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 individuals dealing with hip pain, find the relief they are looking for from spinal decompression to reduce their sciatica pain?
Introduction
When it comes to individuals doing everyday movements, the body can be in weird positions without pain or discomfort. Hence, people can stand or sit for prolonged periods and feel all right when doing strenuous activities. However, as the body ages, the surrounding muscles and ligaments can become weak and tight, while the spinal joints and discs start to be compressed and wear and tear. This is because many individuals make repetitive motions on their bodies that cause pain-like symptoms in the back, hips, neck, and body extremities, leading to referred pain in different body locations. When individuals are experiencing musculoskeletal pain in their bodies, it can cause overlapping risk profiles that can hinder the individual and cause them to be miserable. Additionally, when people experience musculoskeletal pain in their bodies, many will seek treatment to reduce the referred pain-like symptoms associated with the musculoskeletal pain. Today’s article will examine one type of musculoskeletal pain on the hips, how it can cause sciatica pain-like problems, and how treatments like decompression can reduce the pain-like effects of hip pain correlated with sciatica. We talk with certified medical providers who consolidate our patients’ information to provide numerous treatments to relieve hip pain associated with sciatica. We also inform and guide patients on how decompression can help reduce pain-like symptoms like sciatica and restore hip mobility. We encourage our patients to ask their associated medical providers intricated and important questions about the pain-like symptoms they are experiencing from hip pain. Dr. Jimenez, D.C., incorporates this information as an academic service. Disclaimer.
Hip Pain Associated With Sciatica
Do you often experience stiffness in your lower back and hips after sitting down for an excessive period? How about feeling radiating pain running down from your lower back to your legs? Or do you think your hip and thigh muscles become tight and weak, which is affecting your gait stability? Many individuals experiencing these pain-like issues are experiencing hip pain, and it can be an issue when it is not treated over time. Since hip pain is a common and disabling condition that is challenging to diagnose, many individuals often express localized pain in one of the three anatomic regions: the anterior, posterior, and lateral hip sections. (Wilson & Furukawa, 2014) When individuals are dealing with hip pain, they will also experience referred pain in their lower backs, which causes them to be in distress and miserable. At the same time, simple ordinary movements like sitting or standing can affect the muscles and ligaments surrounding the hips and can be damaging. This can cause hip pain to be referred from the lumbar spine and spine problems, which then cause musculoskeletal issues in the lower extremities. (Lee et al., 2018)
So, how would hip pain be associated with sciatica and causing pain in many lower extremities? The hip areas in the musculoskeletal system have numerous muscles surrounding the pelvic bone area that can become tight and weak, causing referred musculoskeletal pain from intrapelvic and gynecologic issues. (Chamberlain, 2021) This means that musculoskeletal disorders like piriformis syndromes associated with hip pain can lead to sciatica. The sciatic nerve travels down from the lumbar region and the buttocks and behind the leg. When a person is dealing with sciatica and is going to their primary doctor to get treated for the pain, their doctors will do a physical examination to see what factors are causing the pain. Some of the common findings during a physical exam were tenderness and palpation of the greater sciatic notch and the reproduction of pain along the hips. (Son & Lee, 2022) This causes associated symptoms that correlate with sciatica and hip pain, including:
Tingling/numbing sensations
Muscle tenderness
Pain while sitting or standing
Discomfort
Is Motion The Key To Healing- Video
Spinal Decompression Reducing Hip Pain
However, many individuals will find non-surgical treatments to help reduce sciatica associated with hip pain. Non-surgical treatments are customized to a person’s pain and are cost-effective while being gentle on the spine. Spinal decompression can help reduce hip pain associated with sciatica. Decompression on the spine allows gentle traction to stretch out weak muscles along the lower back and hips while the spinal discs are experiencing negative pressure. When a person is dealing with sciatica pain associated with hip pain and trying decompression for the first time, they are provided with the relief they deserve. (Crisp et al., 1955)
Additionally, many individuals who incorporate decompression for their hip pain can begin to feel its effects as it helps improve blood flow circulation back to the hips to start the natural healing process. (Hua et al., 2019) When people begin incorporating decompression for their hip pain, they can relax as they feel all their aches and pain gradually disappear as mobility and rotation are back on the lower extremities.
