Back Clinic Sciatica Chiropractic Team. Dr. Alex Jimenez organized a variety of article archives associated with sciatica, a common and frequently reported series of symptoms affecting a majority of the population. Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side.
Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower back and runs down the back of each leg as it controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot. Dr. Jimenez explains how sciatica and its symptoms can be relieved through the use of chiropractic treatment. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Sciatica is a disabling condition characterised by pain in the leg along the distribution of the sciatic nerve. It can be accompanied by back pain, tingling, numbness, reduced strength and reflex changes in the leg.
Sciatica is most commonly caused by irritation of the nerve roots emerging from the lower spine. For this reason it is often considered a type of nerve pain.
It is estimated that around 5 to 10% of people with low back pain have sciatica, equating to around 200,000 to 400,000 Australians. It is notoriously difficult to treat sciatica with over-the-counter medications and complementary therapies.
Our study released today examines the commonly prescribed nerve pain treatment pregabalin for acute and chronic sciatica. The results show that pregabalin does not improve pain symptoms or function, but is associated with unwanted side effects such as dizziness when compared to a placebo.
Huge Uptake Of New Drug
Medicines that have shown to be effective for treating nerve pain were considered to be an exciting new treatment option for sciatica.
Pregabalin became subsidised by the Australian government for nerve pain in 2013 and quickly became widely prescribed for conditions such as sciatica. In its first year of listing, nearly 1.4 million prescriptions were written and in its second year, this figure increased to 2.4 million. This was 32% more than the government predicted.
Since its first approval in 2004 pregabalin has become the most widely prescribed medicine for nerve pain globally, with worldwide sales of between US$3-5 billion annually. The astonishing growth is likely to be a consequence of many factors but may partly be a reflection of the lack of effective treatments for sciatica.
But while pregabalin has been shown to be effective for other types of nerve pain, there was little evidence it helped patients with sciatica. There were also emerging concerns of increased harmful effects, including risk of suicidality and misuse.
We designed our study to examine whether pregabalin is effective and has tolerable side effects in patients with sciatica.
Pregabalin Does Not Work For Sciatica
The research compared the effects of pregabalin against placebo (identical inactive capsules) in 207 patients with sciatica.
Patients were randomly assigned to take up to eight weeks of pregabalin or placebo, prescribed and monitored by a general practitioner or a medical specialist. To keep the results as unbiased as possible, patients, doctors and study staff were kept blinded to who was treated with pregabalin and who received placebo capsules.
This study found after eight weeks there was no difference in the severity of leg pain between those who took pregabalin and those who took placebo capsules. The same result was seen at one year. There were also no differences in other relevant outcomes, such as back pain severity and function, at either eight weeks or one year.
However, people who took pregabalin reported more adverse effects. The most common adverse effect reported in the trial was dizziness.
The study shows that taking pregabalin does not improve your sciatic symptoms when compared with placebo, but you are more likely to have adverse effects when taking pregabalin.
Treatment Options For Sciatica
Few alternative treatment options exist for people suffering from sciatica.
There is limited data describing the effects of nonsurgical treatments such as exercise, spinal manipulation or acupuncture on sciatica.
There is also no convincing evidence to show medicines such as anti-inflammatory drugs, oral corticosteroids or opioid analgesic medicines are effective. Epidural corticosteroid injections have been shown to have a small benefit in the short-term only.
Surgery confers a short-term effect in selected patients with sciatica, but after a year people with sciatica who have not had surgery do just as well as people who�ve had the procedure.
The good news is that sciatica does get better with time. It�s important to stay as active as possible and to avoid prolonged bed rest (as this can delay recovery).
If you�re currently taking pregabalin, speak to a doctor about your condition, and mention any improvement or adverse effects you�ve experienced since starting pregabalin. It�s important not to stop pregabalin abruptly � usually doses should be reduced slowly over a few weeks. Abruptly stopping pregabalin can have some ill effects and should be done with care, close monitoring and advice from a doctor.
It�s unfortunate, but we do not currently have a lot of effective treatment options for people with sciatica. Speak to your doctor or treating clinician (such as a physiotherapist) about what may be appropriate for you, including specific advice on how you can stay as active as possible.
Sciatica specifically refers to pain, weakness, numbness, or tingling in the leg, along the distribution of the the sciatic nerve down the back of the leg. Most commonly however, people will refer to any condition that causes back pain in association with leg symptoms as sciatica.
Common Causes:
True sciatica occurs when there is pressure on, or damage to, the sciatic nerve. This nerve starts in the lower spine and runs down the back of each leg. This nerve controls the muscles of the back of the knee and lower leg and provides senation to the back of the thigh, part of the lower leg and the sole of the foot.
As previously mentioned, the term “sciatica” is often used by patients to describe any condition where there is back pain together with associated leg symptoms. This being the case, there are a number of other conditions that will actually mimic sciatic nerve pain. Sacroiliac joint irritation (sacroiliac joint syndrome), lumbar facet joint irritation (lumbar facet joint syndrome), and piriformis syndrome all frequently produce leg symptoms, and are therefore commonly mistaken for sciatica.
Common Symptoms:
Sciatica pain can vary widely. It may feel like a mild tingling, a dull ache, or even a burning sensation, while in other cases, the pain can be servere enough to make movement practically impossible. Most commonly, sciatica effects only one leg.
