Can physical therapy treatment protocols aimed at improving range of motion and flexibility around the hip and relieving inflammation around the sciatic nerve help individuals experiencing deep buttock pain or piriformis syndrome?
Deep Buttock Pain
Piriformis syndrome, a.k .a. deep buttock pain, is described as sciatic nerve irritation from the piriformis muscle.
The piriformis is a small muscle behind the hip joint in the buttocks.
It is about one centimeter in diameter and functions in the hip joint’s external rotation or turning outward.
The piriformis muscle and tendon are close to the sciatic nerve, which supplies the lower extremities with motor and sensory functions.
Depending on an individual’s anatomic variation of the muscle and tendon:
The two cross over, under, or through each other behind the hip joint in the deep buttock.
This relationship is thought to irritate the nerve, leading to sciatica symptoms.
Piriformis Syndrome
When diagnosed with piriformis syndrome, it is thought that the muscle and tendon bind to and/or spasm around the nerve, causing irritation and pain symptoms.
The theory supported is that when the piriformis muscle and its tendon tighten, the sciatic nerve becomes compressed or pinched. This decreases blood circulation and irritates the nerve from the pressure. (Shane P. Cass 2015)
Tenderness with pressure on the piriformis muscle.
Discomfort in the back of the thigh.
Deep buttock pain behind the hip.
Electric sensations, shocks, and pains travel down the back of the lower extremity.
Numbness in the lower extremity.
Some individuals develop symptoms abruptly, while others go through a gradual increase.
Diagnosis
Doctors will order X-rays, MRIs, and nerve conduction studies, which is normal.
Because piriformis syndrome can be challenging to diagnose, some individuals with minor hip pain may receive a piriformis syndrome diagnosis even if they don’t have the condition. (Shane P. Cass 2015)
It is sometimes referred to as deep buttock pain. Other causes of this type of pain include back and spinal problems like:
Herniated discs
Spinal stenosis
Radiculopathy – sciatica
Hip bursitis
A piriformis syndrome diagnosis is usually given when these other causes are eliminated.
When the diagnosis is uncertain, an injection is administered in the area of the piriformis muscle. (Danilo Jankovic et al., 2013)
Different medications can be used, but the injection itself is used to help determine the specific location of the discomfort.
When an injection is given into the piriformis muscle or tendon, it is often administered by ultrasound guidance to ensure the needle delivers the medication to the correct location. (Elizabeth A. Bardowski, J. W. Thomas Byrd 2019)
Avoiding activities that cause symptoms for at least a few weeks.
Physical Therapy
Emphasize stretching and strengthening the hip rotator muscles.
Non-Surgical Decompression
Gently pulls the spine to release any compression, allowing optimal rehydration and circulation and taking the pressure off the sciatic nerve.
Therapeutic Massage Techniques
To relax and release muscle tension and increase circulation.
Acupuncture
To help relax the piriformis muscle, sciatic nerve, and surrounding area.
Relieve pain.
Chiropractic Adjustments
Realignment rebalances the spine and musculoskeletal system to alleviate pain.
Anti-Inflammatory Medication
To decrease inflammation around the tendon.
Cortisone Injections
Injections are used to decrease inflammation and swelling.
Botulinum Toxin Injection
Injections of botulinum toxin paralyze the muscle to relieve pain.
Surgery
Surgery can be performed in rare cases to loosen the piriformis tendon, known as a piriformis release. (Shane P. Cass 2015)
Surgery is a last resort when conservative treatments have been tried for at least 6 months with little to no relief.
Recovery can take several months.
Sciatica Causes and Treatment
References
Cass S. P. (2015). Piriformis syndrome: a cause of nondiscogenic sciatica. Current sports medicine reports, 14(1), 41–44. doi.org/10.1249/JSR.0000000000000110
Jankovic, D., Peng, P., & van Zundert, A. (2013). Brief review: piriformis syndrome: etiology, diagnosis, and management. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 60(10), 1003–1012. doi.org/10.1007/s12630-013-0009-5
Bardowski, E. A., & Byrd, J. W. T. (2019). Piriformis Injection: An Ultrasound-Guided Technique. Arthroscopy techniques, 8(12), e1457–e1461. doi.org/10.1016/j.eats.2019.07.033
For individuals dealing with plantar fasciitis, every step can be painful. Can taking an integrative approach and utilizing acupuncture help treat this condition and accelerate symptom relief?