References
Chamberlain, R. (2021). Hip Pain in Adults: Evaluation and Differential Diagnosis. American Family Physician, 103(2), 81-89. www.ncbi.nlm.nih.gov/pubmed/33448767
Crisp, E. J., Cyriax, J. H., & Christie, B. G. (1955). Discussion on the treatment of backache by traction. Proc R Soc Med, 48(10), 805-814. www.ncbi.nlm.nih.gov/pubmed/13266831
Hua, K. C., Yang, X. G., Feng, J. T., Wang, F., Yang, L., Zhang, H., & Hu, Y. C. (2019). The efficacy and safety of core decompression for the treatment of femoral head necrosis: a systematic review and meta-analysis. J Orthop Surg Res, 14(1), 306. doi.org/10.1186/s13018-019-1359-7
Lee, Y. J., Kim, S. H., Chung, S. W., Lee, Y. K., & Koo, K. H. (2018). Causes of Chronic Hip Pain Undiagnosed or Misdiagnosed by Primary Physicians in Young Adult Patients: a Retrospective Descriptive Study. J Korean Med Sci, 33(52), e339. doi.org/10.3346/jkms.2018.33.e339
Son, B. C., & Lee, C. (2022). Piriformis Syndrome (Sciatic Nerve Entrapment) Associated With Type C Sciatic Nerve Variation: A Report of Two Cases and Literature Review. Korean J Neurotrauma, 18(2), 434-443. doi.org/10.13004/kjnt.2022.18.e29
Wilson, J. J., & Furukawa, M. (2014). Evaluation of the patient with hip pain. American Family Physician, 89(1), 27-34. www.ncbi.nlm.nih.gov/pubmed/24444505
The discs between the spine’s vertebrae provide cushioning and shock absorption in the spine and the rest of the body. Degenerative changes to the discs are believed to be the start of spinal stenosis. When the discs lack sufficient hydration/water and disc height decreases over time, the cushioning and shock absorption becomes less and less effective. The vertebrae can then become compressed, causing friction. Degenerative spinal stenosis can also develop from excess scar tissue and bone spurs (growth that develops on the edge of a bone) that can form after injury or spinal surgery.
Assessment
A physician will make a diagnosis of spinal stenosis. The doctor will take an imaging scan of the spine to determine the exact location of the degeneration and to measure how narrow the openings have become. Pain, stiffness, limited mobility, and loss of range of motion are often present. If spinal stenosis has caused nerve compression, there may also be pain, numbness, tingling, or weakness in the buttocks (sciatica), thighs, and lower legs. A physical therapist will determine the degree by assessing the following:
Vertebrae mobility – how the spine bends and twists in different directions.
Ability to change positions.
The strength of the core, back, and hip muscles.
Balance
Posture
Gait pattern
Nerve compression to determine if there are any symptoms in the legs.
Milder cases usually do not involve nerve compression, as back stiffness is more common.
In more severe cases, there may be significant pain, limited mobility, and nerve compression, causing leg weakness.
The most common symptom of spinal stenosis is increased pain with backward bending or extension of the lumbar spine. This includes positions that extend the spine, such as standing, walking, and lying on the stomach. Symptoms usually improve when bending forward and when the spine is positioned more into a flexed or bent position, like when sitting and reclining. These body positions open up the spaces in the central spinal canal.
Surgery
Spinal stenosis is the most common reason for undergoing surgery in adults 65 and older. However, surgery is almost always performed as a last resort if pain, symptoms, and disability persist after trying conservative therapies, including chiropractic, non-surgical decompression, and physical therapy, for months or years. The severity of symptoms and current state of health will determine whether a doctor will recommend surgery. (Zhuomao Mo, et al., 2018). Conservative measures can be safer and just as effective. A systematic review or study based on all available primary research found that physical therapy and exercise resulted in similar outcomes to surgery for improving pain and disability. (Zhuomao Mo, et al., 2018). Except for severe cases, surgery is often not necessary.
