For individuals dealing with sciatica, can non-surgical treatments like chiropractic care and acupuncture reduce pain and restore function?

Introduction

The human body is a complex machine that allows the host to be mobile and stable when resting. With various muscle groups in the upper and lower body portions, the surrounding muscles, tendons, nerves, and ligaments serve a purpose for the body as they all have specific jobs in keeping the host functional. However, many individuals have developed various habits that cause strenuous activities that cause repetitive motions to their muscles and nerves and affect their musculoskeletal system. One of the nerves that many individuals have been dealing with pain is the sciatic nerve, which causes many issues in the lower body extremities and, when not treated right away, leads to pain and disability. Luckily, many individuals have sought non-surgical treatments to reduce sciatica and restore body function to the individual. Today’s article focuses on understanding sciatica and how non-surgical therapies like chiropractic care and acupuncture can help reduce the sciatic pain-like effects that are causing overlapping risk profiles in the lower body extremities. We discuss with certified medical providers who consolidate with our patients’ information to assess how sciatica is often correlated with environmental factors that cause dysfunction in the body. We also inform and guide patients on how various non-surgical treatments can help reduce sciatica and its correlating symptoms. We also encourage our patients to ask their associated medical providers many intricate and important questions about incorporating various non-surgical therapies as part of their daily routine to reduce the chances and effects of sciatica from returning. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

Understanding Sciatica

Do you often feel radiating pain that travels down one or both legs when sitting down for a long period? How often have you experienced tingling sensations that cause you to shake your leg to reduce the effect? Or have you noticed that stretching your legs causes temporary relief? While these overlapping pain symptoms can affect the lower extremities, many individuals may think it is low back pain, but in actuality, it is sciatica. Sciatica is a common musculoskeletal condition that affects many people worldwide by causing pain to the sciatic nerve and radiating down to the legs. The sciatic nerve is pivotal in providing direct and indirect motor function to the leg muscles. (Davis et al., 2024) When the sciatic nerve is compressed, many people state that the pain can vary in intensity, accompanied by symptoms like tingling, numbness, and muscle weakness that can affect a person’s ability to walk and function. 

However, some of the root causes that lead to the development of sciatica can play into the factor that causes the pain in the lower extremities. Several inherent and environmental factors are often associated with sciatica, causing lumbar nerve root compression on the sciatic nerve. Factors like poor health status, physical stress, and occupational work are correlated with the development of sciatica and can impact a person’s routine. (Gimenez-Campos et al., 2022) Additionally, some of the root causes of sciatica can include musculoskeletal conditions like herniated discs, bone spurs, or spinal stenosis, which can correlate with these inherent and environmental factors that can reduce many individuals’ motility and life quality. (Zhou et al., 2021) This causes many individuals to seek out treatments to relieve sciatica pain and its correlating symptoms. While the pain caused by sciatica can vary, many individuals often seek non-surgical treatments to alleviate their discomfort and pain from sciatica. This allows them to incorporate effective solutions to managing sciatica. 

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*

For individuals experiencing or managing low back pain and/or sciatica, can lumbar traction therapy help provide consistent relief?

Lumbar Traction

Lumbar traction therapy for lower back pain and sciatica could be a treatment option to help restore mobility and flexibility and safely support an individual's return to an optimal level of activity. It is often combined with targeted therapeutic exercise. (Yu-Hsuan Cheng, et al., 2020) The technique stretches the space between the vertebrae in the lower spine, relieving lower back pain.

• Lumbar or low back traction helps to separate the spaces between the vertebrae.
• Separating the bones restores circulation and helps relieve the pressure on pinched nerves like the sciatic nerve, decreasing pain and improving mobility.

