By Dorthe Krogsgaard and Peter Lund Frandsen,
Treating sciatic pains is a true sport for
reflexologists. Knowing the few most common causes, it is usually quite
simple to treat. That the sciatic nerve can also be involved in knee
problems, swollen legs and other leg problems is perhaps new knowledge
for some – and how many reflexologists realise that the sciatic nerve is
responsible for transmitting back to the central nervous system all the
impulses from the sole of the foot?
Simplicity and knowledge often go hand in hand. Even though it can be
straightforward to treat sciatica, it requires a good knowledge about
the common causes and connections involved. Among other subjects this is
included in Touchpoints workshop ”Round about: The Spine”. In
this article we will show a few important techniques to include in the
treatment of sciatic pain.
Sciatica is pain radiating from the buttocks down
into the leg. Somewhere along its course the sciatic nerve is entrapped,
causing irritation or inflammation and thereby pain.
Fact box – Sciatic Nerve
Latin name: Nervus Ischiadicus
Origin: L4 - S3 (sacral plexus)
Course: Through the pelvis into the gluteal region
profound for the greatest gluteal muscle and distal for the piriform.
Continues down the back of the leg where it splits into two
branches, the peroneal and tibial nerves.
Motor innervation: Hamstrings and complete lower leg
Sensory innervation: Lower leg and foot.
The sciatic nerve is the largest peripheral nerve in the body. In
the gluteal region its diameter is like the little finger.
Slightly simplified, one can distinguish between two main causes of
sciatic pains: Entrapment of the root and muscle tensions in the pelvic
or gluteal regions.
Root pressure involves the spinal nerves from L4-S3. They may be
compromised by a slipped or herniated intervertebral disc, which is most
commonly seen in the 30-50 age group.
Entrapment of the nerve roots may also be due to arthrotic narrowing of
the spinal canal itself (spinal stenosis). This is more often the case
with elderly persons.
The Piriform muscle
A more common cause for sciatica is muscle tensions in the buttocks. The
sciatic nerve leaves the pelvis through an opening (the infrapiriform
foramen) where it shares the limited amount of space with several
muscles, nerves and vessels (see figure 1). The nerve has a special
relation to the piriform muscle, in some persons in actually passes
right through the muscle. The piriform muscle originates on the ventral
surface (inside) of the sacrum at the level of S2-S4 and attaches to the
femur (greater trochanter). Tensions in this muscle can therefore very
easily compress the sciatic nerve (piriformis syndrome) and cause pain.
Luckily this condition is relatively easy to assess and treat.
Figure 1. The sciatic nerve in the gluteal region
Foot reflex for the piriform muscle
The reflex is treated thoroughly with slow, deep movements. It is a good
idea to pay extra attention to the origin (sacrum) and attachment
See Figure 2.
Figure 2. Reflex for the piriform muscle
Nerve reflex point for the sciatic nerve
This point has a well defined location on the upper edge of the heel
bone (figure 3). It should be treated using nerve reflexology technique,
which is an accurate static pressure on the periost of the bone until
pain in the point has vanished (max.15 seconds).
Figure 3. Nerve reflex point for the sciatic nerve
An extraordinary technique
An often amazingly effective technique with sciatica is the so called
nerve mobilisation. This is a method devised by Australian
physiotherapist David Butler. A stretch is applied to the nerve which
can often help free the nerve from pressure and tensions which has
affected it. When the nerve lies free in its surrounding connective
tissue, the circulation inside the nerve is normalised (axoplasmatic
flow) and its function improved.
Technique: Stand next to the table facing away from the client. Hold the
client’s lower leg with the arm closest to the table. Slowly lift the
client’s straight leg. It should be a passive movement without the
client helping. Maintain a constant communication about any pains and as
soon as the familiar sciatic pain is developing, you stop the movement
and lower the leg until the pain stops. Then try to lift the leg again.
Repeat this pattern 10-15 times and for each time try to go a little
higher. You go – so to speak – into the pain and out again, and usually
you will notice that the position eliciting pain is moving further and
further up as the nerve is being mobilised. (See figure 4).
Figur 4. Mobilisation of the sciatic nerve.
Mobilising while treating
A quite unique effect can be achieved by pressing the sciatic nerve
reflex point and at the same time perform the mobilisation as described
above. By so doing the nerve is simultaneously being treated from the
outside by stretching the tissue, and from the inside through the
In the majority of sciatica clients these techniques provide an
immediate effect in the form of increased motility and pain reduction.
Practically, you could start a treatment session by assessing how high
the leg can be raised without pain, then do the mobilise while treating
technique, then ordinary reflexology therapy – and at the end of the
session, try to test the leg again. You – and not the least – the client
will see an astonishing difference.
Naturally, the effect will not last after just one session, but it will
help breaking the vicious circles that have maintained constant muscle
tensions. And it will certainly motivate the client to do more about
The sciatic nerve is of course interesting because so many people suffer
from sciatic pains. But for reflexologists the nerve is of particular
interest, because this is the very nerve conducting all touch and pain
sensations from the feet.
Each foot contains 75,000 free nerve endings registering everything we
do as reflexologists. That incredible amount of information is relayed
to the central nervous system via the sciatic nerve.
Therefore, it makes sense assuming that a proper function of the sciatic
nerve is necessary for a good effect of reflexology, especially if you
are in favour of the theories of reflexology working through the nervous
Nerve mobilisation: David S. Butler: The Sensitive Nervous System,
Noigroup Publications, (2000).
Nerve reflexology: Touchpoint, Denmark with permission from Nico Pauly,