Treatment:
Treatment begins with first determining whether a patient is suffering from true sciatic nerve involvement, or if they are actually suffering from one of the other conditions that frequently mimics sciatica. From there treatment is directed towards reducing inflammation, pain, and spasm, while restoring movement and function to the effected spinal levels. Once normal spinal mechanics are restored, patients are given a simple home exercise program in order to help maintain normal function and to help prevent re-occurances.
What is sciatic nerve pain? Sciatic nerve pain is one of the most tough [ www.youtube.com/watch?v=FUcGA-BvmIQ dolore sciatica] problems for physicians, also those experienced in treating back pain as well as sciatica patients, to determine as well as treat. Sciatica usually presents itself as a prickling and/or numbness, like the sensation one may experience with a pulled hamstring muscle mass, the biceps femoris at the back of the leg. The experience could be plain, almost an ache, with durations of prickling and/or tingling happening throughout specific activities. The prickling and/or numbness experienced, if not dealt with, may develop into a full-on constantly [ www.youtube.com/watch?v=SrFQWAtJtZU click resources] severe phase with discomfort capturing throughout the butts and also radiating down the leg. Sciatic nerve pain might influence one or both legs, typically one, starting as a pain radiating from some point in the lower back, the lumbar spine, after that throughout the gluteal muscle mass (the buttocks), as well as ultimately down the rear of the leg. In innovative instances, sciatic nerve pain gets to right right into the feet as well as toes, triggering discomfort as well as an eventual loss of feeling.
Remarkably, sciatica is not a details condition, it is just a catch-all clinical term put on a constellation of symptoms in order to explain a state the back pain victim remains in. In this instance, sciatic nerve pain is utilized to define a patient’s complaint of pain radiating across the butts, down the leg, and also right into the feet and toes … along with the connected tingling and/or feeling numb. Sciatica could be brought on by a variety of conditions, from stress and anxiety and trauma at a particular area on the spinal column, the reduced back or back curvature, to a much more general condition such as obesity or pregnancy. There are a number of other problems associated with sciatica, all needing varying degrees of clinical intervention and also treatment. A few of the conditions likely to present with sciatica are:
1. Osteomyelitis: An infection of the bone or bone marrow. Osteomyelitis might be debilitating and also in severe cases may also create death. It is tough to identify as well as might go undetected for a long period of time unless appropriate blood examinations are purchased and also the doctor is well trained in contagious diseases influencing the bones.
2. Growths on or near the spine: Lumps, particularly tumors or abnormal growth (e.g., scar tissue) affecting the nerves or nerve roots as they exit the spinal canal and intervertebral foramen, will certainly sciatic nerve pain or sciatic nerve pain.
3. Degenerative Disc Disease: Again, degenerative disc condition is not an illness anymore than sciatic nerve pain, called sciatica, is a specific problem. Degenerative disc condition is a break down of the IVDs, the intervertebral discs, and also is generally an effect old combined with the any or every one of the 5 primary elements influencing the spine as we age.
o Excess weight and/or obesity
o Muscle weakness
o Muscle Imbalance
o Poor nourishment and also diet plan
o Poor hydration or dehydration
4. Herniated (i.e., burst) or protruding disc: This problem might be particularly bothersome if the herniated disc or bulging disc is extending posteriorly (to the back) and right into the spine canal, or impinging on the nerve origin at the intervertebral foramen, hence putting pressure on the spine and/or nerve root; and, sciatica is the result in lots of instances.
Chiropractor, Dr. Alexander Jimenez looks at how sciatica can affect what you do and where you go.
Popular songstress hears her “Body Talk” and finds “Let’s Get Physical” challenging due to low back and leg pain.
In the event you suffer from sciatica, you may have to take time off work due to debilitating leg pain and low back. That�s just what occurred to Olivia Newton-John, who postponed her May 2017 performances because of sciatica flare up.
A statement posted on the star�s official Facebook page said, �We are so sorry to announce the Olivia concerts scheduled for May will be postponed due to a issue that is negative with Olivia’s sciatica.�
In a Facebook post that was separate, Newton John expressed disappointment at having to postpone the shows, but that the symptoms wouldn’t allow her to perform. �I have had a long running issue with sciatica, � she wrote. �I need to take this time with this very debilitating condition.�
Sciatica�s hallmark symptoms of intense low back and leg pain make it among the most well known spinal issues. Individuals who have sciatica frequently describe their pain as electrical-like as it runs in the buttock down and down the trunk of the thigh to the foot. Moving your legs often makes the pain worse performing all night as Newton-John her pain would have during her concerts may have greatly intensified.
Newton-John�s choice to take time to handle her sciatica is an excellent example for anyone who lives with acute low back and leg pain. Avoiding activities that aggravate your sciatica and focusing on mild activities and other treatments go a long way to lower your pain.
Keep Sciatica Pain From Increasing
By Staying Informed
Does one have problems with sciatica? SpineUniverse has many resources that will help you understand this sciatic nerve-associated pain and also the treatments that may assist you to will find relief:
Lower back pain is a common symptoms frequently reported among a majority of the population in the United States. While low back pain generally resolves on its own, constant discomfort could signal the presence of a more serious injury or condition. A variety of factors can lead to spinal damage or injury, manifesting as low back pain, however, when the pain and discomfort includes tingling sensations, numbness and even burning sensations along the lower extremities, damage or injury to the sciatic nerve may have occurred.
Over-exercising, lifting, bending, or twisting abruptly into awkward positions, and even driving for extended periods of time, can strain the sciatic nerve, leading to lower back pain which radiates into the back of the legs as well as other numerous symptoms, known as sciatica.