Physical Therapy for Spinal Stenosis
The objective of physical therapy includes:
Decreasing pain and joint stiffness.
Relieving nerve compression.
Reducing tightness in the surrounding muscles.
Improving the range of motion.
Improving postural alignment.
Strengthening the core muscles.
Improving leg strength to help with balance and overall function.
Stretching of the back muscles, including those running vertically along the spine and those running diagonally from the pelvis to the lumbar spine, helps relieve muscle tightness and pain and can improve overall mobility and range of motion of the lumbar spine.
Stretching the hip muscles, including the hip flexors in the front, the piriformis in the back, and the hamstrings that run from the back of the hip down the leg to the knee, is also important as these muscles are attached to the pelvis, which directly connects to the spine.
Exercises for strengthening the abdominal core muscles, including the muscles in the trunk, pelvis, lower back, hips, and abdomen, help stabilize the spine and protect it from excessive movement and compressive forces.
With spinal stenosis, the core muscles often become weak and inactive and unable to do their job to support the spine. Core exercises often begin by activating the deep abdominal muscles while lying flat on the back with the knees bent.
Exercises will progress as the individual gains more strength and control as the spine stabilizes.
Spinal stenosis physical therapy will also involve balance training and glute exercises for strengthening the leg muscles.
Prevention
Working with a physical therapist can help prevent future problems by maintaining spinal mobility, keeping the individual active, and exercising to maintain strength and stability to provide a solid foundation to support the lower back and prevent symptoms from worsening.
Severe Spinal Stenosis Physical Therapy
Physical therapy usually involves performing stretches for the lower back, hips, and legs, mobility exercises, and core strengthening exercises to improve spinal support and decrease pain. Treatments like heat or electrical stimulation may also be used on a case-by-case basis if there is significant pain or tightness in the back muscles. However, there is not enough clinical evidence to support that there are additional benefits. (Luciana Gazzi Macedo, et al., 2013) The effectiveness of physical therapy is high because surgery alone cannot strengthen the muscles that stabilize the spine, increase the mobility or flexibility of the surrounding muscles, and improve postural alignment.
The Root Causes of Spinal Stenosis
References
Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. doi.org/10.1136/bmj.h6234
Mo, Z., Zhang, R., Chang, M., & Tang, S. (2018). Exercise therapy versus surgery for lumbar spinal stenosis: A systematic review and meta-analysis. Pakistan journal of medical sciences, 34(4), 879–885. doi.org/10.12669/pjms.344.14349
Macedo, L. G., Hum, A., Kuleba, L., Mo, J., Truong, L., Yeung, M., & Battié, M. C. (2013). Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review. Physical therapy, 93(12), 1646–1660. doi.org/10.2522/ptj.20120379
Individuals that have gone through a back injury may develop a synovial spinal cyst as a way to protect the spine that could cause pain symptoms and sensations. Can knowing the signs help healthcare providers develop a thorough treatment plan to relieve pain, prevent worsening of the condition and other spinal conditions?
Spinal Synovial Cysts
Spinal synovial cysts are benign fluid-filled sacs that develop in the spine’s joints. They form because of spinal degeneration or injury. The cysts can form anywhere in the spine, but most occur in the lumbar region/lower back. They typically develop in the facet joints or junctions that keep the vertebrae/spinal bones interlocked.
Symptoms
In most cases, synovial cysts don’t cause symptoms. However, the doctor or specialist will want to monitor for signs of degenerative disc disease, spinal stenosis, or cauda equina syndrome. When symptoms do present, they typically cause radiculopathy or nerve compression, which can cause back pain, weakness, numbness, and radiating pain caused by the irritation. The severity of symptoms depends on the size and location of the cyst. Synovial cysts can affect one side of the spine or both and can form at one spinal segment or at multiple levels.
Effects Can Include
Radiculopathy symptoms can develop if the cyst or inflammation caused by the cyst comes into contact with a spinal nerve root. This can cause sciatica, weakness, numbness, or difficulty controlling certain muscles.
