treatment for sciatic pain in a pregnant client

[Fantabulous]

I am about to begin treating a new client who is nearly 8 months pregant and suffering from severe sciatic nerve pain in both legs, which sometimes results in numbness in her legs, also. As she is very pregnant I plan to treat her side-lying, and I'm wondering if anyone has any suggestions for some really effective treatments that can be carried out successfully while she's on her side. I feel like b/c she'll be on her side, I won't be able to treat her as effectively. Thanks for any input!

 

[eddie f13]

You can do great work in the sidelying position.

Being that I am also almost 8 months pregnant and have had hip and glute issues, I can say I am most comfortable (when on my side) with many pillows or with a snoogle. The more support the better.

Some of the sciatic pain can be caused more from the position of the baby or a misalignment than the musculature itself. If she isn't seeing a chiropractor, I would discuss seeing one with her. That has helped me a lot.

If you have not worked with sidelying before I would practice it on someone before trying it out on your client.
I do a lot of pregnant women in a seated position (straddling a sturdy chair while leaning slightly forward onto a pillow that I have placed on my table) - especially for the back. For me it is just easier.
I use sidelying more for getting into the hips/glutes/rotators and the legs. I use a sort of diaper drap to expose the area and work as needed there.
Then I use a upright seated position (my table tilts) for neck, arms, legs, and feet.

 

[andrei v]

I had massages once a week while I was pregnant, pretty much all of them were side lying, and I can't say any of them were ever unpleasant. She is seeing a physical therapist rather than a chiro b/c of insurance coverage. I'm just not certain from the position of standing behind the client while she's side lying how to best treat the low back, hips and glutes in a way that's effective and that won't send ME to the chiro, too!

 

[J&JLove]

Can you raise your table?

 

[Frances]

Yup--it isn't a top of the line table, but does have a pretty decent height range. Should I put it higher than I would normally? That's probably a logical thing to do, huh?

 

[kathy_is_a_nurse]

If you are concerned with the working position, I would work with her seated for the back and lower back and then move her to sidelying for the glutes, hips and legs.
That is the main reason I like doing the back portion in the seated position, I could never find a very comfortable position for myself when working the back in sidelying.

 

[Liberals make me laugh]

There are a number of points on the meridians on the backs of the legs which can be effective on sciatica in pregnant women. I used them on my wife 11 years ago and they definitely helped.
Bladder 36,37,40,57

 

[Sammy]

One of my younger clients is pregnant with her second child. This pregnancy is already giving her fits with the sciatica and she's only 4 1/2 months along. Her favorite thing is to have me do a pelvic diaphragm release for her whether she is sitting or on her side. It's simple, it's effective, and for her, the most relaxation her hips, low back, etc. get every 2 weeks despite her weekly visits to the chiro......

fwiw

 

[pugpaws2]

I haven't heard of that--could you explain what it is or tell me where I can find info on it online?

 

[Pink Taco]

Pelvic Diaphragm Release - part of the craniosacral 10 step protocol I learned from the Upledger seminars.....

Basically, as one of my male clients dubbed it, it's a "butt sandwich"........ now that you can't get that image out of your mind, let me explain better......

One hand is placed on the client's sacrum palm facing the client ulnar border/little finger toward the client's feet. Opposite hand is place on the client's abdomen, ulnar border/little finger toward pubic symphysis approximately directly opposite the posterior hand. The hands are held against the client's body with approx. 5 grm of pressure [wgt of a nickel] and held steady without moving. Movement will be detected between the hands - a sensation of swirling, circling, wiggling, etc - that is the musculature releasing tension and finding a more natural state of relaxation for itself. Once the movement is no longer detectable, the hands can be removed, OR, additional components of the release can be applied dependent upon circumstances w/ the client.......

hope that helps,
J

 

[Nicks]

Thanks for the tips on the release technique! I will definitely try it.
For those who recommended working with the client seated/leaning on the table, what procedures do you follow in terms of draping?

