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.
Can combining chiropractic treatment with the common therapies of medication, exercise, and/or physical therapy help relieve sciatic endometriosis pain symptoms?
Sciatic Endometriosis
Sciatic endometriosis is a condition in which endometrial cells (tissue that resembles the lining of the uterus) grow outside of the uterine lining and compress the sciatic nerve. This places stress and pressure on the nerve causing back, pelvic, hip, and leg pain, especially before and during the menstrual cycle. It can also cause pain, irregular periods, and infertility. (The American College of Obstetricians and Gynecologists. 2021)
These areas of endometrial tissue growth are also known as lesions or implants.
Women with sciatic endometriosis often experience leg pain and weakness around the time of their menstrual cycle. (Lena Marie Seegers, et al., 2023)
Sciatic endometriosis can also cause pain when urinating, during a bowel movement, during sex, and fatigue, and irregular vaginal bleeding.
The abnormal growth may be caused by higher-than-normal levels of estrogen.
Researchers believe that endometriosis is related to retrograde menstruation, which causes menstrual blood to flow back into the pelvis instead of out through the vagina. (World Health Organization. 2023)
Sometimes, the cells grow in the area of the pelvis right above the sciatic nerve. (Adaiah Yahaya, et al., 2021)
The sciatic nerve is the longest nerve in the body and travels down the back of each leg. (Johns Hopkins Medicine. 2023)
When endometrial lesions place pressure on the sciatic nerve, they can cause irritation and inflammation leading to severe pelvic pain, which makes it harder to conceive. (Liang Yanchun, et al., 2019)
Symptoms
Some women with endometriosis experience no symptoms or misinterpret the symptoms as typical premenstrual syndrome/PMS signs. The most common signs and symptoms of sciatic endometriosis include:
Difficulty walking or standing.
Loss of sensation, muscle weakness, and reflex alteration.
Limping.
Balance problems.
Bloating and nausea.
Constipation or diarrhea before or after a period.
Painful, heavy, and/or irregular periods.
Bleeding between periods.
Pain during sex, urination, and bowel movements.
Pain in the stomach, pelvis, lower back, hips, and buttocks. (MedlinePlus. 2022)
Weakness, numbness, tingling, burning, or dull aching sensations in the back of one or both legs.
Endometriosis, including sciatic endometriosis, typically cannot be diagnosed with a pelvic examination or ultrasound by themselves. A healthcare provider may need to perform a biopsy using laparoscopy and discuss menstrual cycles, symptoms, and medical history.
The laparoscopy procedure involves making tiny incisions and taking a tissue sample with tools attached to a thin tube with a camera. (MedlinePlus. 2022)
Imaging tests, like magnetic resonance imaging/MRI, and computed tomography/CT scans, can help provide essential information about the location and size of any endometrial lesions. (The American College of Obstetricians and Gynecologists. 2021)
Treatment
Symptoms can sometimes be temporarily relieved with over-the-counter/OTC pain relievers. Depending on the condition and severity a healthcare provider may prescribe hormonal treatment to prevent new endometrial implants from growing. These can include:
Hormonal birth control.
Progestin – a synthetic form of progesterone.
Gonadotropin-releasing hormone – GnRH agonists.
If pain persists or worsens, individuals may need to undergo surgery to remove the tissue.
The American College of Obstetricians and Gynecologists. Endometriosis.
Seegers, L. M., DeFaria Yeh, D., Yonetsu, T., Sugiyama, T., Minami, Y., Soeda, T., Araki, M., Nakajima, A., Yuki, H., Kinoshita, D., Suzuki, K., Niida, T., Lee, H., McNulty, I., Nakamura, S., Kakuta, T., Fuster, V., & Jang, I. K. (2023). Sex Differences in Coronary Atherosclerotic Phenotype and Healing Pattern on Optical Coherence Tomography Imaging. Circulation. Cardiovascular imaging, 16(8), e015227. doi.org/10.1161/CIRCIMAGING.123.015227
World Health Organization. Endometriosis.
Yahaya, A., Chauhan, G., Idowu, A., Sumathi, V., Botchu, R., & Evans, S. (2021). Carcinoma arising within sciatic nerve endometriosis: a case report. Journal of surgical case reports, 2021(12), rjab512. doi.org/10.1093/jscr/rjab512
Johns Hopkins Medicine. Sciatica.
Yanchun, L., Yunhe, Z., Meng, X., Shuqin, C., Qingtang, Z., & Shuzhong, Y. (2019). Removal of an endometrioma passing through the left greater sciatic foramen using a concomitant laparoscopic and transgluteal approach: case report. BMC women’s health, 19(1), 95. doi.org/10.1186/s12905-019-0796-0
MedlinePlus. Endometriosis.