Acupuncture Plantar Fasciitis
Plantar fasciitis is when the supportive tissue running under the foot, from the heel to the base of the toes, becomes irritated and painful. The disorder can be difficult to manage, but there are alternative treatment options. Acupuncture plantar fasciitis therapy is one potential method of relief, alleviating pain, and returning the individual to regular activities. Acupuncture involves inserting extremely thin needles into points in the body to restore and balance the normal flow of energy and improve overall health. (Johns Hopkins University. 2024) In traditional Chinese medicine or TCM, the body comprises a series of meridians/channels that supply energy flow or qi/chi.
Facts
Plantar fasciitis is a common disorder affecting the foot. The condition occurs when the plantar fascia, designed to absorb the forces that travel through the arch of the foot, becomes overloaded. When the bottom of the foot is constantly subjected to high amounts of strain, it leads to ligament degeneration, pain, and inflammation. The most common symptom is heel pain, the first thing an individual experiences in the morning or after a long day of work and activities. Anyone can get plantar fasciitis, but those who are more prone to the condition include individuals with:
Acupuncture and its effectiveness are still being studied, but there is evidence suggesting that it is beneficial in plantar fasciitis treatment.
One review found significant pain improvements in individuals who had acupuncture for the condition compared to individuals who received standard treatments like stretching, orthotics, and strengthening. (Anandan Gerard Thiagarajah 2017) The same review also found benefits when comparing acupuncture to a placebo version of the treatment, further reinforcing the findings.
Another medical review found that acupuncture helped alleviate heel pain and improve daily function when combined with nonsteroidal anti-inflammatory medications/NSAIDs such as ibuprofen or naproxen. (Richard James Clark, Maria Tighe 2012)
Side Effects
While acupuncture plantar fasciitis therapy is beneficial, it is important to remember there can be potential side effects that can include:
Pain in the area where the needles were placed.
Bleeding in the area where the needles were placed.
Bruising or skin discoloration.
Allergic reaction or contact dermatitis/itchy rash.
The chances of a serious adverse side effect are relatively low when undergoing acupuncture on the foot.
Acupuncture Points and Sensations
The ways acupuncture works are not yet fully understood, but like other neuromusculoskeletal therapies, the process activates the body’s healing properties.
Inserting a needle into the body’s points stimulates the central nervous system.
This leads to the release of chemicals in the brain, spinal cord, and muscles that promote healing.
These same chemicals and reactions also reduce the body’s sensation of pain. (Teng Chen et al., 2020)
Number of Sessions
The amount of sessions that acupuncture takes to provide pain relief varies from person to person and case to case.
One review found that treating plantar fasciitis weekly with acupuncture produced significant pain relief after four to eight weeks. (Anandan Gerard Thiagarajah 2017)
This corresponds to another medical review that included a study showing significantly improved pain levels in individuals undergoing weekly acupuncture sessions for four weeks. (Richard James Clark, Maria Tighe 2012)
Individuals are recommended to consult a healthcare provider about personalized treatment plans and if they have a bleeding disorder, are on blood thinner medications, or are pregnant.
Thiagarajah A. G. (2017). How effective is acupuncture for reducing pain due to plantar fasciitis?. Singapore medical journal, 58(2), 92–97. doi.org/10.11622/smedj.2016143
Clark, R. J., & Tighe, M. (2012). The effectiveness of acupuncture for plantar heel pain: a systematic review. Acupuncture in medicine : journal of the British Medical Acupuncture Society, 30(4), 298–306. doi.org/10.1136/acupmed-2012-010183
Chan, M. W. C., Wu, X. Y., Wu, J. C. Y., Wong, S. Y. S., & Chung, V. C. H. (2017). Safety of Acupuncture: Overview of Systematic Reviews. Scientific reports, 7(1), 3369. doi.org/10.1038/s41598-017-03272-0
Chen, T., Zhang, W. W., Chu, Y. X., & Wang, Y. Q. (2020). Acupuncture for Pain Management: Molecular Mechanisms of Action. The American journal of Chinese medicine, 48(4), 793–811. doi.org/10.1142/S0192415X20500408
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
Hamstring muscle injuries are common, especially in athletes and individuals with physically demanding jobs. Is there a better chance of full recovery with surgical repair and post-op rehabilitation?