What is Sciatica?
Approximately 5 to 10 percent of individuals experience some form of low back pain from sciatic nerve pain. Most commonly seen in people ranging from 18 to 35 years of age, the prevalence of sciatic symptoms varies tremendously from 1.6 percent throughout the general population to 43 percent in a selected working population. Unfortunately, only 30 percent of individuals suffering from sciatica seek medical attention only after experiencing these painful symptoms for a year or more. In a majority of cases, sciatica is caused by a herniated disc involving nerve root compression.
Not all individuals with lower back pain have sciatica. Lower back pain could result from a variety of factors, most frequently seen in sedentary workers who sit behind a desk for an extended period of time with improper posture while not following ergonomics.
Causes for Sciatica
Several causes of sciatica include trauma from an injury, spondylolisthesis, piriformis syndrome, spinal tumors and obesity. �Sciatica can be debilitating at times when the episode is acute. At that time, it is very difficult to carry out day-to-day activities. Some patients are advised bed rest for three to four weeks so that their condition improves. Majority of the symptoms settle down with non-operative management, which involves extensive rest,� Dr. Sunil Dachepalli, senior orthopedic and joint replacement surgeon and sports medicine expert at Yashoda Hospitals quoted.
For long-distance drivers, they are at a higher risk of developing sciatica because of the constant jolts on bumpy roads which have been known to weaken the discs of the spine. Smooth roads can prevent this though. The individual�s height can also be a component towards the development of sciatica as most discs rupture backwards when the person bends forward. Taller people tend to slouch forward more often and also, when they bend, their center of gravity moves further away from the spine. The pressure on the spine is multiplied by the distance of the force, resulting in more pressure on discs of taller people when they bend forward.
It�s essential to properly diagnose the presence of sciatica and determine the source of the pain and other symptoms. Sciatica caused by a common back complication, such as a spinal misalignment, may require a combination of treatments to relieve an individual�s symptoms as well as treat the underlying cause of the sciatica. Dr. N. Somasekhar Reddy, senior consultant orthopedic surgeon stated, �In 80 percent of the cases where people treat their sciatica on time, it is found that these simple methods can help them get better with time.�
Symptoms of Sciatica
Sciatica is characterized by a sharp pain along with numbness on the leg. The affected leg may also feel weak and appear thinner than the other leg. Additionally, many individuals experience a mild tingling, dull ache, or burning sensation that can also be felt on the back of the calf or on the sole of the foot. The pain and discomfort usually worsens when one lies down and can often make getting enough rest difficult. Occasionally, redness and swelling may appear on the back. An episode of back pain that has lasted continuously for more than four weeks could suggest the presence of sciatica.
Home Remedies for Sciatica
If you�ve been diagnosed with sciatica, there are a several remedies that can help ease the pain. Foremost, ice therapy can be used on the affected are of the back to reduce the swelling. Participating on regular physical activity and exercise can help strengthen the muscles and improve flexibility to prevent degenerative wear and tear changes associated with age. In addition, avoid sitting or standing for prolonged periods of time by taking several breaks to stand, stretch, and walk around. If you must be on your feet, rest one foot on a small stool or footrest and then switch feet throughout the day. Individuals with sciatica symptoms should also avoid wearing high heels. This type of footwear alters the body�s natural posture, adding pressure to the spine which could aggravate your sciatica. And finally, take pressure off your back by sleeping on your side or on your back with a pillow under your knees.
While these remedies can relieve symptoms of sciatica, their effects may only be temporary and it�s still crucial to receive immediate medical attention to diagnose any possible underlying conditions or injuries that could have developed your complications and follow with proper treatment. Chiropractic care focuses on realigning the spine through the use of spinal adjustments and manual manipulation to decrease the stress on the spine as well as strengthen the structures around the vertebra and restore the body�s natural health.
Back pain is a common symptom affecting a wide range of individuals. Various factors can cause back complications but when a person’s lower back pain begins to radiate down into the back of the legs, it could be another issue. Approximately 5 to 10 percent of individuals experience low back pain due to sciatica. Characterized as a group of symptoms rather than a single condition, sciatica can often make an individual’s lifestyle more difficult than a simple low back problem.
When the constant symptoms of low back pain are attributed to sciatica, the radiating pain and discomfort can greatly restrict an individual’s everyday lifestyle, altering their daily activities. After identifying the collection of symptoms associated with sciatica, it’s important for the individual’s to seek a professional medical diagnosis to determine the source of their symptoms. Once diagnosed, following treatment with a qualified healthcare specialist can help them recover from their symptoms and improve their overall health and wellness.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
Chronic low back pain as well as radiating discomfort down one or both legs could indicate the presence of an injury or condition, such as lumbar stenosis. Spinal stenosis in the lumbar spine commonly develops with age, characterized as the narrowing of the spinal canal in the lower back. When this reduction in the vertebrae occurs, extra pressure is placed on the nerves as well as the spinal cord. Because these nerves run from the lower back to the legs, symptoms of leg pain, heaviness and/or cramping may also develop.
Anatomy of the Spinal Canal
The spinal canal located in the region of the lumbar spine is the most frequent section affected by spinal stenosis. The lumbar spine is made up of five vertebrae extending between the ribcage and pelvis, medically labelled from top to bottom as L1 through L5. Each of these vertebrae are properly separated by intervertebral discs which function as shock absorbers, cushioning and distributing the pressure being exerted onto the spine.