Center for Endometriosis Care. Sciatic endometriosis.
Chen, S., Xie, W., Strong, J. A., Jiang, J., & Zhang, J. M. (2016). Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats. European journal of pain (London, England), 20(7), 1044–1057. doi.org/10.1002/ejp.827
Siquara de Sousa, A. C., Capek, S., Howe, B. M., Jentoft, M. E., Amrami, K. K., & Spinner, R. J. (2015). Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases. Neurosurgical focus, 39(3), E15. doi.org/10.3171/2015.6.FOCUS15208
The lumbosacral plexus is located on the posterolateral wall of the lesser pelvis, next to the lumbar spine. A plexus is a network of intersecting nerves that share roots, branches, and functions. The sacral plexus is a network that emerges from the lower part of the spine. The plexus then embeds itself into the psoas major muscle and emerges in the pelvis. These nerves provide motor control to and receive sensory information from portions of the pelvis and leg. Sacral nerve discomfort symptoms, numbness, or other sensations and pain can be caused by an injury, especially if the nerve roots are compressed, tangled, rubbing, and irritated. This can cause symptoms like back pain, pain in the back and sides of the legs, sensory issues affecting the groin and buttocks, and bladder or bowel problems. Injury Medical Chiropractic and Functional Medicine Clinic can develop a personalized treatment plan to relieve symptoms, release the nerves, relax the muscles, and restore function.
Sacral Plexus
Anatomy
The sacral plexus is formed by the lumbar spinal nerves, L4 and L5, and sacral nerves S1 through S4.
Several combinations of these spinal nerves merge together and then divide into the branches of the sacral plexus.
Everybody has two sacral plexi – plural of plexus – one on the right side and left side that is symmetrical in structure and function.
Structure
There are several plexi throughout the body. The sacral plexus covers a large area of the body in terms of motor and sensory nerve function.
Spinal nerves L4 and L5 make up the lumbosacral trunk, and the anterior rami of sacral spinal nerves S1, S2, S3, and S4 join the lumbosacral trunk to form the sacral plexus.
Anterior rami are the branches of the nerve that are towards the front of the spinal cord/front of the body.
At each spinal level, an anterior motor root and a posterior sensory root join to form a spinal nerve.
Each spinal nerve then divides into an anterior – ventral – and a posterior – dorsal – rami portion.
Each can have motor and/or sensory functions.
The sacral plexus divides into several nerve branches, which include:
Superior gluteal nerve – L4, L5, and S1.
Inferior gluteal nerve – L5, S1, and S2.
The sciatic nerve – is the largest nerve of the sacral plexus and among the largest nerves in the body – L4, L5, S1, S2, and S3
The common fibular nerve – L4 through S2, and tibial nerves – L4 through S3 are branches of the sciatic nerve.
Posterior femoral cutaneous nerve – S1, S2, and S3.
Pudendal nerve – S2, S3, and S4.
The nerve to the quadratus femoris muscle is formed by L4, L5, and S1.
The obturator internus muscle nerve – L5, S1, and S2.
The piriformis muscle nerve – S1 and S2.
Function
The sacral plexus has substantial functions throughout the pelvis and legs. The branches provide nerve stimulation to several muscles. The sacral plexus nerve branches also receive sensory messages from the skin, joints, and structures of the pelvis and legs.
Motor
Motor nerves of the sacral plexus receive signals from the brain that travel down the column of the spine, out to the motor nerve branches of the sacral plexus to stimulate muscle contraction and movement. Motor nerves of the sacral plexus include:
Superior Gluteal Nerve
This nerve provides stimulation to the gluteus minimus, gluteus medius, and tensor fascia lata, which are muscles that help move the hip away from the center of the body.
Inferior Gluteal Nerve
This nerve provides stimulation to the gluteus maximus, the large muscle that moves the hip laterally.
Sciatic Nerve
The sciatic nerve has a tibial portion and a common fibular portion, which have motor and sensory functions.
The tibial portion stimulates the inner part of the thigh and activates muscles in the back of the leg and the sole of the foot.
The common fibular portion of the sciatic nerve stimulates and moves the thigh and knee.
The common fibular nerve stimulates muscles in the front and sides of the legs and extends the toes to straighten them out.
Pudendal Nerve
The pudendal nerve also has sensory functions that stimulate the muscles of the urethral sphincter to control urination and the muscles of the anal sphincter to control defecation.
The nerve to the quadratus femoris stimulates the muscle to move the thigh.
