Chiropractic and Physical Therapy care can help!
What is sciatica?
Sciatica is the term used to diagnose radiating pain down the back of the leg, initiating in the low back and ending as low as the foot. This is a very vague and often misused diagnosis and we are here to explain what “Sciatica” is in a little more depth.
We don’t like to use the term sciatica. We like to use the global term “Lumbar Radiculopathy.” More often than not, “sciatica” is used wrongfully. Most of the general population uses the term “sciatica” to describe ANY radiating pain from the back to the leg. However, the sciatic nerve only innervates the POSTERIOR side of the buttock and lower extremity. Therefore, if you have radiating pain down the anterior leg or more lateral (outside) of the leg, it may not actually be your sciatic nerve involved. It also only innervates certain muscle groups and areas of the leg that, and can often be mistaken for nerve root pain or radiculopathy.
What may be causing my radiating pain?
Your sciatic nerve is only one PERIPHERAL nerve that forms from the nerve roots of the lumbar spine. Nerves can be either described as nerve roots or peripheral nerves. Nerve roots refer to L1, L2, L3, L4 and L5 roots and innervate specific parts of the lower extremities for motor and sensory purposes. These are part of the CENTRAL nervous system. Peripheral nerves are those that form from these nerve roots, typically being a combination of multiple levels coming together to create them. Peripheral nerves are part of the PERIPHERAL nervous system. The following examples will help decipher between nerve root injury vs peripheral nerve injury.
The L4 nerve root exits between the L4 and L5 vertebrae and provides both sensory (dermatome) and motor (myotome) function to the low back and leg in a specific pattern. The L4 nerve provides sensation to the lower back, anterior thigh and inside of the calf and ankle. It also provides motor function to the quadriceps and ankle dorsiflexion. Therefore, damage to the L4 NERVE ROOT – can cause numbness and tingle to the low back, anterior thigh or inside of the calf and foot and if severe enough can cause weakness in knee extension and ankle dorsiflexion.
The femoral nerve has contributions from L2-4 nerve roots and allows for motor function of the quadriceps muscles and three other muscles of the thigh – iliacus, pectineus, and sartorius. It also provides sensory innervation to the front and inside of the thigh. An injury to the femoral nerve can cause symptoms including numbness and tingling to the front or inside of the thigh and cause weakness in the quadriceps. You can see how the L4 nerve root injury may radiate further down the leg than the femoral nerve injury.
Below is a comparison of L4 radiculopathy (left) and femoral nerve injury (right). You can see the difference in pathways.
Sciatic nerve anatomy:
We explained above the L4 nerve root vs the femoral peripheral nerve. The sciatic nerve is a combination of the L4, L5, S1, S2, and S3 nerve roots. When these nerves come together in the buttock region, it travels either 1) completely beneath the piriformis muscle as one unit or 2) splits into two and runs underneath and through the piriformis muscle. It continues to run down the backside of the thigh to just above the knee. When it reaches the popliteal fossa (or crevis in the backside of the knee), it splits into two terminal branches known as the deep peroneal/fibular nerve and tibial nerve. These continue to innerve the calf and ankle. We will end the discussion there to prevent any further confusion.
The important messages thus far are:
- nerve root pain and peripheral nerve root injuries present very differently
- Sciatic nerve pain, or sciatica, only refers to the radiating pain down the BACK side of the leg.
Who gets sciatic nerve pain (sciatica) or lumbar radiculopathy?
Anyone can get sciatic nerve pain or lumbar radiculopathy. It can happen as a result of compression on the nerve roots it originates from or injury to the piriformis muscle (the muscle in runs under in the buttock). Injury to the nerve roots can occur via disc herniation, stenosis, spinal fracture or a nervous system injury. Disc herniations can be from a car accident, twisting work injury, core weakness and may other reasons.
More often than not, true sciatic pain is a result of a piriformis muscle injury. Lumbar radiculopathy is typically more of a result of the disc herniation compressing on the specific nerve root.
Who can treat my “sciatica” pain or radiculopathy?
Sciatica and/or lumbar radiculopathy can be treated by numerous health care professionals. The most skilled professionals are often a neurologist, neurosurgeon, chiropractor, and physical therapist. Pain management doctors are often typically used as well when the pain will not subside with conservative treatment. Acupuncturists are also a good resource to relieve pain.
How can Block Sports Chiropractic and Physical Therapy help?
Here are Block Sports in Smithtown and Selden, NY we utilize both chiropractic and physical therapists to combat your back and radicular pain. We not only use appropriate modalities (heat, ice, stim, etc) but are highly skilled in manual techniques to improve joint space, joint stiffness, muscle spasms and mobility dysfunctions/weakness that are likely contributing to your injury, pain and other symptoms. Just a few examples of manual interventions are joint mobilizations, McKenzie implementation, Active Release Technique (ART), joint manipulation, manual stretching, cupping and soft tissue/myofascial release. Our professionals perform a thorough evaluation that will find the true cause and source of pain and other impairments that may be responsible or contributing. We take a broad approach to not only get you out of crisis mode but also prevent the injury from reoccurring. Physical therapy and chiropractic intervention can most definitely help relieve your “sciatica” pain.
Please contact one of our offices in Smithtown or Selden, NY to determine of chiropractor and/or physical therapy care may assist you with your sciatica or lumbar radiculopathy pain.