Each vertebrae of the spine contain what is identified as vertebral arches, protruding arch-shaped bones which create the necessary space within the spinal bones for the spinal cord. That space is referred to as the spinal canal. When the structure of the spine is healthy and it functions effectively, the spinal canal should properly be capable of protecting the spinal cord, providing the necessary and safest space required to maintain overall wellness.
Symptoms of Lumbar Spinal Stenosis
Individuals suffering from spinal stenosis in the lumbar spine commonly describe experiencing symptoms of pain and discomfort along the lower back, hips, buttocks and/or legs. Other prevalent symptoms of the condition include: lower back pain that radiated down one or both buttocks, legs, and/or feet; worsening pain in the lower extremities when walking; tingling sensations or numbness in one or both legs or feet; weakness in one or both legs or feet; restricted mobility or difficulty walking; and issues controlling bladder or bowel movements, a complication which may require immediate medical care.
Sciatica, best known as a set of symptoms rather than a single condition or disorder, can be a common diagnosis for determining the presence of an issue affecting the lower spine. Symptoms of sciatica include a collection of pain and discomfort, tingling sensations and numbness, burning sensations, and muscle weakness. Symptoms of sciatica can indicate a serious complication along the lumbar spine.
For individuals experiencing spinal stenosis in the upper back, referred to as cervical stenosis, the symptoms will be similar along the neck, shoulders, arms and/or hands.
Causes of Lumbar Spinal Stenosis
The gradual degeneration of the spine caused by the natural changes that come with age are the most common cause for the narrowing of the spinal canal, mostly due to the repetitive stress and pressure of the surrounding tissues over the course of several years. As the spinal canal becomes narrower over time, a number of conditions and disorders can develop, causing the compression or impingement of the spinal cord and leading to the irritation and inflammation of the nerve roots. This process will ultimately cause symptoms to manifest along the lower back, buttocks, and/or legs.
Lumbar spinal stenosis can also be caused by the degeneration of the intervertebral discs found between each vertebrae of the spine. Spinal disc shrinkage can impede the disc�s ability to properly separate the individual bones of the spine. This problem can generally lead to a much more severe condition referred to as a lumbar disc herniation. Also, if the spinal cord ligaments have expanded due to the natural wear and tear alteration of the structures of the body, lumbar stenosis can develop. Consequently, the degeneration of the vertebrae in the spine is the most common cause for lumbar spinal stenosis.
Diagnosing Lumbar Stenosis
When visiting a healthcare professional, such as a chiropractor, for the diagnosis of lumbar spinal stenosis, the doctor will primarily conduct a thorough physical examination of the patient to determine the source of the issue. The doctor of chiropractic, or other healthcare specialist, may also extensively review the individual�s medical history, referring them to receive other necessary or additional X-rays or MRI scans. By examining the patient�s symptoms as well as analyzing the test results, a chiropractor will be able to diagnose the individual�s injury or condition to discuss the best possible treatment options for you, including the thorough discussion of the benefits and risks of each option. Finally, the healthcare professional and patient can decide together on the preferred treatment procedure to follow to begin the rehabilitation process and restore their original health and wellness.
Treating Lumbar Spinal Stenosis
Chiropractic focuses on the diagnosis, treatment and prevention of injuries and/or conditions of the musculoskeletal and nervous system. A chiropractor may commonly utilize spinal adjustments and manual manipulations to carefully correct any misalignments in the spine that may be causing the impingement or compression of the spinal nerves. The chiropractic adjustments can help decrease the stress and pressure being placed against the structures and other tissues of the spine, reducing the symptoms of pain and discomfort associated with spinal stenosis along the different regions of the spine. Furthermore, the chiropractor may recommend a series of stretches and exercises according to the individual�s complications to speed up the rehabilitation process and help them regain their original strength, flexibility and mobility.
In the case that other forms of treatment are required to treat the individual�s injuries and/or conditions, the healthcare specialist will refer the patient to other professionals for treatment. A modification of the patient�s physical activities may be recommended as well. Other healthcare providers may provide the use of medications and other treatment methods or techniques, including physical therapy, to help improve the symptoms. While many individuals may try a number of conservative treatments to solve the issue, if the individual�s condition is severe enough to require spinal surgery, a healthcare provider may refer the patient to the appropriate doctor for treatment.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
Athletes are specially trained to exercise and compete vigorously without experiencing injury or aggravating a previously existing condition. However, accidents and direct trauma during their specific sport or physical activity can inevitably result in damage or injury to the individual. Muscle or tissue damage are common in sports and can be dealt with accordingly but when a bone fracture occurs, these may be more delicate and may require additional diagnosis and care in order to properly help an athlete recover.
Among the general population of athletes, stress fractures can be a rare cause of pain, accounting for only 2 percent of all reported sports injuries. However, a considerably higher number of stress fractures are diagnosed in long distance runners and triathletes.
Stress fractures occurring around the pelvis are significantly uncommon although, a majority of them are often considered a differential diagnosis when athletes, specifically long distance runners and triathletes, report hip, groin or buttock pain during and after running. Because stress fractures around the pelvic/hip region, including the sacral, pubic rami and femoral neck region, are rarely diagnosed, understanding and discussing the anatomy of the injury, their clinical presentation, diagnosis and treatment for each of these types of stress fractures is important for an athlete in order to find a solution for those who do encounter it.
