<span style="font-weight: 400;">Last week we ended with the question…</span>

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<h2><b>Should we test client’s who have sciatica or sciatica symptoms?</b></h2>
&nbsp;

<span style="font-weight: 400;">In simple terms, without clinical (Allied Healthcare Practitioner or AHP) training/insurance the answer is</span>

&nbsp;

<span style="font-weight: 400;">NO</span>

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<span style="font-weight: 400;">Since we are not </span><i><span style="font-weight: 400;">qualified</span></i><span style="font-weight: 400;"> in understanding the risks associated with clinical causes of sciatica. This also means our insurance could be invalid if we hurt someone with our advice.</span>

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<h2><b>Is there anything we CAN do?</b></h2>
&nbsp;

<span style="font-weight: 400;">YES </span>

&nbsp;

<span style="font-weight: 400;">We have a really important role in helping clients who have had or are at risk of sciatica. So let's dive into exactly what we CAN do….</span>

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<h2><b>A PT's Role in sciatica symptomatic clients</b></h2>
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<span style="font-weight: 400;">As movement practitioners we have a vital role in the prevention of common modern ailments like sciatica. However due to the complex nature of pain and symptoms combined with our lack of training in clinical understanding we cannot help clients with existing or perhaps 'acute' sciatica. </span>

&nbsp;

<span style="font-weight: 400;">So first let's look at risk factors associated with individuals at risk of sciatica.</span>

<b>Risk factors </b>
<ul>
 	<li style="list-style-type: none;">
<ul>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Previous back injury can increase the risk of experiencing sciatica.</span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Normal ageing causes natural wearing of the joint surfaces potentially resulting in alterations of bones, ligaments and discs which may irritate the nerve</span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Being overweight can cause a shear force due to the alteration in centre of gravity </span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">A physically active job that requires lots of lifting </span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Diabetes can increase the risk of nerve damage </span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Osteoarthritis could cause spine damage putting nerves at an increased risk</span></li>
 	<li aria-level="1"><span style="font-weight: 400;">Smoking can result in the nicotine damaging spinal tissue, weakening bones and discs.</span></li>
 	<li aria-level="1">Sed<span style="font-weight: 400;">entary lifestyle i.e. sitting for long periods reduces may compromise muscle function which may increase the risk of sciatic nerve irritation</span></li>
 	<li aria-level="1"><em><strong>Dy</strong></em><b><i>sfunction of muscles, joints or nerves coming from other parts of the body so the body compensates &amp; may alter the biomechanical load on the nerve</i></b></li>
</ul>
</li>
</ul>
&nbsp;

<span style="font-weight: 400;">So which of the above can we as trainers and coaches help with?</span>

<span style="font-weight: 400;">Some, but not all, right? </span>

<span style="font-weight: 400;"> </span>

<span style="font-weight: 400;">Some things we cannot change, some we need to be mindful of and others are certainly what we are trained in helping with. However the more we understand our clients lifestyles, risk factors and health conditions the better we can be a part of the multidisciplinary team supporting them through behaviour change, better eating habits and also guided movement programming.</span>

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<h2><b>CLIENT EXAMPLE ONE </b></h2>
&nbsp;
<h2><b>Any client that is symptomatic</b></h2>
&nbsp;

<span style="font-weight: 400;">For a health and activity practitioner to work with a client with sciatica symptoms (diagnosed or not!) we MUST stay in our lane for an appropriate duty of care of the suffering client.</span>

&nbsp;

<span style="font-weight: 400;">To keep within our scope of practise we might want to consider these factors:</span>

&nbsp;

<span style="font-weight: 400;">Firstly the client MUST have a diagnosis or clearance from someone who is qualified to do so.</span>

&nbsp;

<span style="font-weight: 400;">THEN if the client approaches us we must ask them for the written report that guides us on what that AHP recommends or suggests of what we can or can't do. (*Keep your eye out for the SafetyNet project coming very soon).</span>

&nbsp;

<span style="font-weight: 400;">Once you have this guidance in a hard copy like a report or email, this protects everyone involved. It also gives you something to work from that creates increased confidence in what you CAN do.</span>

&nbsp;

<span style="font-weight: 400;">Following the guidelines given to you in writing and using your own previous training along with common sense to support your client in moving well. </span>

&nbsp;

<span style="font-weight: 400;">Here are some examples of diagnosis and treatment for sciatica made by an AHP.</span>