Hamstring Muscle Tear
Most often, hamstring muscle injuries are partial tears of the muscle. These types of injuries are muscle strains that occur when the muscle fibers are stretched beyond their normal limits. Complete tears of the hamstring muscle are unusual, but they do occur in both athletes and non-athletes. Determining the optimal treatment plan depends on:
The severity of the tendon tear
The expectations of the injured individual.
Incomplete tears are when the hamstring muscle is stretched too far, but not completely detached.
Complete tears usually occur at the top of the muscle where the tendon tears away from the pelvis.
A complete tear usually occurs when there is a sudden flexion of the hip and extension of the knee joint – when the muscle contracts in this position, it gets stretched beyond its limits.
Basic hamstring strains can be treated with simple steps – rest, ice, anti-inflammatory medications, and conservative therapies.
Symptoms
Symptoms of a hamstring muscle strain can include pain, bruising, swelling, and movement difficulty. (American Academy of Orthopaedic Surgeons. 2021) Individuals who sustain this injury typically experience sudden sharp pain. Signs of a tear can include:
Sharp pain where the buttock and thigh meet.
Difficulty walking.
Sitting can be difficult as the edge of a chair can place pressure directly on the injury.
Spasms and cramping sensations in the back of the thigh.
Weakness in the leg, specifically when bending the knee or lifting the leg behind the body.
Numbness or burning sensations as a result of sciatic nerve irritation.
Swelling and bruising in the back of the thigh – over time it can travel down to the back of the knee and calf and possibly into the foot.
With a complete hamstring tear, there is usually significant swelling and bruising that develops in the back of the thigh.
Diagnosis
The symptoms can be difficult to spot in the early stages which is why X-rays of the hip or thigh are usually obtained.
In some situations, a fragment of bone can get pulled off the pelvis along with the hamstring muscle attachment. MRI testing can be performed to evaluate the attachment and can define critical features of a complete hamstring muscle tear, including: (American Academy of Orthopaedic Surgeons. 2021)
The number of tendons involved.
Complete versus incomplete tearing.
The amount of retraction – the amount the tendons have pulled back.
This will guide the development of treatment.
Treatment
The treatment of a complete tear will depend on different factors. The other variable is the patient and their expectations.
Treatment is more aggressive in younger individuals like high-level athletes.
Treatment is less aggressive in middle-aged individuals.
Often a single tendon tear can be treated non-surgically.
When one tendon is involved, it is typically not pulled very far from its normal attachment and will develop scar tissue in a positive position.
Conversely, when three tendons have been torn, they usually pull more than a few centimeters away from the bone. These cases have better results with surgical repair. (UW Health. 2017)
Surgeons will use patient characteristics – high-level athletes or less physically active individuals – to guide treatment recommendations.
Rehabilitation
Rehabilitation following surgery can take 3-6 months or longer.
The first six weeks limit weight-bearing with the use of crutches.
Patients may be recommended to wear a brace to reduce tension on the repaired hamstring tendons.
Strengthening does not begin until three months post-op, and even light activities are usually delayed. (UW Health. 2017)
Because this injury can have a long recovery time, some individuals may choose nonsurgical treatment.
Sometimes these individuals experience symptoms of discomfort from sitting and may exhibit long-term weakness of the hamstring muscle.
Full recovery from a complete hamstring muscle injury takes time. Studies have shown high-level athletes are able to resume competitive sports after the repair and rehabilitation of an acute hamstring muscle injury. (Samuel K. Chu, Monica E. Rho. 2016)
Delaying surgical treatment may not always lead to optimal results.
When the tendon is torn away from its normal attachment, it begins to scar around the surrounding soft tissues.
When there is a delay of more than a few weeks following the initial injury, regaining the full length of the tendon and muscle can be challenging.