How Stress Fractures Occur
Stress fractures occur over a determined period of time when the bone is no longer capable of withstanding submaximal, repetitive forces. They frequently result when normal stresses cause bone fracture with decreased bone density, such as in an elderly osteoporotic individual, or as a result of an abnormal stress being placed against a normal bone and causing a fracture, such as in a long distance runner.
When the bones are exposed to loading, the introductory physiological response is a respective increase in osteoclastic activity, or bone resorption, leading to temporary structural weakening before new bone formation. If these stresses continue to occur without having the bone properly adjust to this additional, ongoing osteoclastic activity, the pressure may exceed bone regeneration, causing microfractures to occur.
The first characteristic of a stress reaction observed through the use of MRI is bone oedema as well as increased activity on bone scan. Bone scan in the acute phase has high sensitivity but an increased uptake may also be due to infection, bone infarction or neoplastic activity. Researchers from previous studies stated that 60 to 70 percent of X-rays in the acute phase of stress fractures, approximately less than 2 weeks after the injury, have a negative result. Due to its high sensitivity as well as a lack of radiation and high specificity, even despite its elevated cost, MRI is often the preferred procedure to identify stress fractures in their early phases.
Various distinct intrinsic and extrinsic elements have been determined as risk factors for stress fractures. These include but are not limited to: biomechanics, strength and flexibility, nutrition, hormonal and menstrual disturbances, and footwear. These must all be considered prior to assessing an individual with a suspected stress fracture. During an analysis of 8 female athletes with sacral stress fractures, the most significant risk factor for these types of fractures was the rapid increase in impact activity during more intense exercise programs. An increase in workload should thus be considered a significant risk factor for stress fractures.
Anatomy of Sacral Stress Fractures
The sacrum consists of 5 fused vertebrae, S1 to S5, and is triangular in shape. It connects with the ilium at the sacroiliac joint and, due to its shape and function to distribute forces, it�s often described as the foundation to the arch of the pelvis. The sacrum, much like an inverted arch, supports the entire weight of the upper body and transfers force to the pelvis.
Sacral stress fractures most commonly occur in the lateral portion of the sacrum and are more frequently diagnosed in women. It�s been hypothesized that the shape of the female pelvis can lead create difficulty when distributing weight through the sacrum than the average male pelvis. However, it�s also been reported that several male elite Australian triathletes have experienced sacral stress fractures in recent years.
Symptoms
An athlete with a sacral stress fracture will often manifest acute onset back, buttock or hip pain which is generally described to occur suddenly during a run, making them incapable of continuing at the time. The individual may also experience limited mobility and they could or could not suffer pain on the palpation of the sacrum. Additionally, they may not experience any neurological symptoms but symptoms of sciatica may be common during this type of stress fracture. Sciatica can include pain, weakness or numbness and burning or tingling sensations along the lower back, buttock or hip, often radiating down the thigh. The individual may suffer pain or tightness when walking and they will experience symptoms when hopping on the affected side. Athletes with sacral stress fractures also frequently report pain during single leg loading tasks, for example, when putting pants on.
Diagnosis
Due to the extreme overlying soft tissue and complex bone anatomy, simple radiographs can rarely conclude the presence of a sacral stress fracture. Bone scan, MRI or CT can be utilized to effectively diagnose a sacral stress fracture. CT and MRI findings suggest that sacral stress fractures occur as a result of constant compressive forces which lead to microfractures of the trabecular bone. These fractures infrequently develop a visible callus on plain radiograph, therefore, MRI or CT scans should be utilized as a follow up imaging if poor healing is detected.
Treatment
The progression of treatment for an athlete with a sacral stress fracture broadly depends on the athlete�s symptoms as these are generally stable fractures. Rehabilitation procedures will progress from non-weight bearing to weight bearing to progressive return to running activities as the symptoms decrease. In most cases, a period of 6 weeks with no running followed by a 6 to 8-week period of a return to running progression may be required. A majority of published works indicate athletes may have a full return to activity by 4 months with rare cases taking up to 14 months.
Repeated CT scans approximately 4 and 8 months after the individual�s original diagnosis can often display no signs of previous fractures which demonstrate a quicker and fuller healing of the well-vascularized trabeculae microfractures when compared to fractures involving the less well-vascularized cancellous bone. Researchers concluded that women with sacral stress fractures who had the best diets and fewer prior stress injuries or menstrual irregularities, healed the fastest.
Anatomy of Pubic Rami Stress Fractures
The inferior pubic ramus slopes downward and medial from the superior ramus, narrowing as it goes down and it is the region where the adductor magnus, brevis and gracilis connect, including the obturator internus and externus. Pubic Rami stress fractures have been diagnosed among runners, triathletes and military service members. These generally occur in the inferior pubic rami next to the pubic symphysis. Researchers proposed that these fractures are a result of repetitive forces being applied to and transmitted to the bone through muscle contraction or fatigue. In a study on female military service members, it was suggested that over-striding during marching procedures was a potential factor contributing to pubic rami stress fractures.
