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The sciatic nerve is the thickest nerve in the human body. In some individuals it can be as wide as ¾ of an inch. It emanates from the L4-S2 (it can extend to S-3) nerve roots and passes through the greater sciatic notch, down the anterior sacrum, passed (or sometimes through) the piriformis muscle and extends into the posterior thigh, where it separates into the tibial and fibular nerves (also called the common peroneal nerve).
True Sciatica Versus Piriformis Syndrome
True sciatic pain (known as radiculopathy) occurs when one or more of the lower lumbar (L3, L4, L5) or upper sacral (S1, S2) nerves are impinged, or compressed, because of injury to a vertebral disc. This impingement causes the nerve to become inflamed, resulting in debilitating pain. It accounts for less than five percent of what is usually referred to as sciatica. Injuries to the sacroiliac, iliolumbar and sacrotuberous ligaments are more common causes, as well as damaged supraspinous ligaments of L4-5 and L5-S1. Tight or injured gluteus medius and/or maximus muscles can also cause similar pain symptoms.
Piriformis syndrome, which is often confused with radiculopathy, occurs when the sciatic nerve is compressed by the piriformis. There are other nerves in the gluteal region, which can cause similar symptoms. Compression of the superior gluteal nerve can cause weakness in the hip abductors but, because it is primarily a motor nerve, there is usually little or no pain involved. Piriformis syndrome can occur from something as simple as continually sitting on a wallet in the rear pocket of trousers. It can also be the result of a fall or other trauma to the buttock area, which cause muscles to be hypertonic and compress the nerves. The result is pain virtually identical to true sciatica.
Assessing the Difference
The only way to differentiate true sciatica from piriformis syndrome or other nerve impingement is with a doctor’s diagnosis, but there are some stretches that can give an initial assessment regarding the origins of pain.
One way is to have the client sit upright in a chair and extend his or her leg at the knee – straightening out in from of him or her. If the pain increases in the low back, the hip or causes a shooting pain down the leg, it may be because of a disc impinging on the sciatic nerve. Your client should not receive massage for this condition, nor should he or she perform any leg stretches. Your client should be seen by a physician as soon as possible to receive a definitive diagnosis.
Easing the Pain With Essential Oils
Since sciatica may actually become worse with touch therapies, one way to effectively ease the pain is through the use of essential oils. This can be done through aromatherapy or by applying a mixture of essential oils with a carrier, such as almond, olive or jojoba oil to the painful area. Essential oils can also be used in a hot compress applied to the painful area.
Some oils that are commonly recommended, include:
- German Chamomile (Matricaria recutita) – German chamomile is a powerful anti-inflammatory. It also helps to stimulate the production of red blood cells. In addition to being known for its sedative properties, German chamomile also acts as an anti-spasmotic and analgesic (pain reliever).
- Sweet Marjoram (Origanum marjorana) – Sweet marjoram has many of the same properties as German chamomile. It acts as an anti-spasmotic and promotes deep relaxation. It is also a powerful stimulant and should not be used during pregnancy.
- Cypress Oil (Cupressus sempervirens) – Cypress oil comes from the leaves (needles) and cones of the Mediterranean Cypress trees of Europe. It is used for stimulating blood circulation and is a powerful astringent. Like German chamomile and sweet marjoram it is also an anti-spasmotic and often used to relieve the cramps, sprains and strains of athletic injuries as well as the pain of rheumatoid arthritis.
- Eucalyptus (Eucalytus globulus) – In addition to its uses as a decongestant and germicide, eucaplytus is an effective analgesic. It also has been found to have a stimulating effect on the mind.
These essential oils should not be applied directly to the skin, but added to a massage lubricant or added to warm water and used as a compress. For example:
- If using as a compress, add four drops each of the German chamomile, marjoram and cypress to about one teaspoon of massage oil, then add that mixture to a small bowl of very warm water. Use a washcloth or small towel to absorb the liquid. Wring it out and apply to the area of pain. Remove when compress becomes cool and repeat.
- If using in a massage session, add one or more of the essential oils in the proportion of 10-15 drops of essential oil to one ounce of carrier oil or crème. Allow the mixture to sit and blend for two to three hours before using.
- As a pain-relieving bath, 10 drops of essential oil can be added to warm water. Soak the body for no more than 15-20 minutes.
Always remember to use high quality essential oils for therapeutic use. Be sure to learn about the many uses and contraindications of essential oils before using them on clients or in your office. Adding essential oils to your massage therapy repertoire is just one more way to offer the best of care to your clients.
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