&nbsp;
<h2><b>Diagnosis &amp; Treatment of Sciatica </b></h2>
&nbsp;
<h3><b>Sciatic neuropathy</b><span style="font-weight: 400;"> - this is when the body of the sciatic nerve is affected </span></h3>
<h3><b>Herniated disks </b><span style="font-weight: 400;">- causes about 90% of sciatic symptoms although new theories are being discussed, historically, these can occur when the first layer of the cartilage cracks. The thick, clear substance that is there to keep our clients mobile and cushioned can compress your sciatic nerve, causing leg pain and even numbness. </span></h3>
<h3><b>Spinal stenosis - </b><span style="font-weight: 400;">or lumbar spinal stenosis is an abnormal narrowing of your spinal canal. This narrowing can result in pressure on the spinal cord and sciatic nerve roots.</span></h3>
<h3><b>Spondylolisthesis - </b><span style="font-weight: 400;"> can be associated with degenerative disc conditions in seniors, but can be traumatic in juniors. When one vertebrae shunts forward over another, the extended spinal bone can pinch nerves that make up your sciatic nerve.</span></h3>
<h3><b>Piriformis syndrome - </b><span style="font-weight: 400;">is when the piriformis muscle involuntarily contracts or tightens, causing sciatica. </span></h3>
&nbsp;

<span style="font-weight: 400;">Treatment that is non operative is pain killers, physiotherapy or corticosteroid injections. </span>
<h2></h2>
<h2><b>CLIENT EXAMPLE TWO</b></h2>
&nbsp;
<h2><b>Asymptomatic client at increased risk of sciatica </b></h2>
&nbsp;

<span style="font-weight: 400;">When there are no symptoms present but your client is overweight, has a history of back pain and sitting a lot there may be an increased risk of sciatica. However if we are happy after a full consultation that the individual is within our scope of practise we may be able to use some of the techniques listed below to reduce the risk of an onset of sciatica. </span>

&nbsp;
<h2><b>CLIENT EXAMPLE THREE</b></h2>
&nbsp;
<h2><b><em>Asymptomatic</em> client with ‘performance’ issues. </b></h2>
&nbsp;

<span style="font-weight: 400;">These are the ones we can certainly look at testing for sciatic nerve tension. They might say things like </span><span style="font-weight: 400;">they don’t feel their glutes firing. They might say they aren't progressing in their lifts or running times. They may tell you they have tight hamstrings, as if it's a normal thing.</span>

&nbsp;

<span style="font-weight: 400;">…could these be warnings that they are at risk of sciatica? YUP possibly.</span>

<span style="font-weight: 400;">Go back and look at the last time on the list of risk factors again….did ya see? Pretty much every client eh! The lifestyles we all lead these days pose a threat to this common modern ailment.</span>

&nbsp;
<h2><b>How can we test sciatic nerve mobility?</b></h2>
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&nbsp;

&nbsp;

<span style="font-weight: 400;">Yes absolutely! In my opinion, anyone working with the human body should endeavour to gain MSK assessment skills for all the reasons you’re still reading this blog! PT’s included.</span>

&nbsp;

<span style="font-weight: 400;">Consider that the nervous system is one single continuum, a kinetic chain effect if you like. This means that as we saw earlier symptoms can be felt in different parts of the body to the affected area. Sensations can travel down the legs to the toes for example. This can give us the ability to test and identify if a sensation is nerve tension or not. </span>

&nbsp;

&nbsp;
<h2><b>Testing the sciatic nerve </b></h2>
&nbsp;

Fundamentally my strongest advice is to attend a classroom based practical course that teaches you not only how to handle a client at risk of sciatica but also more objective/ evidence bases methods of assessing your client's body. During our <a href="https://www.biomechanicseducation.com/product/pelvis-spine-biomechanics-3-day-workshop-entry-level-3/#tab-description" target="_blank" rel="noopener">Pelvic &amp; Spine Biomechanics Workshop</a>, not only will you receive 2 online classrooms to watch before during and after your training for revision and practise, you will also join us for 2 days of experiencing how to use practical evidence based skills of assessment. During these 2 jam packed days of practical assessment and exercise skills we will teach you how to use the Straight Leg Raise test for accurately identifying sciatic nerve tension along with more than 20 other physical assessments for the pelvis &amp; spine.

The fact you have attended a training session face to face means insurance companies will see your ability far more favourably than a practitioner who only has evidence of being trained online in these types of skills.

&nbsp;

However here is something to demonstrate how (with a client who does NOT have sciatica) we can potentially test for nerve tension literally on the gym floor/bench.