Symptoms
Pubic rami stress fractures are generally detected either in competitive races or during intensive training sessions. These frequently occur at the insertion of the adductors and/or external rotators of the hip. Athletes with pubic rami stress fractures commonly suffer from pain in the hip, buttock, inguinal or adductor region which increases with activity and decreases with rest. It�s important to remember that pain caused by irritation and swelling along these regions may also cause symptoms similar to sciatica. It�s important to receive a proper diagnosis to rule out a compression of the sciatic nerve which could be causing neurological symptoms. Athletes with this type of injury often limp and on clinical testing, they may experience symptoms with passive hip abduction, resisted hip adduction and resisted hip external rotation. Stress fractures of the pelvis can be determined even without radiographic evidence if the following criteria are met by an individual. First, running will be impossible for the athlete as a result of severe discomfort in the groin area. Then, the individual will experience discomfort in the groin with an unsupported stance on the affected leg. And last, an athlete may suffer symptoms of pain and tenderness after deep palpation procedures.
Diagnosis
Simple radiographs may demonstrate displaced fracture lines but a lack of radiographic evidence in the early phases of injury is not uncommon. Bone scan, CT or MRI may be used to determine the presence of fracture and bone oedema may be evident on MRI.
Treatment
These fractures tend to have a high rate for healing following 6 to 10 weeks of rest, however, they have a small risk of non-union and re-fracture if the appropriate amount of rest is not followed. Fractures that display delayed union will likely demonstrate full recovery when further conservative procedures are followed. Progression of treatment should be guided by pain and at first, the individual may require the utilization of crutches as walking may be painful.
Anatomy of Femoral Neck Stress Fractures
The femoral neck is the flattened, pyramid shaped piece of bone which connects the femoral head to the femoral shaft.
Athletes with femoral neck stress fractures generally report hip or groin pain when running. This pain usually has an insidious onset and the symptoms may become significantly worse depending on the intensity or duration of a run. At first, symptoms may occur at the end of a run but as the stress reaction worsens, the pain may begin showing earlier in the run where gradually more time may be required to relieve the pain and discomfort. Athletes with femoral neck stress fractures may experience hip and/or groin pain while resting and may suffer restless nights of sleep due to the symptoms. Often, individuals will also report pain while rolling in bed, single leg stance and during active straight leg raise.
Femoral neck stress fractures are described as either tension or compression stress fractures. Fracture displacement determines the outcome of an injury and tension stress fractures generally have a higher rate of displacement as a result of non-union, malunion or osteonecrosis. Due to this fact, tension stress fractures are considered more serious than compression fractures and may require surgical fixation.
Diagnosis
Conventional radiographs are often negative in the acute setting but may shown signs during instances where symptoms have been present for 2 weeks or more. MRI is the favored standard for diagnosis and should be ordered when a stress fracture of the femoral neck is suspected.
Treatment
Tension side stress fractures require diagnosis from a healthcare professional immediately after its occurred due to their risk of displacement. Compression side fractures are often managed conservatively with protected weight bearing and ongoing monitoring to keep track of the individual�s healing process. Initial phases of management should include non-weight bearing on crutches until there are no symptoms at rest, then progress to partial weight bearing to full weight bearing over a period of 4-6 weeks. A gradual return to run program can be started at 8 to 12-weeks of treatment, once the individual is able to properly walk without experiencing pain and other symptoms.
Return to Activity Plan
With all stress fractures located around the pelvis, a careful, gradual return to activity plan can be an essential element of the rehabilitation process. To make sure the athlete receives progressive loading without sudden increases in workload, the return to activity plan should be at least as long as the time off the individual�s specific activity. For instance, if the athlete had a sacral stress fracture which required 6 weeks of no running, then that athlete needs at least a 6-week gradual return to running plan before they can return to their previous running load.
Hip Strengthening Exercises
A strengthening program of the lower extremities can additionally be implemented early in the rehabilitation process, first beginning with non-weight bearing exercises, which can gradually change as the individual becomes able to weight bear without pain. Early strengthening can also help decrease muscle loss and address any biomechanical complications the athlete might be facing. As the stress fractures heal and the tolerance for load improves, these exercises can be progressed to other higher-load exercises to provide the athlete�s body for the return of their specific sports activity.
Proper stretching and exercising techniques are effective methods and techniques that can help increase an athlete’s strength, mobility and flexibility to prevent experiencing an injury or aggravating a condition. Bone fractures, in this case, pelvic stress fractures, can be challenging to heal but with proper treatment, an athlete will be able to return-to-play in no time.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
Athletes who perform daily rigorous training and/or participate in regular competitions can often be at a higher risk of suffering an injury or developing an injury. Because most sports or physical activities require the repetitive and constant use of the lower extremities, experiencing a complication which affects the lower back, buttocks, thighs and even the feet of the athlete can ultimately alter their performance.
Medial tibial stress syndrome, commonly referred to as shin splints, is not considered to be a medically serious condition, however, it can challenge an athlete�s performance. Approximately 5 percent of all sports injuries are diagnosed as medial tibial stress syndrome, or MTSS for short.
Shin splints, or MTSS, occurs most frequently in specific groups of the athletic population, accounting for 13-20 percent of injuries in runners and up to 35 percent in military service members. Medial tibial stress syndrome is characterized as pain along the posterior-medial border of the lower half of the tibia, which is active during exercise and generally inactive during rest. Athletes describe feeling discomfort along the lower front half of the leg or shin. Palpation along the medial tibia can usually recreate the pain.
Causes of Medial Tibial Stress Syndrome
There are two main speculated causes for medial tibial stress syndrome. The first is that contracting leg muscles place a repeated strain upon the medial portion of the tibia, producing inflammation of the periosteal outer layer of bone, commonly known as periostitis. While the pain of a shin splint is felt along the anterior leg, the muscles located around this region are the posterior calf muscles. The tibialis posterior, flexor digitorum longus, and the soleus all emerge from the posterior-medial section of the proximal half of the tibia. As a result, the traction force from these muscles on the tibia probably aren�t the cause of the pain generally experienced on the distal portion of the leg.
