Sciatica "The Scourge & The Treatments"

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.

Nerve Activity Abnormalities

• Leg cramps are associated with increased, abnormal nerve signaling.

Lack of Physical/Exercise Activity

• 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

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

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: https://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: https://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

A common symptom of sciatica is radiating/spreading pain running down the leg. However, the leg pain could be something to do with the blood vessels. If the pain travels from the low back to the hip, through the buttocks, down the leg, and into the foot, then more than likely it is sciatica. However, sciatica is just one condition that causes leg pain; other causes of leg pain include:

• Bone spurs
• Herniated disc
• Arthritis
• All can irritate the sciatic nerve causing sciatica.

The vascular system, also called the circulatory system, comprises the vessels that circulate blood and lymph throughout the body. Problems with the vascular system are a less common cause of leg pain but can be severe. Therefore, it is vital to learn to tell the difference.

Deep Vein Thrombosis

Deep vein thrombosis - DVT happens when a blood clot forms in a deep vein in the body and not the superficial veins just under the skin. The legs' deep veins are susceptible to clotting. The formation of a clot can happen:

• After surgery
• From an accident
• When recovering, bed resting and not moving.
• When the body is in the same position for a long time with little to no movement, like a long plane ride.
• On long plane rides, try to get up and walk around every hour. If unable to walk, do three sets of 20 reps of heel-to-toe exercises every hour.

Deep vein thrombosis can cause leg pain or swelling but can also present without causing any symptoms. Other risk factors include:

• Diabetes
• Obesity
• Atherosclerosis

Blood Clots

Three main factors place individuals at risk for blood clots. They are:

Hypercoagulability

• This is when the blood is more prone to clotting. This can occur through:
• Genetics
• Medications
• Pregnancy
• Kidney disease
• Trauma

Venous stasis

• This is when blood flow circulation is slower than it should be. This usually happens from:
• Sedentary lifestyle
• Heart conditions
• Obesity
• Smoking
• Clotting disorders

Vascular Trauma

• Blunt or penetrating injury to the blood vessel and/or its walls.

Pain running down the leg from a blood clot feels like:

• Tightness
• Cramping soreness
• Throbbing
• Possible warmth
• Swelling.

Blood clots and sciatica are reported to feel relatively different. The pain from a blood clot does not spread out and does not extend from or to the back. Sciatica does not cause swelling, redness, and warmth. If a doctor suspects a blood clot is causing the pain, they will order an ultrasound to confirm the diagnosis. If it is deep vein thrombosis, blood thinners could be recommended for three to six months.

• A doctor may recommend aspirin, which can help in the prevention of blood clots.
• Compression stockings/socks could also be recommended.
• In some cases, the clot may have to be surgically removed.

Vascular Conditions and Pain Running Down The Leg

Other blood vessel conditions that can cause individuals to believe they have sciatica include:

Peripheral artery disease - PAD

This often presents in individuals with diabetes or who smoke. It causes pain in the calf area but does not radiate throughout the leg. The pain usually presents with physical effort movement. If the pain occurs when at rest, this could be a serious medical emergency. Peripheral artery disease is a chronic condition that can worsen if lifestyle changes are not made to reduce risk factors.

Acute limb ischemia

This condition can cause leg pain, but not the same as sciatica. What happens is the leg is not receiving blood, causing:

• Intense pain in the extremity
• Change in the color of the skin
• Numbness
• Weakness
• Loss of a pulse

This vascular condition is a medical emergency and requires immediate treatment.

Acute compartment syndrome

This can happen after some kind of trauma to the leg.

• The pain is acute, with the leg swelling up and a building up of tight pressure.
• It usually affects the lower part of the leg.
• This condition can also cause:
• Numbness
• Tingling
• Visible swelling
• Bruising

It is considered a medical emergency and needs to be treated quickly to avoid complications.

Varicose veins

Varicose veins can cause some pain running down the leg and/or aching, but the discomfort is not as intense. Treatment has come a long way, is less invasive, and includes:

• Compression stockings, including prescription socks/stockings
• Laser treatments
• Minimally invasive procedures
• Not staying on the feet too much
• Elevating the legs
• Maintaining an ideal weight can help

Vascular Disorder Prevention

Healthy lifestyle habits are recommended to keep the vascular system operating correctly. This includes:

• Getting regular exercise
• Maintaining a healthy weight
• Eating a proper diet
• Quitting smoking
• Controlling diabetes
• Controlling hypertension
• Controlling other conditions that increase the risk of vascular problems.

Sciatica Treatment

If it is sciatica, fortunately, most cases go away on their own, but if treatment is needed, it is recommended to start with conservative treatments such as:

• Chiropractic
• Physical therapy
• Anti-inflammatory medication
• Muscle relaxants
• Corticosteroid injections
• In severe cases, surgery like a microdiscectomy or laminectomy will be performed to relieve pressure on the sciatic nerve.

Body Composition

Why might blood pressure be different when measuring on each arm?

The heart sits just to the left of the midline in the chest cavity. The aorta is the largest blood vessel in the body. It leaves through the left side of the heart and transports blood to a network of blood vessels that branch out, supplying the body with oxygen and nutrients. The arteries that branch off the aorta and go to the left and right sides of the body are different.

On the right, the brachiocephalic trunk comes off the aorta and splits into the right common carotid artery and right subclavian artery. The left common carotid and left subclavian arteries branch directly off the aorta. The differences mean that the risk for arterial thrombosis is not the same for the right and left subclavian arteries. Arterial thrombosis causes the blood vessels to become stiff, causing obstruction over time and is more likely to happen in the left subclavian than in the right. The difference in arterial branching affects blood pressure measurements on the left and right arms. The blood vessels are surrounded by:

• Muscle
• Fat
• Connective tissue

When muscles place pressure on the blood vessels around the heart, it can cause short-term turbulence changes that can affect blood pressure.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

American Heart Association. Atherosclerosis and cholesterol. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis

American Heart Association. What is excessive blood clotting (Hypercoagulation?) https://www.heart.org/en/health-topics/venous-thromboembolism/what-is-excessive-blood-clotting-hypercoagulation

Centers for Disease Control and Prevention. What is venous thromboembolism? https://www.cdc.gov/ncbddd/dvt/facts.html

Cleveland Clinic. Compartment syndrome. https://my.clevelandclinic.org/health/diseases/15315-compartment-syndrome

Mayo Clinic. Deep vein thrombosis overview. https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557

Mayo Clinic. Sciatica. https://www.mayoclinic.org/diseases-conditions/sciatica/diagnosis-treatment/drc-20377441

Mayo Clinic. Sciatica overview. https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435

Mayo Clinic. Varicose veins. https://www.mayoclinic.org/diseases-conditions/varicose-veins/diagnosis-treatment/drc-20350649

Obara, Hideaki et al. “Acute Limb Ischemia.” Annals of vascular diseases vol. 11,4 (2018): 443-448. doi:10.3400/avd.ra.18-00074

ScienceDirect. (n.d.) “Virchow’s Triad.” https://www.sciencedirect.com/topics/medicine-and-dentistry/virchows-triad