The nerve to the obturator internus muscle stimulates the muscle to rotate the hips and stabilize the body when walking.
The nerve to the piriformis muscle stimulates the muscle to move the thigh away from the body.
Conditions
The sacral plexus, or areas of the plexus, can be affected by disease, traumatic injury, or cancer. Because the nerve network has many branches and portions, symptoms can be confusing. Individuals may experience sensory loss or pain in regions in the pelvis and leg, with or without muscle weakness. Conditions that affect the sacral plexus include:
Injury
A traumatic injury of the pelvis can stretch, tear, or harm the sacral plexus nerves.
Bleeding can inflame and compress the nerves, causing malfunction.
Neuropathy
Nerve impairment can affect the sacral plexus or parts of it.
Neuropathy can come from:
Diabetes
Vitamin B12 deficiency
Certain medications – chemotherapeutic meds
Toxins like lead
Alcohol
Metabolic illnesses
Infection
An infection of the spine or the pelvic region can spread to the sacral plexus nerves or produce an abscess, causing symptoms of nerve impairment, pain, tenderness, and sensations around the infected region.
Cancer
Cancer developing in the pelvis or spreading to the pelvis from somewhere else can compress or infect the sacral plexus nerves.
Treatment of the Underlying Medical Condition
Rehabilitation begins with the treatment of the underlying medical condition causing the nerve problems.
Cancer treatment – surgery, chemotherapy, and/or radiation.
Antibiotic treatment for infections.
Neuropathy treatment can be complicated because the cause may be unclear, and an individual can experience several causes of neuropathy simultaneously.
Major pelvic trauma like a vehicle collision can take months, especially if there are multiple bone fractures.
Motor and Sensory Recovery
Sensory problems can interfere with walking, standing, and sitting.
Adapting to sensory deficits is an important part of treatment, rehabilitation, and recovery.
Chiropractic, decompression, massage, and physical therapy can relieve symptoms, restore strength, function, and motor control.
Sciatica Secrets Revealed
References
Dujardin, Franck et al. “Extended anterolateral transiliac approach to the sacral plexus.” Orthopaedics & traumatology, surgery & research: OTSR vol. 106,5 (2020): 841-844. doi:10.1016/j.otsr.2020.04.011
Eggleton JS, Cunha B. Anatomy, Abdomen and Pelvis, Pelvic Outlet. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK557602/
Garozzo, Debora et al. “In lumbosacral plexus injuries can we identify indicators that predict spontaneous recovery or the need for surgical treatment? Results from a clinical study on 72 patients.” Journal of brachial plexus and peripheral nerve injury vol. 9,1 1. 11 Jan. 2014, doi:10.1186/1749-7221-9-1
Gasparotti R, Shah L. Brachial and Lumbosacral Plexus and Peripheral Nerves. 2020 Feb 15. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 20. Available from: www.ncbi.nlm.nih.gov/books/NBK554335/ doi: 10.1007/978-3-030-38490-6_20
Norderval, Stig, et al. “Sacral nerve stimulation.” Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke vol. 131,12 (2011): 1190-3. doi:10.4045/tidsskr.10.1417
Neufeld, Ethan A et al. “MR Imaging of the Lumbosacral Plexus: A Review of Techniques and Pathologies.” Journal of Neuroimaging: official journal of the American Society of Neuroimaging vol. 25,5 (2015): 691-703. doi:10.1111/jon.12253
Staff, Nathan P, and Anthony J Windebank. “Peripheral neuropathy due to vitamin deficiency, toxins, and medications.” Continuum (Minneapolis, Minn.) vol. 20,5 Peripheral Nervous System Disorders (2014): 1293-306. doi:10.1212/01.CON.0000455880.06675.5a
Yin, Gang, et al. “Obturator Nerve Transfer to the Branch of the Tibial Nerve Innervating the Gastrocnemius Muscle for the Treatment of Sacral Plexus Nerve Injury.” Neurosurgery vol. 78,4 (2016): 546-51. doi:10.1227/NEU.0000000000001166
Lying down on the couch or bed when the lower leg seizes with intense sensations and pain that doesn’t stop, and the muscle could be hard to the touch. When trying to move the leg, it feels paralyzed. Nocturnal leg cramps, called muscle spasms or Charley horses, occur when one or more leg muscles tighten involuntarily. Individuals can be awake or asleep when a leg cramp strikes. Chiropractic treatment, decompression, and massage therapies can help relieve symptoms, stretch and relax the muscles, and restore function and health.
Nocturnal Leg Cramps
Nocturnal leg cramps most often affect the gastrocnemius/calf muscle. However, they can also affect the muscles in the front of the thigh/quadriceps and the back of the thigh/hamstrings.