&nbsp;

<span style="font-weight: 400;">First of all it's important to understand the visco-elasticity of the nerves. The nerves don't really like to be stretched, and certainly not quickly, if they are stiff or immobile somewhere in the body. So when testing we must ask the client to move very slowly.</span>

&nbsp;

<span style="font-weight: 400;">Let's consider the anatomy of the sciatic nerve specifically and positions that mean the sciatic nerve becomes <em>tensioned.</em> For example the sciatica nerve passes down the back of the body and divides to pass down the back of both legs. This means w</span><span style="font-weight: 400;">e could ask our client to sit with the hips at 90 degrees and if possible on a high seat or table that means both thighs are fully supported while the feet are hanging freely off the floor.</span>

&nbsp;

<span style="font-weight: 400;">Now asking the client to relax the hands behind the body like this:</span>

&nbsp;

&nbsp;

<img class="aligncenter wp-image-27973" src="https://www.biomechanicseducation.com/wp-content/uploads/2021/06/IMG_8673-scaled.jpg" alt="" width="361" height="361" />

&nbsp;

&nbsp;

<span style="font-weight: 400;">We ask them to slowly start to slump forwards, rounding the back to lengthen the sciatica nerve in the upper body, if</span><span style="font-weight: 400;"> they dont get any tension here then we ask them to start to extend one knee slowly like this:</span>

&nbsp;

&nbsp;

<img class="aligncenter wp-image-27974" src="https://www.biomechanicseducation.com/wp-content/uploads/2021/06/IMG_8671-scaled.jpg" alt="" width="372" height="372" />

&nbsp;

&nbsp;

<span style="font-weight: 400;">Until they feel THE BEGINNING of tension or tightness.</span>

&nbsp;

<span style="font-weight: 400;">If they do and this sensation is in the upper body ask them to stay in that position and to simply lower the leg like this:</span>

&nbsp;

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<img class="aligncenter wp-image-27975" src="https://www.biomechanicseducation.com/wp-content/uploads/2021/06/IMG_8674-scaled.jpg" alt="" width="374" height="374" />

&nbsp;

&nbsp;

<span style="font-weight: 400;">If the sensation in the upper body changes in anyway this confirms nerve tension because the haven't altered the position of the area of the body were they felt the tension.</span>

&nbsp;

<span style="font-weight: 400;">If however the sensation occurs in the lower body, ask them to simply lift the chin, like this:</span>

&nbsp;

&nbsp;

&nbsp;

<img class="aligncenter wp-image-27976" src="https://www.biomechanicseducation.com/wp-content/uploads/2021/06/IMG_8675-scaled.jpg" alt="" width="390" height="390" />

&nbsp;

&nbsp;

<span style="font-weight: 400;">If this results in a change of the sensation in their leg, again this confirms nerve tension because they aren't moving the leg to feel the change there.</span>

&nbsp;

<span style="font-weight: 400;">In other words; by moving the opposite end of the body if the sensation changes in any way it will likely be nerve tension they are feeling as opposed to a muscle tension.</span>

&nbsp;

Alternatively they could also simply move the ankle like this since the nerve also passes behind the ankle;

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&nbsp;

<img class="aligncenter wp-image-27977" src="https://www.biomechanicseducation.com/wp-content/uploads/2021/06/IMG_8676-scaled.jpg" alt="" width="386" height="386" />

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&nbsp;
<h2><span style="font-weight: 400;">NOTE: THIS IS NOT A DIAGNOSTIC TEST FOR SCIATICA - merely sciatic nerve mobility</span></h2>
&nbsp;

What I hope you will find interesting is that there is still a lot we can do for our clients when learning about what can happen when the sciatic nerve simply becomes tight which could indicate a risk of sciatica but also could present other movement problems....

&nbsp;
<h2><b>Interesting fact:</b></h2>
&nbsp;
<h2><b>Did you know…..</b></h2>
&nbsp;
<h2 style="text-align: center;"><i><span style="font-weight: 400;">It has been demonstrated that reduced nerve mobility inhibits muscle performance</span></i></h2>
<h2 style="text-align: center;"></h2>
<h2 style="text-align: center;"><span style="font-weight: 400;">Greening J, Smart S, Leary R, Hall-Craggs M, </span></h2>
<h2 style="text-align: center;"><span style="font-weight: 400;">O'Higgins P, Lynn B , Butler, DS. Lancet. (1999)</span></h2>
&nbsp;

<span style="font-weight: 400;">Imagine the anatomy of the sciatic nerve and the closely related anatomy &amp; muscles we spoke about previously in <a href="https://www.biomechanicseducation.com/a-pts-guide-to-sciatica/" target="_blank" rel="noopener">A PT's Guide to Sciatic Part 1 </a></span>

<span style="font-weight: 400;">Also consider how brilliant the body is at compensating for this by altering our client's muscle tone and therefore quality of movement </span>

&nbsp;

<span style="font-weight: 400;">Consider a seated leg extension exercise for example….</span>

&nbsp;

&nbsp;

<img class="aligncenter wp-image-27960" src="https://www.biomechanicseducation.com/wp-content/uploads/2021/06/IMG_8658.jpg" alt="" width="478" height="473" />

&nbsp;

<span style="font-weight: 400;">To perform this exercise the quads need to overcome:</span>

