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Importance of Positional Testing For Sciatica and Piriformis Syndrome

Background on sciatica and the sciatic nerve:

True Sciatica is when the sciatic nerve becomes pinched exiting the spine which causes pain, irritation ,inflammation, and weakness.


The nerve exits from L4-S3 and come together to form the sciatic nerve. This nerve innervates numerous muscles of the leg from a motor standpoint and some branches of the nerve being sensory only which may feel more like pins and needles and numbness.


However true sciatica is very rare and is more often what is known as piriformis syndrome which causes the sciatic nerve to become entrapped.


Check out this blog to learn more about piriformis syndrome:


Positional testing:

Often people may go in for nerve testing to determine if they have sciatica or nerve entrapment. The client will be asked to lie down flat on a table and the testing will occur in this position. However, most people don’t live their life laying face up on a table, and more often they will complain on sciatica during standing, sitting, and other positions they use in their daily life.


Client Experience Part 1:

I recently had a client come in who has had sciatica for the last 10 years. She just came to me that day after being tested for sciatica. They had her lay face up on a table and took imaging as well as ran tests, when I asked if she ever feels her sciatica symptoms when laying down she told me no.


Assessing for Sciatic Nerve Entrapment

The sciatic nerve innervates a large variety of muscles all the way down the leg. We can follow the path of the sciatic nerve and test the muscles related to it to see if they are receiving motor innervation from the nerve. To ensure we are as accurate as possible we will test a lot of the muscle related to the nerve. If this follows proper nerve entrapment rules and is related to a muscular issue and not skeletal, we will find a muscle that is locked and unable to let go somewhere further up the chain with everything else below it inhibited (weak). If we can release this muscle we can see if the other muscles come back online and have a proper motor response.



Client Experience Part 2:

After the client told me she didn’t suffer any sciatica symptoms supine (laying on your back) I wanted to see and confirm for myself. Sure enough all the muscles for the most part tested okay or at least didn’t have any nerve entrapment related symptoms.


However, when I had her go to a seated position which is when she feels sciatica symptoms the most that was another story. The piriformis was locked and everything below it that is innervated by the sciatic nerve was weak. So not only did we clear that but we found if she tilted her pelvis in a slouch position it would also create nerve entrapment, then moving the neck to specific positions where her laptops are would also recreate nerve entrapment. We ended up testing and clearing a large variety of nerve entrapment positions and restored motor function to the lower body.


Client update: She returned 2 weeks later and mentioned for the first time in 10 years she had no symptoms of sciatica!


P-DTR:

Proprioceptive-Deep Tendon Reflex gives us the tool to properly assess for if someone has nerve entrapment or if it is something else. We are also given the tools to treat these topics.


If you’re feel nerve entrapment symptoms schedule your session today!


Learn more about P-DTR here:


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