Often, the tight muscle relaxes in less than 10 minutes.
The leg and area can feel sore and tender afterward.
Frequent calf cramps at night can cause sleep problems.
Nocturnal leg cramps are more common among women and older adults.
Causes
There are no known exact cause/s, making most cases idiopathic. However, there are known factors that can increase the risk. These can include:
Prolonged Sitting and Position
Sitting with the legs crossed or the toes pointed for long periods shortens/pulls the calf muscles, which can cause cramping.
Prolonged Standing and Posture
Individuals standing for long periods are likelier to experience nocturnal cramps from the stressed muscles.
Muscle Overexertion
Too much exercise can create an overworked muscle and can contribute to cramps.
Muscles need to be stretched regularly to function correctly.
Lack of physical activity for long periods weakens the muscles, making them more susceptible to injury.
Shortening The Tendons
The tendons, which connect muscles and bones, shorten naturally over time.
Without stretching, this could lead to cramping.
Cramps may be related to foot position when sleeping, with the feet and toes extending away from the body, known as plantar flexion.
This shortens the calf muscles, making them more susceptible to cramping.
Leg cramps at night are unlikely a sign of a more serious medical condition, but they are associated with the following conditions:
Musculoskeletal disorders.
Structural issues – flat feet or spinal stenosis.
Metabolic disorders like diabetes.
Pregnancy.
Medications – statins and diuretics.
Neurological disorders, like motor neuron disease or peripheral neuropathy.
Neurodegenerative disorders.
Liver, kidney, and thyroid conditions.
Cardiovascular conditions.
Chiropractic and Physical Therapy
Rehabilitation with chiropractic, massage, and physical therapy depends on the severity of the injury and condition. A chiropractic treatment plan can include the following:
Calf muscle stretching.
Targeted Stretch Exercises.
Progressive calf stretching exercises – a regular stretching and flexibility program will increase the range of motion and prevent future calf injuries.
Foam rolling – gentle self-massage with a foam roller can help reduce spasms and improve blood circulation.
Percussive massage.
Muscle strengthening exercises will build muscle strength and coordination to prevent future strain injuries.
At-home therapy can include:
Maintain Hydration
Fluids allow for normal muscle function.
Individuals may need to adjust how much fluid is drunk based on weather, age, activity level, and medications.
Change Sleeping Position
Individuals should avoid sleeping in positions in which the feet are pointing downward.
Try sleeping on the back with a pillow behind the knees.
Self Massage
Massaging the affected muscles will help them relax.
Use one or both hands or a massage gun to knead and loosen the muscles gently.
Stretching
Various stretches will maintain the treatment, help keep the muscles relaxed and retrain the muscles.
Stationary Cycle
A few minutes of easy pedaling can help loosen the leg muscles before bed.
Walking on the Heels
This will activate the muscles on the other side of the calf, allowing the calves to relax.
Supportive Footwear
Poor footwear can aggravate issues with the nerves and muscles in the feet and legs.
Orthotics may help.
Heat Application
Heat can soothe tight muscles and increases blood flow to the area.
Apply a hot towel, water bottle, heating pad, or muscle topical cream to the affected area.
A warm bath or shower (if available, shower massage setting) can also help.
Sciatica Secrets Revealed
References
Allen, Richard E, and Karl A Kirby. “Nocturnal leg cramps.” American family physician vol. 86,4 (2012): 350-5.
Butler, J V et al. “Nocturnal leg cramps in older people.” Postgraduate medical journal vol. 78,924 (2002): 596-8. doi:10.1136/pmj.78.924.596
Garrison, Scott R et al. “Magnesium for skeletal muscle cramps.” The Cochrane Database of systematic reviews vol. 2012,9 CD009402. Sep 12, 2012, doi:10.1002/14651858.CD009402.pub2
Giuffre BA, Black AC, Jeanmonod R. Anatomy, Sciatic Nerve. [Updated 2023 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK482431/
Handa, Junichi, et al. “Nocturnal Leg Cramps and Lumbar Spinal Stenosis: A Cross-Sectional Study in the Community.” International Journal of general medicine vol. 15 7985-7993. Nov 1 2022, doi:10.2147/IJGM.S383425
Hsu D, Chang KV. Gastrocnemius Strain. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK534766/
Mayo Clinic Staff. (2019). Night leg cramps. mayoclinic.org/symptoms/night-leg-cramps/basics/causes/sym-20050813
Monderer, Renee S et al. “Nocturnal leg cramps.” Current Neurology and Neuroscience report vol. 10,1 (2010): 53-9. doi:10.1007/s11910-009-0079-5
The piriformis is a large and powerful muscle beneath the gluteal/buttocks muscles. It runs from the bottom of the sacrum, where the base of the spine and pelvis converge to the top of the femur. This muscle plays a critical role in running motion; it helps externally rotate the hips and upper leg outward, provides hip flexibility and stability, and stabilizes the pelvis. The sciatic nerve passes next to, over, under, or through the piriformis muscle. When the piriformis contracts or spasms, it can irritate, become entangled and compress the nerve, resulting in painful symptoms. This can lead to various problems and is how piriformis syndrome occurs.
