Patient Pre and Post Foot/Cranial Therapy (using combination of proprioceptive activators and oral night splints).  Note the reduction in the anterior (nutated) rotation of the sacrum and forward head position.  When this patient was fitted only with a proprioceptive (foot) activator, the sacrum remained locked in a anteriorly rotated position.  This case demonstrates the necessity of treating both the foot and cranial lesion in order to reverse the postural distortions.

Note:  Not all Sciatic Pain is due to Postural Distortions.  Differential Diagnosis must be done in order to determine the etiology (cause) of the pain.

Case History – Sciatica secondary to a concurrent ascending (foot) and descending (cranial) postural distortional pattern

Chief Complaint:  Pain radiating from the left buttocks to the foot.  Pain is episodic but exacerbating over the past 12 months, to a point of disability.

Prior Objective Findings:  MRI demonstrated a herniation between L5-S1. 

Prior Diagnosis:  Sciatica secondary to L5-S1 herniation. Patient was never evaluated structurally for postural distortions.

Prior Treatment:  Cortisone Injections, Codeine and Anti-Inflammatory (Ibuprofen)

Prior Course:  Responding poorly to medication, sciatic pain becoming progressively worse 

Due to the poor response to drug therapy, the patient was referred to our clinic for a postural evaluation and treatment (as needed): 

Findings:  Patient demonstrated a severe anterior rotation of the innominates, left > right and a nutated sacrum.  Concurrently both a foot lesion (Primus Metatarsus Supinatus, left > right) and cranial lesion (anterior rotation of the temporals, Left > right) was diagnosed. 

Discussion:  In this case, the sciatic nerve is being mechanically compressed against the greater sciatic notch by the severe anterior rotation of the sacrum (e.g., Piriformis Syndrome).  A secondary cranial lesion has developed which is also holding the sacrum in an anteriorly rotated position.

Focus of Therapy:  to reduce the anterior rotation of the sacrum.

Treatment:  Foot activators to control the foot lesion, dental activator to control the cranial lesion (See photo to right)

Course:  Patient states “The pain is becoming less frequent and less intense”

Further Therapy Planned:  Pilates to strengthen the abdominal muscles, weight reduction, dental referral for a mouth stimulator.