 

[Kala]

For those who recommended working with the client seated/leaning on the table, what procedures do you follow in terms of draping?

I use a sheet and have them wrap it around themselves with the opening in the front (held closed by them). Once they are seated I will lower the back of the sheet to around the sacrum and make sure the sides are secure enough not to expose them. This give you access to the entire back, shoulders and neck.

 

[Mickey]

Thanks for the tips on the release technique! I will definitely try it.
For those who recommended working with the client seated/leaning on the table, what procedures do you follow in terms of draping?

Honestly, clothed works best for me when a client is seated. But then I do either sidelying OR seated with my pregnant clients. In school when we did the sidelying pg. massage, we used draping, and when we did seated, the client remained clothed.

 

[valerie]

I use a sheet and have them wrap it around themselves with the opening in the front (held closed by them). Once they are seated I will lower the back of the sheet to around the sacrum and make sure the sides are secure enough not to expose them. This give you access to the entire back, shoulders and neck.

Then when that part is finished how do you have them transition to the table? I can picture the transition but it seems awkward with being naked, pregnant, and arranging the sheet.

Sounds like a better option, though! I will give it a try tomorrow with a new pregnant client. I really hate side lying for the back!

 

[royboy]

I never thought I'd hear myself say this, but it actually seems there might be a purpose for the dreaded hospital gown! Access to the back without exposing the front, easy to do up the back, get back on the table and re-open, light-weight enough to leave on during the rest of the treatment. Kind of a compromise between suggestions to have the client remain clothed and draping with a sheet. Now, where to find one....

 

[iTz moleman!]

Now, where to find one....

There are some plus-sized and sale priced gowns here.

 

[Pompal 09.]

Then when that part is finished how do you have them transition to the table? I can picture the transition but it seems awkward with being naked, pregnant, and arranging the sheet.

When you are done working with them seated, they take the sheet and wrap it around themselves, just this time the opening is to the back. Have them sit on the table and get into position and then you can adjust the sheet as you need. It sounds much more awkward than it actually is. You can try it yourself to see what works best.
With my routine, the next position is seated on the table - with the table tilted up. This is easy to get into while keeping yourself covered with the sheet. After that it is also an easy transition to sidelying.

The thing with hospital gowns that would concern me is how short they are. I think I would feel more exposed laying sidelying on a table with a hospital gown on than I would fiddling with a sheet for a little bit.

 

[johnny4nuthin]

Well I didn't get to read your reply in time, but this is how it went with me today:

I draped a towel over the chair, back against the table, and a pillow on the table for her to rest upon. She undressed and wrapped the sheet around her with the opening at the front. When I came back in the room I lowered the back of the sheet to her sacral area. She may have just let the front fall away which was fine with me, but her glutes where covered which is what I wanted. I did the back massage and it was fabulous! So much better than side lying and I will do it this way until I get a body cushion (I really don't know if/when that will happen). When the back portion was complete I arranged the table with pillows for her to do side lying. I don't have a table that sits up. As she got on the table I was getting an extra blanket so I didn't see anything and I draped the extra blanket over her. The sheet was funky on her, but I was able to access the legs and arms without disrupting her modesty. So I feel the whole process went fine. It was so much easier doing a good job on the back and side lying with legs, arms, neck head work fine for me.

Thanks for sharing!

 

[Tiia]

The thing with hospital gowns that would concern me is how short they are. I think I would feel more exposed laying sidelying on a table with a hospital gown on than I would fiddling with a sheet for a little bit.[/quote]

I was planning to use sheets in addition. Even if it were longer, it would still be better to be covered up. It was also really helpful to hear how it went in practice, too. I know how valuable a massage can be when you're pregnant, and I'm greatful for all of the help on this topic!

 

[Naughtyfox]

Glad it worked out for you AKB. It does take a little getting used to, but I like working seated so much better than sidelying for the back.

Yogamom - let us know how things work out if you decide to use some hospital gowns.