Research

Researchers say lumbar traction with exercise did not improve individual outcomes compared to physical therapy exercises on their own (Anne Thackeray et al., 2016). The study examined 120 participants with back pain and nerve root impingement who were randomly selected to undergo lumbar traction with exercises or simple exercises for pain. Extension-based exercises focused on bending the spine backward. This movement is considered effective for individuals with back pain and pinched nerves. The results indicated that adding lumbar traction to physical therapy exercises did not offer significant benefits over extension-based exercise alone for back pain. (Anne Thackeray et al., 2016)

A 2022 study found that lumbar traction is helpful for individuals with lower back pain. The study investigated two different lumbar traction techniques and found that variable-force lumbar traction and high-force lumbar traction helped to relieve lower back pain. High-force lumbar traction was also found to reduce functional disability. (Zahra Masood et al., 2022) Another study found lumbar traction improves the range of motion in the straight leg raise test. The study examined different forces of traction on herniated discs. All the levels improved the individuals' range of motion, but the one-half body-weight traction setting was associated with the most significant pain relief. (Anita Kumari et al., 2021)

Treatment

For individuals with only low back pain, exercise, and postural correction may be all that is needed to provide relief. Research confirms physical therapy exercises can help decrease pain and improve mobility (Anita Slomski 2020). Another study revealed the importance of centralizing sciatic symptoms during repetitive movements. Centralization is moving the pain back to the spine, which is a positive sign that the nerves and discs are healing and occurs during therapeutic exercise. (Hanne B. Albert et al., 2012)

A chiropractor and physical therapy team can educate patients on preventing back pain episodes. Chiropractors and physical therapists are body movement experts who can show which exercises are best for your condition. Starting an exercise program that centralizes symptoms can help individuals return to their normal lifestyle quickly and safely. Consult a healthcare provider before starting any exercise program for back pain.

Movement Medicine: Chiropractic

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 studies 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

Cheng, Y. H., Hsu, C. Y., & Lin, Y. N. (2020). The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis. Clinical rehabilitation, 34(1), 13–22. https://doi.org/10.1177/0269215519872528

Thackeray, A., Fritz, J. M., Childs, J. D., & Brennan, G. P. (2016). The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial. The Journal of orthopaedic and sports physical therapy, 46(3), 144–154. https://doi.org/10.2519/jospt.2016.6238

Masood, Z., Khan, A. A., Ayyub, A., & Shakeel, R. (2022). Effect of lumbar traction on discogenic low back pain using variable forces. JPMA. The Journal of the Pakistan Medical Association, 72(3), 483–486. https://doi.org/10.47391/JPMA.453

Kumari, A., Quddus, N., Meena, P. R., Alghadir, A. H., & Khan, M. (2021). Effects of One-Fifth, One-Third, and One-Half of the Bodyweight Lumbar Traction on the Straight Leg Raise Test and Pain in Prolapsed Intervertebral Disc Patients: A Randomized Controlled Trial. BioMed research international, 2021, 2561502. https://doi.org/10.1155/2021/2561502

Slomski A. (2020). Early Physical Therapy Relieves Sciatica Disability and Pain. JAMA, 324(24), 2476.

https://doi.org/10.1001/jama.2020.24673

Albert, H. B., Hauge, E., & Manniche, C. (2012). Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions?. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 21(4), 630–636. https://doi.org/10.1007/s00586-011-2018-9

Individuals experiencing shooting, aching pain in the lower extremities, and intermittent leg pain could be suffering from neurogenic claudication. Can knowing the symptoms help healthcare providers develop an effective treatment plan?

Neurogenic Claudication

Neurogenic claudication occurs when spinal nerves become compressed in the lumbar or lower spine, causing intermittent leg pain. Compressed nerves in the lumbar spine can cause leg pain and cramps. The pain usually worsens with specific movements or activities like sitting, standing, or bending backward.  It is also known as pseudo-claudication when the space within the lumbar spine narrows. A condition known as lumbar spinal stenosis. However, neurogenic claudication is a syndrome or group of symptoms caused by a pinched spinal nerve, while spinal stenosis describes the narrowing of the spinal passages.

