make sure that all of the relevant hip tissue gets plenty of time under compression, and that I explore different directions of myofascial traction as I do so. It's a great opportunity to make use of the grip provided by the drape to sink in and hold specific areas for longer durations.
Massage Sloth thank you sooo much for replying means a lot. I’m constantly watching videos to improve. I started working for a chiropractor 4mths ago.
I need to find someone who can help me sciatic pain.
Wow you got beautiful arms ❤
I can’t even touch these areas , it hurt soooo bad just my mom touching it makes me scream 😓 I can’t do crunches, my tailbone is so tender.
If you're able, I encourage you to seek a referral to physical therapy. They'll be able to do some evaluation to see where the pain is coming from, and give you a customized regimen of stretching and strengthening to hopefully convince the area that it doesn't need so much sensitivity. Massage might be more appropriate once the pain is no longer so acute, but for now you deserve medical evaluation and care. Best of luck!
@@MassageSloth thank you, I definitely will
I was not prepared
Good video but if you can't immediately find greater trochanter & iliac crest, you have no business even putting hands on people for professional purposes lol
You are making all those words up. Isceel tuberosity cannot be real
It's ischial, and it's real