Nerve Mobilization for Sciatica

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There are times that sciatic may be caused by a herniated disc, spinal stenosis, pregnancy, or piriformis syndrome.By KDS4444 - CC BY-SA 4.0,

There are times that sciatic may be caused by a herniated disc, spinal stenosis, pregnancy, or piriformis syndrome.

By KDS4444 - CC BY-SA 4.0,

Nerve Mobilizations Are Used To Assess for an increased mechanosensitivity of the nervous system

Neurovascular bundles may be exposed to mechanical irritation or a noxious biochemical environment at many different points. Prolonged irritation may result in a reduction of intraneural blood flow. In turn, local hypoxia of a peripheral nerve leads to a drop in tissue pH that triggers the release of inflammatory mediators, known as “inflammatory soup”. This noxious substance may contribute to ongoing nociception without overt nerve damage (Govea et al. 2017).

Straight Leg Raise or Slump test to assess the neuroimmune system will give valuable information about the clinical presentation (Urban et al. 2015).

Sometimes patients still may test negative, but this does still not rule out nerve irritation (Schmid et al. 2013), in these cases a more refined neurological assessment approach may be needed.

Nerve Mobilizations Are Used To Restore the Altered Homeostasis in and Around The Nervous System

If the nervous system is involved, nerve mobilizations have shown to be of use for sciatic pain (Basson et al. 2017, Neto et al. 2017). The application of specific soft tissue treatment may help to diminish intraneural edema and/or pressure by mobilizing neural tubes (Gilbert et al. 2015). 

Erik Dalton demonstrates a simple and effective sciatic nerve mobilization routine for radicular low back, hip and leg pain.

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Baselgia, L.T., Bennett, D.L., Silbiger, R.M., Schmid, A.B. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/27449322

Basson, A., Olivier, B., Ellis, R., Coppieters, M., Stewart, A., Mudzi, W. (2017). The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28704626

Ellis, R., Osborne, S., Whitfield, J., Parmar, P., Hing, W. (2017). The effect of spinal position on sciatic nerve excursion during seated neural mobilisation exercises: an in vivo study using ultrasound imaging. J Man Manip Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28559669

Gilbert, K. K., James, C. R., Apte, G., Brown, C., Sizer, P. S., Brismée, J., & Smith, M. P. (2015). Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: Implications for the treatment of neuropathic pain and dysfunction. Journal of Manual & Manipulative Therapy. (OPEN ACCESS)
http://www.ncbi.nlm.nih.gov/pubmed/26917940 

Govea, R.M., Barbe, M.F., Bove, G.M. (2017). Group IV nociceptors develop axonal chemical sensitivity during neuritis and following treatment of the sciatic nerve with vinblastine. J Neurophysiol.
https://www.ncbi.nlm.nih.gov/pubmed/28701542

Jeong, U.C., Kim, C.Y., Park, Y.H., Hwang-Bo, G., Nam, C.W. (2016). The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. J Phys Ther Sci.
https://www.ncbi.nlm.nih.gov/pubmed/26957726

Lewis, R.A., Williams, N.H., ... Wilkinson, C. (2015). Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J.
https://www.ncbi.nlm.nih.gov/pubmed/24412033

Müller-Schwefe, G., Morlion, B., ... Sichère, P. (2017). Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin.
https://www.ncbi.nlm.nih.gov/pubmed/28277866

Neto, T., Freitas, S.R., Marques, M., Gomes, L., Andrade, R., Oliveira, R. (2017). Effects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis. Musculoskelet Sci Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28637597

Petersen, T., Laslett, M., Juhl, C. (2017). Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord.
https://www.ncbi.nlm.nih.gov/pubmed/28499364

Pinto, R.Z., Verwoerd, A.J.H., Koes, B.W. (2017). Which pain medications are effective for sciatica (radicular leg pain)? BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/29025735

Rade, M., Pesonen, J., Airaksinen, O. (2017). Reduced Spinal Cord Movement With the Straight Leg Raise Test in Patients With Lumbar Intervertebral Disc Herniation. Spine (Phila Pa 1976).
https://www.ncbi.nlm.nih.gov/pubmed/28542104

Ropper, A.H., Zafonte, R.D. (2015). Sciatica. N Engl J Med.
https://www.ncbi.nlm.nih.gov/pubmed/25806916 

Schmid, A.B., Nee, R.J., Coppieters, M.W. (2013). Reappraising entrapment neuropathies--mechanisms, diagnosis and management. Man Ther. 
https://www.ncbi.nlm.nih.gov/pubmed/24008054 

Urban, L.M., MacNeil, B.J. (2015). Diagnostic Accuracy of the Slump Test for Identifying Neuropathic Pain in the Lower Limb. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/26107044