Symptoms

Neurogenic claudication symptoms can include:

• Leg cramping.
• Numbness, tingling, or burning sensations.
• Leg fatigue and weakness.
• A sensation of heaviness in the leg/s.
• Sharp, shooting, or aching pain extending into the lower extremities, often in both legs.
• There may also be pain in the lower back or buttocks.

Neurogenic claudication is different from other types of leg pain, as the pain alternates - ceasing and beginning randomly and worsens with specific movements or activities. Standing, walking, descending stairs, or flexing backward can trigger pain, while sitting, climbing stairs, or leaning forward tends to relieve pain. However, every case is different. Over time, neurogenic claudication can affect mobility as individuals try to avoid activities that cause pain, including exercise, lifting objects, and prolonged walking. In severe cases, neurogenic claudication can make sleeping difficult.

Neurogenic claudication and sciatica are not the same. Neurogenic claudication involves nerve compression in the central canal of the lumbar spine, causing pain in both legs. Sciatica involves compression of nerve roots exiting from the sides of the lumbar spine, causing pain in one leg. (Carlo Ammendolia, 2014)

Causes

With neurogenic claudication, compressed spinal nerves are the underlying cause of the leg pain. In many cases, lumber spinal stenosis - LSS is the cause of pinched nerve. There are two types of lumbar spinal stenosis.

• Central stenosis is the main cause of neurogenic claudication. With this type, the central canal of the lumbar spine, which houses the spinal cord, narrows, causing pain in both legs.
• Lumbar spinal stenosis can be acquired and develop later in life due to spine deterioration.
• Congenital means the individual is born with the condition.
• Both can lead to neurogenic claudication in different ways.
• Foramen stenosis is another type of lumbar spinal stenosis that causes the narrowing of spaces on either side of the lumbar spine where nerve roots branch off the spinal cord. The associated pain is different in that it is either in the right or left leg.
• The pain corresponds to the side of the spinal cord where the nerves are being pinched.

Acquired Lumbar Spinal Stenosis

Lumbar spinal stenosis is usually acquired due to the degeneration of the lumbar spine and tends to affect older adults. The causes of the narrowing can include:

• Spinal trauma, such as from a vehicle collision, work, or sports injury.
• Disc herniation.
• Spinal osteoporosis - wear-and-tear arthritis.
• Ankylosing spondylitis - a type of inflammatory arthritis that affects the spine.
• Osteophytes - bone spurs.
• Spinal tumors - non-cancerous and cancerous tumors.

Congenital Lumbar Spinal Stenosis

Congenital lumbar spinal stenosis means an individual is born with abnormalities of the spine that may not be apparent at birth. Because the space within the spinal canal is already narrow, the spinal cord is vulnerable to any changes as the individual ages. Even individuals with mild arthritis can experience symptoms of neurogenic claudication early on and develop symptoms in their 30s and 40s instead of their 60s and 70s.

Diagnosis

Diagnosis of neurogenic claudication is largely based on the individual's medical history, physical examination, and imaging. The physical examination and review identify where the pain is presenting and when. The healthcare provider may ask:

• Is there a history of lower back pain?
• Is the pain in one leg or both?
• Is the pain constant?
• Does the pain come and go?
• Does the pain get better or worse when standing or sitting?
• Do movements or activities cause pain symptoms and sensations?
• Are there any usual sensations while walking?

Treatment

Treatments can consist of physical therapy, spinal steroid injections, and pain meds. Surgery is a last resort when all other therapies are unable to provide effective relief.

Physical Therapy

A treatment plan will involve physical therapy that includes:

• Daily stretching
• Strengthening
• Aerobic exercises
• This will help improve and stabilize the lower back muscles and correct posture problems.
• Occupational therapy will recommend activity modifications that cause pain symptoms.
• This includes proper body mechanics, energy conservation, and recognizing pain signals.
• Back braces or belts may also be recommended.