Running Piriformis Syndrome
The proper function of the piriformis muscle is essential for athletes who participate in running sports. Repetitive activities, like running, can fatigue the muscle and irritate and inflame the nerve.
Symptoms
Piriformis syndrome can be challenging to diagnose because it can be confused for a herniated disc, sciatica, a proximal hamstring strain/high hamstring tendinitis, or lower back problems. A few symptoms that can help determine whether the piriformis is the cause include:
Sitting, Stairs, Squatting Discomfort or Pain
Individuals don’t always experience discomfort while running.
Instead, it’s sitting, climbing stairs, and squatting where pain symptoms present.
Pain while running, specifically an overstretched sensation when going up a hill or increasing speed, is more associated with a proximal hamstring strain.
Tenderness
The area around the piriformis is tender.
Applying pressure can cause discomfort or pain around the area and radiate down the leg.
Centered Pain
Piriformis syndrome is usually felt in the middle of the glutes.
A proximal hamstring strain typically causes non-radiating pain at the bottom of the glutes, where the hamstrings connect to the pelvis.
Causes
Pelvic misalignment.
Pelvic misalignments created by other conditions, like a tilted pelvis, functional leg-length discrepancy, or practicing unhealthy posture, make the piriformis work harder to compensate, which leads to tightness and/or spasms.
Sudden increases in distance or workout intensity can worsen any weakness in the piriformis and other gluteal muscles.
Continuing to run, which is possible, can worsen and prolong the condition.
When running, the muscle’s signal transmissions are interrupted by inflammation and/or compression and cannot synchronize with each other.
The result is the inability to withstand the repetitive strain of running.
Resting may not be enough to alleviate piriformis syndrome. This is especially true if the problem involves spine and pelvic misalignment. Chiropractic can provide significant relief from running piriformis syndrome. A combination of spinal, pelvic, and extremity adjustments, therapeutic massage, MET, decompression, stretches, and anti-inflammatory nutrition will take the pressure off overly tight areas, realign the body, and maintain nervous system function.
Running form could be evaluated and checked for leg-length discrepancies and muscle-strength imbalances.
Running can continue if the individual can do so without pain or symptoms.
But it is recommended to avoid slanted surfaces, which increase the risk of pelvic misalignment.
Avoid long runs, which increase the chance of overload and fatigue.
The goal is to relax and release the piriformis.
If it’s impinging on the sciatic nerve, loosening and releasing the muscle will significantly lessen radiating pain.
Orthotics may be recommended for excessive overpronation or inward movement of the foot when landing.
Other treatments to stop piriformis spasms.
Ice and take over-the-counter anti-inflammatory medications can be used during acute phases when the area is tender.
Work out tight spots using a foam roller or percussive massager.
Stretching and loosening the muscle before and after runs can help it relax and increase blood flow.
Ahmad Siraj, Sidra, and Ragini Dadgal. “Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release.” Cureus vol. 14,12 e32952. 26 Dec. 2022, doi:10.7759/cureus.32952
Chang A, Ly N, Varacallo M. Piriformis Injection. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
Heiderscheit, Bryan, and Shane McClinton. “Evaluation and Management of Hip and Pelvis Injuries.” Physical Medicine and rehabilitation clinics of North America vol. 27,1 (2016): 1-29. doi:10.1016/j.pmr.2015.08.003
Julsrud, M E. “Piriformis syndrome.” Journal of the American Podiatric Medical Association vol. 79,3 (1989): 128-31. doi:10.7547/87507315-79-3-128
Kraus, Emily, et al. “Piriformis Syndrome With Variant Sciatic Nerve Anatomy: A Case Report.” PM & R: the Journal of Injury, Function, and Rehabilitation vol. 8,2 (2016): 176-9. doi:10.1016/j.pmrj.2015.09.005
Lenhart, Rachel, et al. “Hip muscle loads during running at various step rates.” The Journal of Orthopedic and sports physical therapy vol. 44,10 (2014): 766-74, A1-4. doi:10.2519/jospt.2014.5575
Sulowska-Daszyk, Iwona, and Agnieszka Skiba. “The Influence of Self-Myofascial Release on Muscle Flexibility in Long-Distance Runners.” International Journal of environmental research and public health vol. 19,1 457. Jan 1, 2022, doi:10.3390/ijerph19010457
It’s not unusual for runners to experience tingling, pins and needles, and numbness in their feet while running. Running foot numbness is a relatively common problem for runners and can be easily remedied. Numbness will present in one part of the foot or just the toes. Sometimes it can spread throughout the whole foot. Different causes, most of which are not serious, can be easily dealt with. Serious causes can be treated with chiropractic, massage, decompression therapy, and functional medicine.
