Lower back pain is an extremely common condition in today’s world that is often poorly managed. There are many ways to define back pain as well as many conditions and injuries that are responsible for it. For today’s discussion, we’ll focus on sciatica nerve pain.
The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness in the leg. Many will have unbearable pain while sitting while others can hardly stand on the affected leg. A sharp, stinging pain down the leg is commonly felt with this condition. Sciatica originates in the lower back and travels through the buttocks muscles down the back of the leg and ultimately to the bottom of the foot via other nerve branches. Along the way, towards the foot, the nerve can become entrapped within the soft tissues it travels through. We can see clearly in the picture to the left that the sciatic nerve starts in the lower back and makes its way through the posterior thigh down to the foot. There are various entrapment sites where the nerve can become irritated and/or caught up in the soft tissues of the lower back and lower extremity. Depending on the location of the entrapment, the individual will present with a variety of symptom patterns. The sciatic nerve entrapment symptom pattern can be anywhere from the lower back to the sole of the foot. The nerve splits and branches into the common peroneal nerve as it makes its way to the anterior side of the lower leg and the tibial nerve as it continues down the back of the leg to the foot. Keep in mind that the nerve can become entrapped anywhere along its course but we’ll discuss the most common sites in the following paragraphs.
Starting at the lower back, the sciatic nerve can be entrapped as it exits the foramen in the lumbar spine. When the issue is here, most of the time the individual will experience entire leg symptoms.
Moving down the chain, another common area of sciatic entrapment is in the hip rotator muscles. This group is made up of the piriformis, superior gemellus, inferior gamellus, obturator internus and quadratus femoris. Again, an entrapment at this location of muscles will more than likely cause entire leg symptoms.
As the nerve continues down the leg it can become entrapped in the hamstrings, primarily the long head of the biceps femoris. This site of entrapment will produce entire leg symptoms most of the time.
The nerve continues to go past the knee into the anterior shin as well as the bottom of the foot. There are a few other entrapment sites here but for the sake of our discussion you should have a decent understanding of the symptomatology the sciatic nerve can produce.
The sciatic nerve is just one nerve in our body that can wreak havoc over a large area when entrapped. The good thing about nerve entrapments…..most of the time they can be resolved with Active Release Techniques (ART), primarily long tract nerve releases. The main goal with this method is to move the nerve while trapping the muscle(s) in position. The nerve is pulled through or under the muscle. When performed correctly, the patient will feel the nerve free up accompanied by a reduction in their symptoms rather quickly. Nerve entrapment patients will typically feel change in their symptoms in 1-2 visits while complete resolution may take 3-6 visits depending on the type of injury and how long it has been present.
Live your best,
Brian Gervais, DC, CCSP