Another theory of this tension is that the deep crural fascia, or the DCF, the tough, connective tissue which surrounds the deep posterior muscles of the leg, may pull excessively on the tibia, causing trauma to the bone. Researchers at the University of Honolulu evaluated a single leg from 5 male and 11 female adult cadavers. Through the study, they confirmed that in these specimens, the muscles of the posterior section of muscles was introduced above the portion of the leg that is usually painful in medial tibial stress syndrome and the deep crural fascia did indeed attach on the entire length of the medial tibia.
Doctors at the Swedish Medical Centre in Seattle, Washington believed that, given the anatomy, the tension from the posterior calf muscles could produce a similar strain on the tibia at the insertion of the DCF, causing injury.
In a laboratory study conducted using three fresh cadaver specimens, researchers concluded that strain at the insertion site of the DCF along the medial tibia advanced linearly as tension increased in the posterior leg muscles. The study confirmed that an injury caused by tension at the medial tibia was possible. However, studies of bone periosteum on individuals with MTSS have yet to find inflammatory indicators to confirm the periostitis theory.
The second theory believed to cause medial tibial stress syndrome is that repetitive or excessive loading may cause a bone-stress reaction in the tibia. When the tibia is unable to properly bear the load being applied against it, it will bend during weight bearing. The overload results in micro damage within the bone, not just along the outer layer. If the repetitive loading exceeds the bone�s ability to repair, localized osteopenia can occur. Because of this, some researchers consider a tibial stress fracture to be the result of a continuum of bone stress reactions that include MTSS.
Utilizing magnetic resonance imaging, or MRI, on the affected leg can often display bone marrow edema, periosteal lifting, and areas of increased bony resorption in athletes with medial tibial stress syndrome. This supports the bone-stress reaction theory. An MRI of an athlete with a diagnosis of MTSS can also help rule out other causes of lower leg pain, such as a tibial stress fracture, deep posterior compartment syndrome, and popliteal artery entrapment syndrome.
Risk factors for MTSS
While the cause, set of causes or manner of causation of MTSS is still only a hypothesis, the risk factors for athletes developing it are well-known. As determined by the navicular drop test, or NDT, a large navicular drop considerably corresponds with a diagnosis of medial tibial stress syndrome. The NDT measures the difference in height position of the navicular bone, from a neutral subtalar joint position in supported non-weight bearing, to full weight bearing. The NDT explains the degree of arch collapse during weight bearing. Results of more than 10 mm is considered excessive and can be a considerable risk factor for the development of MTSS.
Research studies have proposed that athletes with MTSS are most frequently female, have a higher BMI, less running experience, and a previous history of MTSS. Running kinematics for females can be different from that of males and has often been demonstrated to leave individuals vulnerable to suffer anterior cruciate ligament tears and patellofemoral pain syndrome. This same biomechanical pattern may also incline females to develop medial tibial stress syndrome. Hormonal considerations and low bone density are believed to be contributing factors, increasing the risk of MTSS in the female athlete as well.
A higher BMI in an athlete demonstrates that they have more muscle mass rather than being overweight. The end result, however, is the same in that the legs bear a considerably heavy load. It�s been hypothesized that in these cases, the bone growth accelerated by the tibial bowing may not advance quickly enough and injury to the bone may occur. Therefore, those with a higher BMI may need to continue their training programs gradually in order to allow the body to adapt accordingly.
Athletes with less running experience are more likely to make training errors, which may be a common cause for medial tibial stress syndrome. These include but are not limited to: increasing distance too quickly, changing terrain, overtraining, poor equipment or footwear, etc. Inexperience may also lead the athlete to return to activity before the recommended time, accounting for the higher prevalence of MTSS in those who had previously experienced MTSS. A complete recovery from MTSS can take from six months up to ten months, and if the original injury does not properly heal or the athlete returns to training too soon, chances are, their pain and symptoms may return promptly.
Biomechanical Analysis
The NDT is used as a measurable indication of foot pronation. Pronation is described as a tri-planar movement consisting of eversion at the hindfoot, abduction of the forefoot and dorsiflexion of the ankle. Pronation is a normal movement of the body and it is absolutely essential in walking and running. When the foot impacts the ground at the initial contact phase of running, the foot begins to pronate and the joints of the foot acquire a loose-packed position. This flexibility helps the foot absorb ground reaction forces.
During the loading response phase, the foot further pronates, reaching peak pronation by approximately 40 percent during stance phase. In mid stance, the foot moves out of pronation and back to a neutral position. During terminal stance, the foot supinates, moving the joints into a fastened position, creating a rigid lever arm from which to generate the forces for toe off.
Starting with the loading response phase and throughout the rest of the single leg stance phase of running, the hip is stabilized and supported as it is extended, abducted and externally rotated by the concentric contraction of the hip muscles of the stance leg, including the gluteals, piriformis, obturator internus, superior gemellus and inferior gemellus. Weakness or fatigue in any of these muscles can develop an internal rotation of the femur, adduction of the knee, internal rotation of the tibia, and over-pronation. Overpronation therefore, can be a result of muscle weakness or fatigue. If this is the case, the athlete may have a completely normal NDT and yet, when the hip muscles don�t function as needed, these can overpronate.