Running Foot Numbness
Reasons, why the feet experience numbing sensations when running, include:
Improper footwear.
Laces that are tied too tightly.
Foot strike pattern.
Foot structure.
Training schedule.
Muscle tightness.
Compressed nerve.
Medical conditions like neuromas or peripheral neuropathy.
Footwear
A common cause of running foot numbness is having overly tight shoes that place added pressure on nerves.
If this could be the reason, the remedy is to get new shoes.
Try to find a store that specializes in running shoes and ask for help.
Footwear professionals look at the size of the foot, the shape, and running gait.
For example, individuals with a wide foot may need a style with a wider/larger toebox or the front of the shoe that houses the forefoot.
Get a pair that’s one-half to a full size larger than a regular everyday shoe size.
This is because when running, the feet swell, especially in hot and humid weather.
Going up a half or whole size will also accommodate thicker socks for individuals that run in cold weather.
Sometimes numbness can result from biomechanical issues that can be corrected with the proper shoe.
Tight Laces
Sometimes it’s not the shoes but the laces that are too tight.
Pulling a little tighter to get a firm fit around the ankle is common, but this can entrap nerves on top of the foot at the ankle/anterior tarsal tunnel, similar to the carpal tunnel in the wrist.
This can be problematic for individuals with high arches.
Loosening the laces are recommended.
However, runners may feel insecure with looser laces.
Experimenting with different lacing techniques is recommended to find one that keeps the shoes comfortable without creating undue pressure over the top of the foot.
Using padding under the tongue of the shoe can help.
Foot Fall Pattern
Sometimes running form can put pressure on nerves that, lead to numbness.
Overstriding– Landing heel first with the foot ahead of the body’s center of gravity places the feet on the ground for too long.
Correcting this issue can be achieved by shortening the stride and focusing on landing on the midsole.
This way, the feet will land directly under the body.
Running like stepping on hot coals is recommended, keeping the movements light and quick.
Correcting overstriding saves energy and lowers the risk of shin splints.
A sports chiropractor, physical therapist, or running coach can help fine-tune form for specific guidance.
Foot Structure
The anatomy of the feet, specifically the arches, can contribute to running foot numbness.
Flat feet mean the entire bottom of each foot is in contact with the floor when barefoot.
Overly flexible feet are more likely to experience nerve compression.
This can be corrected with shoe orthotic inserts.
Over-the-counter orthotics may work, but custom orthotics are another option if they don’t.
Muscle Tightness
Stiff, inflexible muscles can lead to anatomical conditions that generate nerve pressure.
Warm-up exercises before running will get the muscles loose and ready.
Stretching is very important before and after running.
Individuals prone to muscle tightness should include flexibility exercises.
Yoga can improve flexibility and body alignment.
Foam rollers and other massage tools will work out kinks in areas where tightness forms and affects nerves, like the quadriceps, calves, hamstrings, and I.T. band.
Regular sports massage and chiropractic can help keep the body pliable.
Sciatic Nerve Issues
A compressed nerve causes a decrease in the sensation to the areas the nerve supplies.
Foot numbness, especially around the heel or the sole, can be caused by sciatic nerve compression.
The pain from sciatica might originate in the back but can end up causing numbness in the feet and/or toes.
Poor posture, tight piriformis muscles, or other back injuries can also cause sciatica.
A chiropractor or physical therapist can prescribe decompression therapy, MET stretches, and rehabilitative exercises.
Prevention
Most of the time, running foot numbness can be treated by adjusting footwear or technique. Here are a few tips for injury prevention:
Evaluate Shoes
First, make sure the shoelaces are not overly tight.
If the shoes are uncomfortable when running, look for another set and get a custom fitting.
Running Form
Avoid overstriding by focusing on landing on the midsole instead of the heel.
This will take the pressure off of the feet.
Foot Orthotics
Individuals with flat feet, high arches, or overly flexible feet should consider orthotics.
Avoid Overtraining
Work rest days into the training schedule and gradually build up to avoid overuse injuries.