This could delay the rehabilitation process and may limit the potential for full recovery. (Ho Yoon Kwak, et al., 2011)
With severe injuries, there is a better chance of full recovery with surgical repair but could involve a long recovery and commitment to a post-op rehabilitation plan.
Chu, S. K., & Rho, M. E. (2016). Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play. Current sports medicine reports, 15(3), 184–190. doi.org/10.1249/JSR.0000000000000264
Kwak, H. Y., Bae, S. W., Choi, Y. S., & Jang, M. S. (2011). Early surgical repair of acute complete rupture of the proximal hamstring tendons. Clinics in orthopedic surgery, 3(3), 249–253. doi.org/10.4055/cios.2011.3.3.249
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
Constipation is a leading cause of low back pain in America and can cause a chain reaction in the rest of the body. When the digestional tract swells, it generates added stress on the back and surrounding nerves. Prolonged constipation and pressure can cause sciatica symptoms. Constipation sciatica can be relieved through chiropractic treatment, therapeutic massage, non-surgical spinal decompression, and functional medicine to alleviate symptoms and restore optimal body function.
Constipation Sciatica
Sciatica is irritation, compression, and inflammation of the sciatic nerve, which supplies the thighs, lower legs, and feet. It is usually caused by a pinched/compressed of one or more spinal nerve roots between the vertebrae of the lower back. The buildup of stool in the intestines can cause a dull aching sensation in the low back that can radiate to surrounding areas. Common causes of constipation include:
Bowel movements vary for everyone, and not having a movement daily does not mean constipation is occurring. Some individuals have only three movements a week, while others have multiple movements daily. A recommended indicator of constipation is if there has been a sudden decrease in typical bowel movements. The digestive tract occupies a significant region of the lower torso. Back pain symptoms can present after the rectum becomes obstructed or stools have solidified in the colon. Once constipation has developed, the blockage presses against the nerves and muscles of the back. This causes a range of discomfort signaling by the brain, which worsens as the backup grows. Symptoms of general constipation include:
Feeling full despite not eating anything.
Bloating.
Swelling.
Abdominal cramping.
Infrequent bowel movements.
Discomfort or aching when trying to pass a stool.
Hard and/or lumpy stool.
Constipation is considered chronic when two or more of the following symptoms occur for at least three months:
Further decreased bowel movements.
Straining to defecate.
Stools do not loosen without the use of laxatives.
Passage of hard pebble/pellet stools.
Consistent abdominal pain that is relieved by even slight movement.
Feeling as if the bowels are not fully emptied or a blockage in the rectum.
Feeling the need to assist the release by pressing on the abdomen.
Chiropractic Treatment
Chiropractic treatment can realign the spine, release compressed nerves, increase the frequency of bowel movements, and through the massage and relaxation of the muscles, help to soften stools. Intestinal muscles push the stool to the anus, where it leaves/evacuates the body. Special nerve cells in the intestine, known as ganglion cells,innervate the muscles to push. These nerves connect to the celiac ganglion, which connects to the spinal cord through nerve roots that exit the spine in the lower thoracic and upper lumbar region. The celiac ganglion innervates the liver, stomach, gallbladder, spleen, kidneys, small intestine, and the ascending and transverse colon. Treatment for constipation and back pain depends on the cause of the symptoms. For example, if the constipation is caused by dehydration, a chiropractor will instruct the patient on water intake as part of the personalized treatment plan.
Diagnosis to Recovery
References
Fernandes, Walkyria Vilas Boas, et al. “The effect of a six-week osteopathic visceral manipulation in patients with non-specific chronic low back pain and functional constipation: study protocol for a randomized controlled trial.” Trials vol. 19,1 151. 2 Mar. 2018, doi:10.1186/s13063-018-2532-8
Panarese, Alba, et al. “Chronic functional constipation is strongly linked to vitamin D deficiency.” World journal of gastroenterology vol. 25,14 (2019): 1729-1740. doi:10.3748/wjg.v25.i14.1729
Rédly, Monika. “The effects of chiropractic care on a patient with chronic constipation.” The Journal of the Canadian Chiropractic Association vol. 45,3 (2001): 185–191.