Neurogenic claudication/impingement and inflammation of spinal nerves can cause cramping, pain, and/or tingling in the lower back, legs, hips, and buttocks. (Martin J. Wilby et al., 2009)
If the spinal cord is involved, it may cause myelopathy/severe spinal cord compression that can cause numbness, weakness, and balance problems. (Dong Shin Kim et al., 2014)
Symptoms related to cauda equina, including bowel and/or bladder problems, leg weakness, and saddle anesthesia/loss of sensation in the thighs, buttocks, and perineum, can present but are rare, as are synovial cysts in the middle back and neck. If thoracic and cervical synovial cysts develop, they can cause symptoms like numbness, tingling, pain, or weakness in the affected area.
Causes
Spinal synovial cysts are generally caused by degenerative changes like osteoarthritis that develop in a joint over time. With regular wear and tear, facet joint cartilage/the material in a joint that provides protection, a smooth surface, friction reduction, and shock absorption begins to waste away. As the process continues, the synovium can form a cyst.
Traumas, large and small, have inflammatory and degenerative effects on joints that can result in the formation of a cyst.
Around a third of individuals who have a spinal synovial cyst also have spondylolisthesis.
This condition is when a vertebrae slips out of place or out of alignment onto the vertebra underneath.
It is a sign of spinal instability.
Instability can occur in any spine area, but L4-5 are the most common levels.
This segment of the spine takes most of the upper body weight.
Epidural corticosteroid injections can reduce inflammation and could be an option to relieve pain.
Patients are recommended to receive no more than three injections per year.
Surgical Options
For severe or persistent cases, a doctor may recommend decompression surgery to remove the cyst and surrounding bone to relieve pressure on the nerve root. Surgical options range from minimally invasive endoscopic procedures to larger, open surgeries. The best surgical option varies based on the severity of the situation and whether associated disorders are present. Surgical options include:
Laminectomy – Removal of the bony structure that protects and covers the spinal canal/lamina.
Hemilaminectomy – A modified laminectomy where a smaller portion of the lamina is removed.
Facetectomy – The removal of part of the affected facet joint where the synovial cyst is located, usually following a laminectomy or hemilaminectomy.
Fusionof the facet joints and vertebra – Decreases vertebral mobility in the injured area.
Most individuals experience immediate pain relief following a laminectomy or hemilaminectomy.
Fusion can take six to nine months to heal completely.
If surgery is performed without fusion where the cyst originated, the pain could return, and another cyst could form within two years.
Surgery Complications include infection, bleeding, and injury to the spinal cord or nerve root.
How I Gained My Mobility Back With Chiropractic
References
Wilby, M. J., Fraser, R. D., Vernon-Roberts, B., & Moore, R. J. (2009). The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine, 34(23), 2518–2524. doi.org/10.1097/BRS.0b013e3181b22bd0
Kim, D. S., Yang, J. S., Cho, Y. J., & Kang, S. H. (2014). Acute myelopathy caused by a cervical synovial cyst. Journal of Korean Neurosurgical Society, 56(1), 55–57. doi.org/10.3340/jkns.2014.56.1.55
Epstein, N. E., & Baisden, J. (2012). The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surgical neurology international, 3(Suppl 3), S157–S166. doi.org/10.4103/2152-7806.98576
Individuals who have gone through recent low back surgery, like a lumbar laminectomy and discectomy, could they benefit from physical therapy for full recovery? (Johns Hopkins Medicine. 2008)
Rehabilitation Exercise Program
A lumbar laminectomy and discectomy is a surgical procedure performed by an orthopedic or neurologic surgeon to help decrease pain, relieve associated symptoms and sensations, and improve flexibility and mobility. The procedure involves cutting away disc and bone material that presses against, irritates, and damages the spinal nerves. (Johns Hopkins Medicine. 2023)
Post-Surgery
The therapist will work with the individual to develop a rehabilitation exercise program. The objective of a rehabilitation exercise program is to help the individual:
Relax their muscles to prevent muscle tensing and becoming over-cautious
Regain full range of motion
Strengthen their spine
Prevent injuries
A guide on what to expect in physical therapy.
