Sciatic nerve damage: treatment and link to neuromotor reprogramming

What treatment should be used in the case of sciatic nerve damage? Neuromotor reprogramming may be part of the answer. Find out more about the Allyane method.

Definition

Sciatica, or sciatic nerve damage, is a very common condition, with a prevalence of 2% of adults in the French population, i.e. over 1.3 million people [1]. It presents as a radiating pain in the area of the nerve path. There are more or less severe forms of damage. The most common form is that caused by a herniated disc. It can also be degenerative (osteoarthritis, narrowing of the canal) or traumatic, which can lead to sensations of numbness, muscle weakness or even paralysis.

The sciatic nerve is the longest and largest nerve in the body. It originates from the spinal cord in the pelvis and innervates the tips of the toes, giving several collaterals along the way. Its motor function is essentially flexion of the leg and foot, and extension of the foot as well. Its sensory territory extends over the posterolateral aspect of the leg and the entire foot [2].

A paralysis of this nerve can cause difficulty or even the impossibility to bend the knee, to stand up or to stand on tiptoes. This will subsequently cause underuse of the lower limb with sometimes significant consequences such as limping. This can cause compensation and therefore pain in other areas.

Treatment of sciatica

As far as rehabilitation is concerned, the main lines of action to be favoured are stretching, mobility, strengthening of the trunk (gainage) and then progressively moving from static to dynamic, while increasing the adapted load.

It is important to treat systemically and not just locally.

We can think of the human body as a rubber band stretched from head to toe. If one area of the elastic band becomes taut - which here can be represented by the back of the thigh - the other areas upstream and downstream will experience a decrease in length and will therefore have to adapt. This often results in stiffness, and this often applies to the least resistant areas such as the extremities. This is why orthopaedic inserts can be of interest as a complement to rehabilitation, with the aim of weaning them off afterwards and not keeping them for life by remaining passive.

Persistence of symptoms

Despite having worked on these different aspects, the patient may still complain of discomfort, or it may go away for a while and then come back. This is when we question ourselves as to which aspect we have neglected. Very often we do not look at the mental aspect of the movement. In other words, we could use techniques to improve our understanding of a particular movement by focusing on how my brain visualises the movement.

Indeed, any controlled movement requires a good visualization and the feeling of the gesture. The technique of mental visualisation is much discussed and used in many sports disciplines, but still very little in rehabilitation. This is why there is still a lack of literature on the subject. But wouldn't it be interesting to take a more central interest in our rehabilitation methods instead of focusing mainly on the peripheral aspect?

Treatment with Allyane neuromotor reprogramming

Neuromotor reprogramming has an important place throughout the rehabilitation of our patients. Indeed, the brain represents the command centre, and it is therefore logical to focus more on the use of more "central" methods. The Allyane method consists of work combining mental imagery, proprioceptive identification of the defined gesture and multi-sensory stimulation via low frequency sounds emitted by a medical device. These sound sequences allow the brain waves to be synchronised with the alpha rhythm, a rhythm that is conducive to motor learning in visualisation. [3,4,5]

The assessment is crucial for the development of the work to be carried out. There is nothing new about the analysis of the different assessments (pain, motor, sensory, functional, questions about activities of daily living and sports). The practitioner carries out a precise clinical assessment, with the help of the video for the biomechanical analysis and the explanation to the patient of the points to be corrected.

Most of the time, sciatica leads to a limp because of the analgesic position. The patient sometimes doesn't realise this, and the video helps to make them aware of this. Video recording is something that is easy to set up in the practice with all the technological aids of today.

The exchange between practitioners is a necessity. The doctor who provides general and especially diagnostic information, the osteopathic approach on the biomechanical aspect in addition to physiotherapy, the orthopaedic follow-up on the postural level. This multidisciplinary approach becomes interesting and above all necessary in order to carry out assessments and to focus the patient in the best possible way.

The course of an Allyane session

After completing the assessment and collecting the patient's goals, the session usually consists of working on the reactivation of one or more muscles that have been somehow "forgotten" by the brain, which we call central motor inhibition , also known asArthrogenic Muscle Inhibition (AMI). There are several interesting publications documenting, for example, the motor inhibition produced following knee surgery such as cruciate ligament surgery [6,7]. In theory, we start with the reactivation of the stabilising muscles, which allow a clearer sense of balance. Then we continue with the mobilising muscles to improve the performance of the movement, particularly in terms of fluidity of movement.

This method is very easy to integrate into our daily activity, and allows us to have an even more holistic look and to understand more about the logic of the brain's functioning.

Conclusion: Allyane's place in the treatment of sciatica

Sciatica rehabilitation is frequently encountered in our practices. However, there are forms that are difficult to treat, where we do not always understand why the patient is stagnating. One part of the rehabilitation might have been left out, and what we notice today is the more central aspect of the movement: how do I perform this movement and what sensations does this movement give me?

The Allyane method is one of the methods that can provide complementary solutions and reflections to our daily practices.

Bibliography :

[1] VIDAL RECOS (11/2016), Common acute lumbosciatica

[2] Kamina (2009), Clinical Anatomy4th edition, Ed. Maloine, pp.532-536

[3] Neuper, C., Scherer, R., Reiner, M., and Pfurtscheller, G. (2005). Imagery of motor actions: differential effects of kinesthetic and visual-motor mode of imagery in single-trial EEG. Brain Res Cogn Brain Res, 25, 668-77

[4] Neuper C., Scherer R., Wriessnegger S., and Pfurtscheller G. (2009). Motor imagery and action observation: modulation of sensorimotor brain rhythms during mental control of a brain-computer interface. Clin Neurophysiol, 120, 239-47

[5] Klimesch W. EEG alpha and theta oscillations reflect cognitive and memory performance: a review and analysis. Brain Res Brain Res Rev. 1999 Apr;29(2-3):169-95. doi: 10.1016/s0165-0173(98)00056-3.

[6] Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum. Dec 2010;40(3):250-66.

[7] Sonnery-Cottet B, Saithna A, Quelard B, Daggett M, Borade A, Ouanezar H, et al. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med. March 2019;53(5):289-98.