&nbsp;
<ol>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Gravity</span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Set resistance </span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Tension in opposing tissues </span>
<ul>
 	<li style="font-weight: 400;" aria-level="2"><span style="font-weight: 400;">knee flexors</span></li>
 	<li style="font-weight: 400;" aria-level="2"><span style="font-weight: 400;">knee capsule</span></li>
 	<li style="font-weight: 400;" aria-level="2"><span style="font-weight: 400;">sciatic nerve </span></li>
</ul>
</li>
</ol>
&nbsp;

<span style="font-weight: 400;">No.s 1 &amp; 2 I think we understand pretty well but let's take No. 3 into a bit more detail in relation to the sciatica nerve. </span><i><span style="font-weight: 400;">The mechano-receptor activity in the sciatic nerve can inhibit the quadriceps contraction</span></i><span style="font-weight: 400;">. What does this mean? Well this means that if the sciatic nerve is inhibited theoretically any of its links, anywhere in the body could impede the function or contraction efficiency of a muscle and in this example the function of the quads. </span>

&nbsp;

<span style="font-weight: 400;">So much so in a study we saw improved quad strength output of 50% in 10 days AFTER using sciatic nerve mobilisations!</span>

&nbsp;

<span style="font-weight: 400;">So there is a lot we CAN do while staying on our lane </span>

&nbsp;
<h1><b>NEXT TIME….</b></h1>
&nbsp;
<h2><span style="font-weight: 400;">Can we mobilise the sciatica nerve? if so how?</span></h2>
<p class="p1">Planning how to mobilise the nerves in preparation for client’s sport or chosen activity</p>
&nbsp;
<h2 class="p1">Finally did you know….?</h2>
<p class="p1"><span class="s1">The risk factors listed here can start as biomechanical dysfunction</span><span class="Apple-converted-space"> </span></p>

<h3 class="p1">Ok so what?<span class="Apple-converted-space"> </span></h3>
<p class="p1">Well the best role we can play as PTs is in risk reduction, performance optimising &amp; appropriate referral</p>
<p class="p1">Otherwise known as PREHAB – <span class="s1">I also like something I heard called MEHAB, My Rehab, quite nice for your PTs</span></p>
<p class="p1">We can also play a role in POST rehab</p>
<p class="p1">Since rehab programmes consist of exercise and THIS really is our expertise</p>
&nbsp;

References:

<span style="font-weight: 400;">B W Koes, M W van Tulder, W C Peul. (2007) Diagnosis and treatment of sciatica. The British Medical Journal. </span><span style="font-weight: 400;">334</span><span style="font-weight: 400;"> doi: </span><a href="https://doi.org/10.1136/bmj.39223.428495.BE"><span style="font-weight: 400;">https://doi.org/10.1136/bmj.39223.428495.BE</span></a><span style="font-weight: 400;"> </span>

<a href="https://www.sciencedirect.com/science/article/pii/S2214854X16300218#!"><span style="font-weight: 400;">Lewis, S. Jurak, J. Lee, C. Lewis, R. Gest,T</span></a><span style="font-weight: 400;">.  (2016)  </span>Anatomical variations of the sciatic nerve, in relation to the piriformis muscle.<span style="font-weight: 400;">Science Direct</span> <a href="https://www.sciencedirect.com/science/journal/2214854X/5/supp/C"><span style="font-weight: 400;">Volume 5</span></a><span style="font-weight: 400;">, Pages 15-19</span>

<span style="font-weight: 400;">Spine-Health (2020) Sciatic Nerve Anatomy. </span><a href="https://www.spine-health.com/conditions/spine-anatomy/sciatic-nerve-anatomy"><span style="font-weight: 400;">https://www.spine-health.com/conditions/spine-anatomy/sciatic-nerve-anatomy</span></a><span style="font-weight: 400;"> - accessed 7/6/21</span>

<span style="font-weight: 400;">TeachMeAnatomy (date unknown) The Sciatic Nerve </span><a href="https://teachmeanatomy.info/lower-limb/nerves/sciatic-nerve/"><span style="font-weight: 400;">https://teachmeanatomy.info/lower-limb/nerves/sciatic-nerve/</span></a><span style="font-weight: 400;"> - accessed 7/6/21</span>

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<hr />

<h1>Would you like to learn how to assess your client's sciatic nerve?</h1>
Why not join us for our extremely popular <a href="https://www.biomechanicseducation.com/product/pelvis-spine-biomechanics-3-day-workshop-entry-level-3/#tab-description" target="_blank" rel="noopener">Pelvic &amp; Spine Biomechanics Workshop?</a>

&nbsp;

<a href="https://www.biomechanicseducation.com/product/pelvis-spine-biomechanics-3-day-workshop-entry-level-3/#tab-description" target="_blank" rel="noopener">Nottingham July 24th/25th</a>

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&nbsp;

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