Postural Retraining
After back surgery, individuals have to work to maintain proper posture when sitting and standing. (Johns Hopkins Medicine. 2008)
Postural control is important to learn as it maintains the lower back in the optimal position to protect and expedite the healing of lumbar discs and muscles.
A physical therapist will teach the individual how to sit with proper posture and use lumbar support.
Attaining and maintaining proper posture is one of the most important things to help protect the back and prevent future back problems.
Walking helps to improve cardiovascular health and blood circulation throughout the body.
This helps to provide added oxygen and nutrients to the spinal muscles and tissues as they heal.
It is an upright exercise that puts the spine in a natural position, which helps to protect the discs.
The therapist will help set up a program tailored to the individual’s condition.
Prone Press Up
One of the exercises to protect the back and lumbar discs is prone press-ups. (Johns Hopkins Medicine. 2008) This exercise helps keep the spinal discs situated in the proper position. It also helps to improve the ability to bend back into lumbar extension.
To perform the exercise:
Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
Keep the back and hips relaxed.
Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
There should be a slight pressure in the lower back while pressing up.
Hold the press-up position for 2 seconds.
Slowly lower back down to the starting position.
Repeat for 10 to 15 repetitions.
Sciatic Nerve Gliding
Individuals who had leg pain coming from the back prior to surgery may have been diagnosed with sciatica or an irritation of the sciatic nerve. Post-surgery, individuals may notice their leg feels tight whenever straightening it out all the way. This could be a sign of an adhered/trapped sciatic nerve root, a common problem with sciatica.
After lumbar laminectomy and discectomy surgery, a physical therapist will prescribe targeted exercises called sciatic nerve glides to stretch and improve how the nerve moves. (Richard F. Ellis, Wayne A. Hing, Peter J. McNair. 2012)
Nerve glides can help free the stuck nerve root and allow for normal motion.
To perform the exercise:
Lie on the back and bend one knee up.
Grab underneath the knee with the hands.
Straighten the knee while supporting it with the hands.
Once the knee is fully straightened, flex and extend the ankle about 5 times.
Return to the starting position.
Repeat the sciatic nerve glide 10 times.
The exercise can be performed several times to help improve how the nerve moves and glides in the lower back and leg.
Supine Lumbar Flexion
After surgery, gentle back flexion exercises can help safely stretch the low-back muscles and gently stretch the scar tissue from the surgical incision. Supine lumbar flexion is one of the simplest exercises to improve lumbar flexion range of motion.
To perform the exercise:
Lie on the back with the knees bent.
Slowly lift the bent knees towards the chest and grasp the knees with both hands.
Gently pull the knees toward the chest.
Hold the position for 1 or 2 seconds.
Slowly lower the knees back to the starting position.
Perform for 10 repetitions.
Stop the exercise if experiencing an increase in pain in the lower back, buttocks, or legs.
Hip and Core Strengthening
Once cleared, individuals can progress to an abdominal and core strengthening program. This involves performing specific motions for the hips and legs while maintaining a pelvic neutral position. Advanced hip strengthening exercises help generate strength and stability in the muscles that surround the pelvic area and lower back. A physical therapist can help decide which exercises are recommended for the specific condition.
Return-to-Work and Physical Activities
Once individuals have gained an improved lumbar range of motion, hip, and core strength, their doctor and therapist may recommend working on specific activities to help them return to their previous level of work and recreation. Depending on job occupation, individuals may need to:
Work on proper lifting techniques.
Require an ergonomic evaluation if they spend time sitting at a desk or workstation.
Some surgeons may have restrictions on how much an individual can bend, lift, and twist from two to six weeks after surgery.
Low-back surgery can be difficult to rehab properly. Working with a healthcare provider and physical therapist, individuals can be sure to improve their range of motion, strength, and functional mobility to return to their previous level of function quickly and safely.