Spinal Steroid Injections

Healthcare providers may recommend epidural steroid injections.

• This delivers a cortisone steroid to the outermost section of the spinal column or the epidural space.
• Injections can provide pain relief for three months to three years. (Sunil Munakomi et al., 2024)

Pain Meds

Pain medications are used to treat intermittent neurogenic claudication. These include:

• Over-the-counter analgesics like acetaminophen.
• Nonsteroidal anti-inflammatory drugs or NSAIDs like ibuprofen or naproxen.
• Prescription NSAIDs may be prescribed if needed.
• NSAIDs are used with chronic neurogenic pain and should only be used when required.
• The long-term use of NSAIDs can increase the risk of stomach ulcers, and the overuse of acetaminophen can lead to liver toxicity and liver failure.

Surgery

If conservative treatments are unable to provide effective relief and mobility and/or quality of life are affected, surgery known as a laminectomy may be recommended to decompress the lumbar spine. The procedure may be performed:

• Laparoscopically - with small incisions, scopes, and surgical instrumentation.
• Open surgery - with a scalpel and sutures.
• During the procedure, facets of the vertebra are partially or completely removed.
• To provide stability, the bones are sometimes fused with screws, plates, or rods.
• Success rates for both are more or less the same.
• Between 85% and 90% of individuals undergoing the surgery achieve long-lasting and/or permanent pain relief. (Xin-Long Ma et al., 2017)

Movement Medicine: Chiropractic Care

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 studies or studies supporting our posts. We provide copies of supporting research studies that are 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 contact 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

Ammendolia C. (2014). Degenerative lumbar spinal stenosis and its imposters: three case studies. The Journal of the Canadian Chiropractic Association, 58(3), 312–319.

Munakomi S, Foris LA, Varacallo M. (2024). Spinal Stenosis and Neurogenic Claudication. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430872/

Ma, X. L., Zhao, X. W., Ma, J. X., Li, F., Wang, Y., & Lu, B. (2017). Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials. International journal of surgery (London, England), 44, 329–338. https://doi.org/10.1016/j.ijsu.2017.07.032

Can individuals with piriformis syndrome incorporate acupuncture with various therapies to reduce sciatic nerve pain and other symptoms?

Introduction

As many individuals move around from one location to another thanks to the lower body extremities, the surrounding muscles, ligaments, nerve roots, and tissues help contribute to the sensory-motor function of the hips, legs, buttocks, and feet. All these muscle groups factor in to ensure they can be mobile without the effects of pain or discomfort. However, many factors and issues can cause the surrounding muscles to develop musculoskeletal problems over time, affecting a person’s mobility. One of the muscles that helps share the responsibility for mobility to hips and buttocks is the piriformis muscle, which is often overlooked when various injuries or repetitive motions start to affect a person’s ability to walk. Today’s article examines how piriformis syndrome affects mobility, how sciatic pain correlates with piriformis syndrome, and how therapies like acupuncture can help reduce piriformis syndrome. We talk with certified medical providers who consolidate our patients’ information to provide numerous treatments to minimize piriformis syndrome affecting a person’s mobility. We also inform and guide patients on how treatments like acupuncture can help reduce sciatic nerve pain associated with piriformis syndrome. We encourage our patients to ask their associated medical providers intricated and important questions about the referred pain-like symptoms they are experiencing from piriformis syndrome that is affecting their ability to walk. Dr. Jimenez, D.C., incorporates this information as an academic service. Disclaimer.

