A 52 year-old woman sought muscular treatment for low back pain and severe sciatic pain. Her job required sitting for long periods of time (a known source of sciatica). Acute symptoms began when she leaned over to pick up a fallen pen. MRI imaging showed no significant lumbar pathology. Physical Therapy treatment had been focusing on stretch and strengthening exercises when she started at Neuromuscular Therapy.
Evaluation, clinical reasoning & treatment strategizing
After an extensive palpation screen for tenderness, active and latent trigger points were found in the gluteus medius and piriformis muscles that reproduced pain experienced in her posterior thigh. The proposed treatment needed to be gentle to avoid further irritation of the sciatic nerve in the gluteal region.
Myofascial unwinding and gentle trigger point deactivation were applied to the gluteal region. The gluteus minimus actually proved to be the key pain culprit (Travell & Simons in their book ‘Myofascial Pain and Dysfunction’ refer to gluteus minimus as the “pseudo-sciatica” muscle). NMT glides, compression with active contraction, and muscle energy techniques helped restore good resting length of gluteal muscles. The TFL muscle was treated in a side-lying position. Satellite trigger points were later deactivated in her posterior thigh, which diminished the rest of her familiar, residual pain.
Results and follow-up
Despite the severity of her initial symptoms, pain-free movement was obtained after just four sessions. Since NMT was quickly added into her program, this patient was able to complete a course of Physical Therapy without recurrence of the sharp, shooting pain. She continues to receive NMT every 6-8 weeks for maintenance and continues to perform a lumbo-pelvic strengthening homecare program.