Piriformis syndrome, commonly known as sciatica, can literally be a pain in the butt. Mauri B. Holland, a medical massage therapist and registered reflexologist in Pensacola, says she’s learned to ease this pain by releasing the muscles that put pressure on the sciatic nerve.

“While chiropractic, physical therapy and yoga do help, massage therapy is one of the best ways to reduce piriformis syndrome,” Holland says. “A massage therapist will mobilize the muscles in the low back and hips, releasing trigger points and referred trigger points, and making the muscle tissues more pliable.”

A trigger point is a knot in the “belly” of the muscle or in a tendon where muscle attaches to bone, she says. Massage therapists work deep into the fascia (muscle tissue), to release the trigger points that could be putting pressure on the sciatic nerve. This nerve starts in the lower spine; passes through the sacroiliac (SI) joint, which gives the hips mobility; and then passes under the piriformis muscle and over deeper muscles. Pressure on the sciatic nerve can cause pain to be referred down the leg.

Working Out the Knots

Neuromuscular therapy can help ease this pain and restore range of motion in the hips, Holland says. She combines this modality with techniques of deep-tissue and Swedish massage to make therapeutic massage a “pleasant yet healing” experience.

“In a massage session, I release trigger points in quadratus lumborum, gluteus maximus and gluteus minimus,” she says. “There could also be some muscle tension or even adhesions built up in the sacroiliac joint. Sinking deep into the hips and glutes, I’ll find the piriformis muscle actually sitting on top of the sciatic nerve. When this muscle is shortened, inflamed or has a knot, it can cause discomfort or excruciating pain.”

The sciatic nerve is the largest nerve in the human body, about as big around as a thumb. When it’s angry, it can do some damage—potentially affecting muscles from the hips to the hamstrings and as far down as the ankle, Holland says. 

By carefully putting pressure on the piriformis muscle, she makes it release and go back to its normal state, taking pressure off the sciatic nerve. She then massages the other muscles associated with it, to reduce the referred pain. 

Holland incorporates reflexology techniques both where the sciatic nerve makes its way under the large ankle bone, and along the side of the foot to help work the opposite end of the nerve. 

“By working both ends of the nerve, from the low back and hips to the ankle and foot, I free up a pathway for the nerve to send and receive signals more efficiently,” she says.

Sciatica pain may come back a week or two after therapy, but regularly scheduled massages can generally keep the pain at bay, Holland says. She recommends having a weekly massage until the pain is at a minimum, then having a massage every two weeks thereafter.  

Other Treatments for Sciatic Pain

Other treatments Holland recommends include cryotherapy and thermotherapy—ice to numb the nerve, and heat to relax the muscles around it. Some creams, like CBD oil or Biofreeze, can also ease nerve and muscle pain, she says.

“Young Living Essential Oils sells a quality CBD oil,” she says. “PanAway is a good essential oil for reducing muscle tension and pain.” 

Certain yoga poses, such as Child’s Pose and Pyramid Pose, and pysical therapy stretches, such as the figure four made with the leg (if it doesn’t cause knee pain), can relieve tension in the hips and low back, Holland says. They open the SI joints and lengthen the piriformis muscle, easing pressure on the sciatic nerve.

“Some of my clients with sciatica tell me they experience discomfort when walking, standing or sitting for long periods of time,” she says. “I always suggest taking a walk or doing some stretches to reduce the muscle tension. If they’ve been in pain, they may notice that after compensating by changing their body mechanics, other muscles may be sore. I recommend several one-hour medical massage sessions, followed by a 90-minute full-body massage or hot stone massage to promote wellness and relaxation.”

Mauri B. Holland, LMT, has a practice inside Breathe Wellness Center, 125 S. Alcaniz St., Pensacola, FL. For appointments or information, contact her at 850-501-5391.