In a runner who has considerable overpronation, the foot may continue to pronate into mid stance, resulting in a delayed supination response, causing for there to be less power generation at toe off. The athlete can make the effort to apply two biomechanical fixes here that could contribute to the development of MTSS. First of all, the tibialis posterior will strain to prevent the overpronation. This can add tension to the DCF and strain the medial tibia. Second, the gastroc-soleus complex will contract more forcefully at toe off to improve the generation of power. However, it�s hypothesized that the increased force within these muscle groups can add further tension to the medial tibia through the DCF and possibly irritate the periosteum.
Evaluating Injury in Athletes
Once understood that overpronation is one of the leading risk factors for medial tibial stress syndrome, the athlete should begin their evaluation slowly and gradually progress through the procedure. Foremost, the NDT must be performed, making sure if the difference is more than 10mm. Then, it�s essential to analyze the athlete�s running gait on a treadmill, preferably when the muscles are fatigued, such as at the end of a training run. Even with a normal NDT, there may be evidence of overpronation in running.
Next, the athlete�s knee should be evaluated accordingly. The specialist performing the evaluation should note whether the knee is adducted, whether the hip is leveled or if either hip is more than 5 degrees from level. These can be clear indications that there is probably weakness at the hip. Traditional muscle testing may not reveal the weakness; therefore, functional muscle testing may be required.
Additionally, it should be observed whether the athlete can perform a one-legged squat with arms in and arms overhead. The specialist must also note if the hip drops, the knee adducts and the foot pronates. Furthermore, the strength of the hip abductors should be tested in side lying, with the hip in a neutral, extended, and flexed position, making sure the knee is straight. All three positions with the hip rotated in a neutral position and at end ranges of external and internal rotation should also be tested. Hip extensions in prone with the knee straight and bent, in all three positions of hip rotation: external, neutral and internal can also be analyzed and observed to determine the presence of medial tibial stress syndrome, or MTSS. The position where a healthcare professional finds weakness after the evaluation is where the athlete should begin strengthening activities.
Treating the Kinetic Chain
In the presence of hip weakness, the athlete should begin the strengthening process by performing isometric exercises in the position of weakness. For example, if there is weakness during hip abduction with extension, then the athlete should begin isolated isometrics in this position. Until the muscles consistently activate isometrically in this position for 3 to 5 sets of 10 to 20 seconds should the individual progress to adding movement. Once the athlete achieves this level, begin concentric contractions, in that same position, against gravity. Some instances are unilateral bridging and side lying abduction. Eccentric contractions should follow, and then sport specific drills.
In the case that other biomechanical compensations occur, these must also be addressed accordingly. If the tibialis posterior is also displaying weakness, the athlete should begin strengthening exercises in that area. If the calf muscles are tight, a stretching program must be initiated. Utilizing any modalities possible might be helpful towards the rehabilitation process. Last but not least, if the ligaments in the foot are over stretches, the athlete should consider stabilizing footwear. Using a supported shoe for a temporary period of time during rehabilitation can be helpful to notify the athlete to embrace new movement patterns.
MTSS and Sciatica
Medial tibial stress syndrome, otherwise known as shin splints, ultimately is a painful condition that can greatly restrict an athlete�s ability to walk or run. As mentioned above, several evaluations can be performed by a healthcare professional to determine the presence of MTSS in an athlete, however, other conditions aside from shin splints may be causing the individuals leg pain and hip weakness. That is why it�s important to also visit additional specialists to ensure the athlete has received the correct diagnosis for their injuries or conditions.
Sciatica is best referred to as a set of symptoms that originate from the lower back and is caused by an irritation of the sciatic nerve. The sciatic nerve is the single, largest nerve in the human body, communicating with many different areas of the upper and lower leg. Because leg pain can occur without the presence of low back pain, an athlete�s medial tibial stress syndrome could really be sciatica originating from the back. Most commonly, MTSS can be characterized by pain that is generally worse when walking or running while sciatica is generally worse when sitting with an improper posture.
Regardless of the symptoms, it�s essential for an athlete to seek proper diagnosis to determine the cause of their pain and discomfort. Chiropractic care is a popular form of alternative treatment which focuses on musculoskeletal injuries and conditions as well as nervous system disorders. A chiropractor can help diagnose an athlete�s MTSS as well as overrule the presence of sciatica as a cause of the symptoms. In addition, chiropractic care can help restore and improve an athlete�s performance. By utilizing careful spinal adjustments and manual manipulations, a chiropractor can help strengthen the structures of the body and increase the individual�s mobility and flexibility. After suffering an injury, an athlete should receive the proper care and treatment they need and require to return to their specific sport activity as soon as possible.
Chiropractic and Athletic Performance
In conclusion, the best way to prevent pain from MTSS is to decrease the athlete�s risk factors. An athlete should have a basic running gait analysis and proper shoe fitting as well as include hip strengthening in functional positions as part of the strengthening program. Furthermore, one must ensure the athletes fully rehabilitate before returning to play because the chances of recurrence of medial tibial stress syndrome can be high.
Chiropractic care is an effective form of alternative treatment which is commonly preferred by many athletes as it can help with the recovery of an injury and/or condition without the need for medications or surgery. Most athletes are specially trained to prevent injuries, however, the constant and repetitive overworking of the structures of the body can gradually begin to degenerate, leading to issues like shin splints which may potentially manifest symptoms of sciatica if left untreated for an extended period of time.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