Piriformis Syndrome Affecting Mobility

Have you been experiencing muscle tightness in your hips or buttock region, affecting your walking ability? Do you feel sensations of numbness, tingling, or burning pain traveling down to your knees and feet? Or, after a long day of work, do you feel pain when you are sitting down? Most of these symptoms are often correlated with piriformis syndrome. The six surrounding muscles surrounding the gluteal region of the thighs and hips all work together to provide lower body movement while stabilizing the hips and rotating the thighs. The piriformis muscle is a small, flat, pear-shaped muscle that runs on top of the sciatic nerve. Piriformis syndrome is a clinical musculoskeletal condition that causes sciatic nerve entrapment that causes many individuals to report shooting and burning pain down to their buttock region. (Hicks et al., 2024) This causes many people to think they are dealing with low back pain associated with sciatica. When a person is dealing with piriformis syndrome, they will experience limited mobility in their hips, which, over time, if not treated, will affect the thighs and legs. 

How Does Sciatic Nerve Pain correlate with Piriformis Syndrome?

Additionally, since piriformis syndrome is correlated with sciatic nerve pain, some clinical findings causing overlapping risk profiles include restricted external hip rotation and muscle tightness of the lumbosacral muscles. Other clinical findings range from palpatory pain over the greater sciatic notch to aggravated pain in a seated position. (Sharma et al., 2023) Since sciatic nerve entrapment is correlated with piriformis syndrome, it is still regarded as the non-discogenic cause of sciatica. (Son & Lee, 2022) When that sciatic nerve gets trapped within the piriformis muscle, many people will experience numbness, tingling sensations, and similar pain patterns in the legs, just like sciatica; however, when individuals are looking for treatments to reduce the sciatic nerve pain and improve the piriformis muscle.

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*

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

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*

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 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.
• If instability occurs, a cyst can develop.
• However, cysts can form without instability.

Diagnosis

• Cysts are generally diagnosed through MRI. (Nancy E, Epstein, Jamie Baisden. 2012)
• They can sometimes be seen with ultrasound, X-ray, or CT scans.

Treatment

Some cysts remain small and cause few to no symptoms. Cysts only need treatment if they are causing symptoms. (Nancy E, Epstein, Jamie Baisden. 2012)

Lifestyle Adjustments

• A healthcare professional will recommend avoiding certain activities that worsen symptoms.
• Individuals might be advised to begin stretching and targeted exercises.
• Physical therapy or occupational therapy may also be recommended.
• Intermittent use of over-the-counter nonsteroidal anti-inflammatories/NSAIDs like ibuprofen and naproxen can help relieve occasional pain.

Outpatient Procedures

• For cysts that cause intense pain, numbness, weakness, and other issues, a procedure to drain fluid/aspiration from the cyst may be recommended.
• One study found that the success rate ranges from 0 percent to 50 percent.
• Individuals who go through aspiration usually need repeat procedures if fluid build-up returns. (Nancy E, Epstein, Jamie Baisden. 2012)
• 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.
• Fusion of the facet joints and vertebra - Decreases vertebral mobility in the injured area.

1. Most individuals experience immediate pain relief following a laminectomy or hemilaminectomy.
2. Fusion can take six to nine months to heal completely.
3. If surgery is performed without fusion where the cyst originated, the pain could return, and another cyst could form within two years.
4. Surgery Complications include infection, bleeding, and injury to the spinal cord or nerve root.

How I Gained My Mobility Back With Chiropractic 

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 studies 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 discuss the subject matter above further, please contact 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

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. https://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. https://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. https://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 Exercise

Walking is one of the best exercises after lumbar surgery. (Johns Hopkins Medicine. 2008)

• 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:

1. Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
2. Keep the back and hips relaxed.
3. Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
4. There should be a slight pressure in the lower back while pressing up.
5. Hold the press-up position for 2 seconds.
6. Slowly lower back down to the starting position.
7. 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:

1. Lie on the back and bend one knee up.
2. Grab underneath the knee with the hands.
3. Straighten the knee while supporting it with the hands.
4. Once the knee is fully straightened, flex and extend the ankle about 5 times.
5. Return to the starting position.
6. Repeat the sciatic nerve glide 10 times.
7. 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:

1. Lie on the back with the knees bent.
2. Slowly lift the bent knees towards the chest and grasp the knees with both hands.
3. Gently pull the knees toward the chest.
4. Hold the position for 1 or 2 seconds.
5. Slowly lower the knees back to the starting position.
6. Perform for 10 repetitions.
7. 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.