Stretch to prevent muscle imbalances, keep muscles loose, and improve the range of motion.
Chiropractic and Physical Therapy
If symptoms don’t improve, see a doctor, podiatrist, or chiropractor so they can rule out conditions and develop a personalized treatment plan.
Benefits of Custom Foot Orthotics
References
Aldridge, Tracy. “Diagnosing heel pain in adults.” American family physician vol. 70,2 (2004): 332-8.
Atik, Aziz, and Selahattin Ozyurek. “Flexible flatfoot.” Northern Clinics of Istanbul vol. 1,1 57-64. 3 Aug. 2014, doi:10.14744/nci.2014.29292
Jackson, D L, and B L Haglund. “Tarsal tunnel syndrome in runners.” Sports medicine (Auckland, N.Z.) vol. 13,2 (1992): 146-9. doi:10.2165/00007256-199213020-00010
Souza, Richard B. “An Evidence-Based Videotaped Running Biomechanics Analysis.” Physical Medicine and rehabilitation clinics of North America vol. 27,1 (2016): 217-36. doi:10.1016/j.pmr.2015.08.006
Sridhara, C R, and K L Izzo. “Terminal sensory branches of the superficial peroneal nerve: an entrapment syndrome.” Archives of physical medicine and Rehabilitation vol. 66,11 (1985): 789-91.
The hamstring muscles attach, through a tendon called the proximal hamstring tendon, to the ischial tuberosity, the bones used to sit deep in the buttock muscles. When the tendon is subjected to overuse/repetitive stresses and strains, the internal structure can become compromised, leading to weakness and pain symptoms. This is known as proximal hamstring tendinopathy. Tendinopathy is an overuse injury where the tendon is repeatedly strained until microscopic tears form. It is common in athletes that do a lot of running but also in individuals that sit for prolonged periods. If left untreated, high hamstring tendinopathy can lead to progressive degeneration of the tissues, leading to chronic weakness, pain, and dysfunction.
High Hamstring Tendinopathy
The hamstrings are a powerful muscle group that extends the hip and flexes the knee. They experience stress and pressure during activity and inactivity/sitting and are susceptible to strain injuries. Tendons attach muscle to bone and are designed to take compressive and tensile weight/loads that stretch or flex. A tendon is made up of fibrous tissue containing organized type 1 collagen. Tendons receive blood; however, the supply is less where the tendon attaches to the bone and is commonly where tendinopathy occurs.
Injury
A hamstring injury involves the bruising, irritation, or tearing of the hamstring tendon or muscle tissue. Severity can range from:
Microtears that cause stiffness and pain symptoms but heal fast on their own.
Severe ruptures that cause debilitating pain, dysfunction and require medical intervention.
The tendon attaches to the ischial tuberosity or sitting buttock bone. Tendons can have a spasm-like reaction to sudden or quick shift changes. A sudden change can cause adverse changes to the tendon. Too much load on the tendon beyond its ability to recover can cause the structure to change and the collagen to break down/tear like a rope tearing and unraveling. High hamstring tendinopathy happens around the hip area and presents as buttock or upper thigh pain. Individuals report deep, dull, radiating buttock pain during walking, running, and prolonged sitting or driving. Sometimes the sciatic nerve can become irritated or entrapped by an affected tendon’s scar tissue, causing sciatica-like symptoms.
Stages of Tendon Pathology
Reactive Phase
Caused by an acute overload of physical activity or inactivity.
The tendon will thicken temporarily to decrease the stress; however, there may be no inflammation.
The tendon can return to normal if the load is reduced or sufficient time for recovery and repair is allowed.
Disrepair
Chronically overloaded.
Unsuccessful healing.
More negative tendon changes occur.
Reversibility is possible with load management and targeted exercises to stimulate the tendon and surrounding tissues.
Degenerative
Continual progression of adverse tendon changes.
More common in older individuals.
Continue load management and strength training to maximize the tendon’s tolerance.
Chiropractic Treatment
A chiropractic therapy team will develop a personalized treatment program to improve tendon structure and strengthen the hamstrings, gluteal, and side abdominal muscles. They will begin with tendon symptom-relieving massage to loosen the muscles and get the blood circulating, MET-targeted stretches to lengthen the muscles, and spinal and pelvic adjustments to realign the body.