Trager, Robert James, et al. “Association between radicular low back pain and constipation: a retrospective cohort study using a real-world national database.” Pain reports vol. 6,3 e954. 26 Aug. 2021, doi:10.1097/PR9.0000000000000954
Nerve irritation occurs when the nerves exiting the spine become irritated and sensitized. Also known as nerve gliding restriction, it is a condition whereby a nerve becomes irritated by inflamed swelling of structures close to the nerve, such as joints, ligaments, muscles, or discs, that have sustained an accumulative strain which results in swelling and inflammation. A thorough chiropractic assessment and examination can diagnose the extent of the irritation and develop a personalized treatment plan.
Nerve Irritation
When swelling and inflammation interfere with the nerve root, the nerve transmits signals to the brain to let it know there is a threat. The brain interprets these signals and creates a protective response to avoid worsening the damage to the nerve. The protective reactions vary from person to person but can include the following:
Muscle tightness and guarding
Aching sensation
Cramping
Radiating discomfort or pain
Pins and needles
Tingling
Numbness
Nerve root irritation also inhibits the body from recovering as fast as it should.
Nerve irritation is not to be confused with nerve root compression or radiculopathy. This is when the nerve becomes compressed/pinched, resulting in the loss of its functions like muscle strength and sensation. Sometimes individuals with nerve irritation can also experience increased neural tension. The nerves adapt to the mechanical loads placed on them through regular movements. Restrictions to neural mobility can cause symptoms to worsen along the pathway and distribution of the nerve.
The nervous system consists of the brain, spine, and nerve branches.
The branches, similar to electrical cables, cannot stretch.
Tension is generated when straightening out body areas, creating a pull and gliding of the nerve to the spinal cord.
When nerve irritation occurs, signals are sent to protect the body, brain, spine, and branches.
Causes
Most commonly, nerve irritation occurs when a structure adjacent to the nerve; this could be a joint, ligament, and/or muscle that accumulates strain and becomes dysfunctional, swollen, inflamed, and/or spasms resulting from protective guarding.
Mild nerve irritation can include accumulated strain from postural overload and swelling from a minor tear in an adjacent ligament.
Often nothing shows as a problem on an MRI scan.
Severe nerve irritation can include disc herniation and shows up on an MRI scan; surgery could be required in some cases.
Symptoms
Stiffness
Tightness
Aches
Pains
Persist even after days of rest, stretching, targeted exercises, avoiding movements, etc.
Stretching feels good at first, but the pain returns or worsens a few hours later or the next day.
The irritation blocks the effective recovery of muscle, joint, tendon, and ligament discomfort symptoms.
Chiropractic Care
Treatment involves various therapies and strengthening the supporting structures while relaxing and releasing tight structures to avoid recurring injuries. Chiropractic care realigns the spine, corrects joints that have shifted out of place, helps to regulate the nervous system’s function, and relieves irritation and inflammation. Whether in the form of an adjustment, traction, or guided exercise, all systems in the body are moved closer to a balanced state. This includes the:
Nervous system
Immune system
Respiratory system
Circulatory system
Endocrine system
Skeletal system
All help support the body’s self-healing process and increase the nervous system’s function.
The chiropractic team will guide the patient through the rehabilitation process to get back to full strength.
Peroneal Nerve Irritation
References
Ellis, Richard F, and Wayne A Hing. “Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy.” The Journal of manual & manipulative therapy vol. 16,1 (2008): 8-22. doi:10.1179/106698108790818594
Gibson, William, et al. “Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults.” The Cochrane database of systematic reviews vol. 9,9 CD011976. 14 Sep. 2017, doi:10.1002/14651858.CD011976.pub2
O’Shea, Simone D et al. “Peripheral muscle strength training in COPD: a systematic review.” Chest vol. 126,3 (2004): 903-14. doi:10.1378/chest.126.3.903
Rozmaryn, L M et al. “Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome.” Journal of hand therapy: official Journal of the American Society of Hand Therapists vol. 11,3 (1998): 171-9. doi:10.1016/s0894-1130(98)80035-5
Sipko, Tomasz, et al. “Mobility of cervical spine and postural equilibrium in patients with spinal overload syndrome.” Ortopedia, traumatologia, rehabilitacja vol. 9,2 (2007): 141-8.
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