Ellis, R. F., Hing, W. A., & McNair, P. J. (2012). Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. The Journal of orthopaedic and sports physical therapy, 42(8), 667–675. doi.org/10.2519/jospt.2012.3854
Individuals feeling tingling or pins and needles sensations that overtake the arms or legs could be experiencing paresthesia, which occurs when a nerve has been compressed or damaged. Can knowing the symptoms and causes help in diagnosis and treatment?
Paresthesia Body Sensations
The numbness or tingling feeling when an arm, leg, or foot has fallen asleep is not so much about blood circulation but nerve function.
Paresthesia is an abnormal sensation felt in the body due to the compression or irritation of nerves.
It can be a mechanical cause like a compressed/pinched nerve.
Or it may be due to a medical condition, injury, or illness.
The symptoms typically last for 30 minutes or less.
Shaking the affected limb often relieves the sensations.
Paresthesia usually affects only one arm or leg at a time.
However, both arms and legs can be affected, depending on the cause.
Consult a healthcare provider if the symptoms last for more than 30 minutes. Treatment may be required if paresthesia body sensations are brought on by a serious underlying cause.
Causes
Sitting with incorrect and unhealthy postures can compress a nerve and generate symptoms. However, some causes are more concerning and can include:
If the symptoms don’t go away after 30 minutes or keep returning for unknown reasons, call a healthcare provider to find out what is causing the abnormal sensations. A worsening case should be monitored by a healthcare provider.
Peripheral neuropathy caused by diabetes usually begins with a feeling of paresthesia in the foot/feet and can worsen and lead to other complications.
A healthcare provider will work with the individual to understand the symptoms and perform the appropriate diagnostic tests to determine the cause. A healthcare provider will choose the tests based on a physical examination. Common diagnostic procedures include: (Merck Manual Professional Version. 2022)
Magnetic resonance imaging – MRI of the spine, brain, or extremities.
X-ray to rule out bone abnormalities, like a fracture.
Blood tests.
Electromyography – EMG studies.
Nerve conduction velocity – NCV test.
If paresthesia is accompanied by back or neck pain, a healthcare provider may suspect a compressed/pinched spinal nerve.
If the individual has a history of diabetes that is poorly controlled, they may suspect peripheral neuropathy.
Treatment
Treatment for paresthesia depends on the diagnosis. A healthcare provider can help determine the best course of action for the specific condition.
Nervous System
If symptoms are triggered by a central nervous condition like MS, individuals will work closely with their healthcare provider to get the appropriate treatment.
If paresthesia is caused by compression of a spinal nerve, like sciatica, individuals may be referred to a chiropractor and physical therapy team to release the nerve and pressure. (Julie M. Fritz, et al., 2021)
A physical therapist may prescribe spinal exercises to relieve compression of the nerve and restore normal sensations and motion.
Strengthening exercises to restore flexibility and mobility may be prescribed if weakness presents along with paresthesia body sensations.
Herniated Disc
If a herniated disc is causing the abnormal sensations, and there has been no improvement with conservative measures, a healthcare provider may suggest surgery to relieve pressure on the nerve/s. (American Association of Neurological Surgeons. 2023)
In surgical procedures like a laminectomy or discectomy, the objective is to restore nerve function.
Post-surgery, individuals may be recommended to a physical therapist to help regain mobility.
National Institute of Neurological Disorders and Stroke. (2023) Paresthesia.
American Association of Neurological Surgeons. (2023) Herniated disc.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018) Peripheral neuropathy.
Merck Manual Professional Version. (2022) Numbness.
Razazian, N., Yavari, Z., Farnia, V., Azizi, A., Kordavani, L., Bahmani, D. S., Holsboer-Trachsler, E., & Brand, S. (2016). Exercising Impacts on Fatigue, Depression, and Paresthesia in Female Patients with Multiple Sclerosis. Medicine and science in sports and exercise, 48(5), 796–803. doi.org/10.1249/MSS.0000000000000834
Fritz, J. M., Lane, E., McFadden, M., Brennan, G., Magel, J. S., Thackeray, A., Minick, K., Meier, W., & Greene, T. (2021). Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica : A Randomized Controlled Trial. Annals of internal medicine, 174(1), 8–17. doi.org/10.7326/M20-4187
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
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