I am often asked, "Can the Feldenkrais Method® help with sciatica?" or ‘do you have experience with sciatica?’ I am likely to answer those questions by saying, "I have experience working with people who have sciatic pain" or "I have clients who experience/used to experience back pain and/or sciatic pain."
My response may sound like an annoying semantic quibble, but it is actually to the point of what makes the Feldenkrais Method unique! We can make some generalizations about sciatica and back pain, but when you get down to the nitty-gritty, no one has back pain or ‘sciatica’ in the same way or for the same reason. Additionally, people respond to their pain differently, and their lives enable them to help themselves to different degrees.
What exactly is sciatica? Perhaps the simplest explanation is what it feels like: pain or sometimes numbness, that radiates down the back of the buttock and leg and can even travel under the foot. It may or may not include back pain. The pain manifests as occasional tingling, sudden shocks, a dull ache, burning, or even a terrible grinding pain. Anatomically, sciatica gets its name from the sciatic nerve, which is the nerve formed by the nerves exiting the spinal column in the bottom of the lower back and sacrum. It runs down the through the pelvis, the big muscles in the buttock, down the back of the leg, and under the foot. The most common reason for the pain is that somewhere along the route the nerve has been compromised (squashed) or impinged (touched). According to studies, this most often occurs at the root: where the nerve exits in the lower back, hence the link to lower back difficulty or pain, but it could be in the pelvis, or in the muscles around the pelvis/hip joint.
One approach to dealing with sciatic pain is to look at the structure and to attempt to diagnose where the nerve is being impinged on/compressed and then to take steps to prevent that impingement/compression either through surgery or other treatments such as physiotherapy, osteopathy, or chiropractic. I would call these structural approaches with basically a mechanistic solution i.e. fix the structure to relieve the pain. Analgesics or steroid injections might also be used for symptomatic relief.
However, there are some interesting studies that cast doubt on whether impingement is the issue as often as thought. There is an interesting study in New England Journal of Medicine 1994 in which spinal MRIs were performed on approximately 100 active, symptom-free adults ranging in age from the mid-50s to the mid-80s, then sent to radiologists for blind interpretation. Roughly half showed sufficiently severe spinal abnormalities that, if the MRI had come from a patient complaining of back pain, the abnormality would have been identified as the source of the pain. Given that these people had no pain despite having the same kind of abnormalities that are usually given as the cause of pain, it could also suggest that we can’t be sure impingement of the sciatic nerve is the cause when there IS pain or that the surgery or physio works by reducing the impingement.
The eminent pain specialist, Patrick Wall, points out in his book, The Science of Suffering (p122) that a trial for a procedure that injected a fluid into the spine to dissolve a protruding disc showed a very high rate of recovery simply by injecting a totally innocuous fluid instead. We are beginning to discover the dynamic nature of chronic pain and that it is not necessarily directly linked to tissue damage but can involve physiological changes that increase our sensitivity to some kinds of pain. Wall suggests that invasive approaches might sometimes work by simply disturbing the tissues and interrupting the pain cycle in that way.
I don’t have the answer any more than anyone else, but I hold these possibilities in mind when I work. In any case, from the evidence of who turns up in my studio, it is clear that while structural approaches are often successful, they don’t always work for everyone. Some clients come because the structural approaches they've tried haven't worked for them. Some are at the point where surgery is considered the only viable next step and they don’t want to go that route unless they absolutely have to. Others come to me because tan educational approach interests them.
So what do I, as a Feldenkrais® practitioner, do that is different? Well for starters, I am not a doctor; I am not diagnosing anyone. (If my students want or need that approach, I will point them in the appropriate direction.) As a Feldenkrais practitioner, I look at how the person is, how they move and hold themselves, and how they respond. I am looking (and feeling) to discover – and enable the person to discover – how they function and the patterns they have developed. It may be that layers of patterns have built up in response to an initial pain and may well be part of producing more pain. I once worked with a student where 50% of their pain could be attributed to secondary patterns.
When I'm working with someone, I think in terms of "habits of pain." The habits might be of muscle activity compressing the nerve or causing a vertebra or disc to be disrupted and so impinge on the nerve. Or the habit might be a dynamic cycle of pain that has built up and setting up the trigger for pain at a different level. In general, I like to work without triggering the pain if possible, both to offer relief and to remind the person that pain is not inevitable or necessary. This may seem obvious, but actually, it is not always how methods work: some can involve extremely painful palpitation of ‘tight’ muscles or ‘trigger points’ for release.
As I work I am looking at how the person’s weight is supported by the pelvis, the hips, legs, and connection of the feet to the ground. I am asking what is going on in the ribs and upper spine that may affect how they bear weight. I am even, and often very crucially, asking how they carry their head, as this is a very significant part of which leg we carry our weight over. Sometimes there is more weight and a compacted feel on the side where they feel pain, and the job can be to enable the student to learn how to stand and move with equal distribution. This may lead me to spend time working with the pain-free side to improve it, so it does its share of the work and relieves the other side; sometimes the pain is on the looser side, which cannot find its support. I also look at how the person uses their back. This may involve spending time with the ribs and chest so that the student learns to participate more fully in the movement of the back. In turn, that may involve working with breathing so that the client can feel how the ribs and chest need to move with the breath. And of course, I will be looking at clarifying how the leg and back work together both in the specific way the hip joint is working but also in how the lower leg bones and ankle are involved and the way the leg and back relate through the movement of the pelvis and lower back.
I will look to help them find a different way of using themselves and the support of their skeleton and the ground so that muscles that habitually – and unnecessarily – tighten to hold them up don’t feel the need to do so to keep them safe anymore. As you can probably determine by now, I can’t possibly enumerate all the ways I would work as it really depends on what is going on with the person!
Does it work? Yes, however in my experience, that depends on the client/student’s state of being and what is going on as part of their ‘sciatica’. Sometimes it doesn’t take a lot to shift a pattern enough to improve enough to be free of pain. Sometimes – and with stubborn cases of ‘sciatica’ this can be especially true – it may take considerable time as there may be a deep investment in some of the physical and emotional patterns involved that is very difficult for the person to shift even with great application and diligence. Sometimes it is a case of finding ‘enough’ improvement to be better ‘enough.’ The wonderful thing about the Feldenkrais Method is that it is about learning and not fixing, so time spent with it always brings discoveries and is never wasted.
Victoria Worsley discovered the Feldenkrais Method aged 17 as part of her actor training in Paris. She now has a busy and very diverse Feldenkrais practice in North London, UK. She has taught in a number of British drama schools and is the author of Feldenkrais for Actors, How To Do Less and Discover More published by Nick Hern Books Nov 2016. She runs and holds a black belt in Goju Ryu karate so she often has clients involved in related sports as well.
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You can read a longer version of this article at www.feldenkraisworks.co.uk/326/