Sciatica Explained
References
Buckley, Mark R et al. “Distributions of types I, II and III collagen by region in the human supraspinatus tendon.” Connective tissue research vol. 54,6 (2013): 374-9. doi:10.3109/03008207.2013.847096
Lempainen, Lasse, et al. “Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy.” Muscles, ligaments, and tendons journal vol. 5,1 23-8. 27 Mar. 2015
Mattiussi, Gabriele, and Carlos Moreno. “Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided “Intratissue Percutaneous Electrolysis” application.” Muscles, ligaments, and tendons journal vol. 6,2 248-252. 17 Sep. 2016, doi:10.11138/mltj/2016.6.2.248
Ono, T et al. “Estimation of tensile force in the hamstring muscles during overground sprinting.” International Journal of sports medicine vol. 36,2 (2015): 163-8. doi:10.1055/s-0034-1385865
White, Kristin E. “High hamstring tendinopathy in 3 female long-distance runners.” Journal of chiropractic medicine vol. 10,2 (2011): 93-9. doi:10.1016/j.jcm.2010.10.005
Wilson, Thomas J et al. “Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair.” Orthopedic Journal of sports medicine vol. 5,7 2325967117713685. 3 Jul. 2017, doi:10.1177/2325967117713685
Wobble cushions are small round inflatable support pillows made of a flexible material that can be used to stand and sit on. The cushion creates instability, hence wobble, to engage the lower back, hips, and core muscles. They promote core stability, strengthen muscle tone, and improve balance and body posture. A flexible body helps in injury prevention. At Injury Medical Chiropractic and Functional Medicine Clinic, we utilize innovative techniques and therapies to reduce stress, assist in healing musculoskeletal damage from injuries, disease, or conditions, and keep the spine and whole body healthy.
Wobble Cushions
A common reason for back aches and pains is sitting for long periods. Individuals unintentionally slouch or hunch over as they go through their day, causing strain to the back muscles, gluteal muscles, core muscles, hips, and spine. This causes the lower half of the body to weaken and causes the top muscles to take up the slack to support the torso and lower body.
Muscle Spasms
Muscle spasms can be the acute type that is forceful and involuntary, and chronic sustained stiffness, tightness, cramping, and pain. Lower back discomfort and/or sciatica symptoms vary depending on the cause, location, and severity of the strain or injury. Signs could be dull, burning, or sharp at a single point or over a broad region that could spread into one or both legs. Types of low back discomfort:
Acute symptoms last less than three months. Most individuals with acute episodes will have at least one recurrence.
Recurrent means the acute symptoms return.
Chronic symptoms last longer than three months.
Cushion Benefits
Encouraging active sitting improves posture allowing individuals to sit and stay focused for longer as their body awareness improves, reducing hunching, slumping, slouching, and fidgeting. Other wobble cushion benefits include:
Decreased muscle stress and strain on the joints and ligaments, which improves proprioceptive sense or body awareness.
Increases blood circulation and oxygenation throughout the body.
Helps rehydrate the discs and circulate spinal fluid. Spinal discs do not have a direct blood supply; therefore, movement is required to pump and circulate healthy fluids.
Allows more flexibility in the spine, hips, and core muscles.
Improves overall posture.
The purpose of wobble cushions is not to provide comfort. They are supposed to be uncomfortable and unstable to make the individual sit up straight. The cushion can be placed on a chair or the floor to effectively practice balancing without putting pressure on the back, knees, or feet. They can also be used for practicing standing balance. Various factors to consider when looking for a cushion include:
Stability
Comfort
Resilience
Alignment
All play a role in determining the best option.
Discussing options with a doctor or chiropractor is recommended to ensure that the cushion meets your needs and preferences.
Spinal Hygiene
References
Alrwaily, Muhammad, et al. “Stabilization exercises combined with neuromuscular electrical stimulation for patients with chronic low back pain: a randomized controlled trial.” Brazilian journal of physical therapy vol. 23,6 (2019): 506-515. doi:10.1016/j.bjpt.2018.10.003
Haksever, Bunyamin et al. “The Dynamic Innovative Balance System Improves Balance Ability: A Single-Blind, Randomized Controlled Study.” International journal of sports physical therapy vol. 16,4 1025-1032. 1 Aug. 2021, doi:10.26603/001c.25756
Honert, Eric C, and Karl E Zelik. “Foot and shoe responsible for the majority of soft tissue work in the early stance of walking.” Human movement science vol. 64 (2019): 191-202. doi:10.1016/j.humov.2019.01.008
Ostelo, Raymond Wjg. “Physiotherapy management of sciatica.” Journal of physiotherapy vol. 66,2 (2020): 83-88. doi:10.1016/j.jphys.2020.03.005
Shahvarpour, A et al. “Active-passive biodynamics of the human trunk when seated on a wobble chair.” Journal of biomechanics vol. 49,6 (2016): 939-945. doi:10.1016/j.jbiomech.2016.01.042
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