Sciatica, Causes, Symptoms and Tips

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 studies 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

Johns Hopkins Medicine. (2008). The road to recovery after lumbar spine surgery.

Johns Hopkins Medicine. (2023). Minimally Invasive Lumbar Discectomy.

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. https://doi.org/10.2519/jospt.2012.3854

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.

1. Incomplete tears are when the hamstring muscle is stretched too far, but not completely detached.
2. If the tear completes, the injury is more significant, as the ends are no longer connected. (American Academy of Orthopaedic Surgeons. 2021)
3. Complete tears usually occur at the top of the muscle where the tendon tears away from the pelvis.
4. 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.
5. Complete tears are recognized as different injuries and may require more invasive treatments. (American Academy of Orthopaedic Surgeons. 2021)
6. Individuals who sustain this type of injury describe a sharp stabbing in the back of the thigh.
7. The injury may occur in athletes or middle-aged individuals. (American Academy of Orthopaedic Surgeons. 2021)

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.

Understanding Long-Lasting Injuries

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, please contact 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 Academy of Orthopaedic Surgeons. (2021) Hamstring muscle injuries.

UW Health. (2017) Rehabilitation guidelines following proximal hamstring primary repair.

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. https://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. https://doi.org/10.4055/cios.2011.3.3.249

 Are treatments more successful when patients know key terms that describe their back pain and associated conditions?

Nerve Pain Types

When individuals need to better understand their spine diagnosis, being able to distinguish between key terms can make a significant difference in understanding the development of a personalized treatment plan. Terms that describe back pain and various associated conditions can include:

• Sciatica
• Radiating and Referred pain
• Radiculopathy
• Radiculitis
• Neuropathy
• Neuritis

Causes of Back Pain

Back pain symptoms are most commonly caused by the continued practice of unhealthy/poor posture and overcompensated and weakened muscles. Even for individuals that exercise regularly, the movement choices that are made throughout the day can disrupt the way the muscles, tendons, ligaments, and fascia function to maintain proper body alignment.

• Injuries to, and conditions of, the structures of the spinal column like the bones, discs, and nerves, are generally more serious than posture problems and soft tissue-related pain.
• Depending on the diagnosis, structural problems can cause symptoms related to nerve compression, irritation, and/or inflammation. (Michigan Medicine, 2022)

Spine and Nervous System

• The peripheral nerves extend out to the extremities with sensation and movement capabilities.
• Nerve roots exit the spinal canal which is part of the peripheral nervous system.
• The spinal nerve root then exits the spinal column through the foramen. (American Academy of Neurological Surgeons, 2023)
• The branching of nerves from the spinal cord and exit out of the foramina occurs at every level of the spine.

Terms

There are different medical terms when getting a spine diagnosis or going through the treatment process.

Radiculopathy

• Radiculopathy is an umbrella term, describing any disease process that affects a spinal nerve root and is something that's happening to the body.
• When a healthcare provider informs you that your pain is due to radiculopathy, a number of more specific diagnoses, clinical signs, and symptoms may be included as part of the description.
• Common causes of radiculopathy include herniated disc/s and spinal stenosis.
• Less common causes can include a synovial cyst or tumor that presses on the nerve root. (Johns Hopkins Medicine, 2023)
• Radiculopathy can occur in the neck, low back, or in the thoracic area.
• Often, radiculopathy is brought on by some form of compression of the nerve root.
• For example, extruded material from a herniated disc can land on a nerve root, causing pressure to build.
• This can cause symptoms associated with radiculopathy, including numbness, weakness, pain, or electrical sensations. (Johns Hopkins Medicine, 2023)

Even though there's a spinal nerve root on either side of the spinal column, injury, trauma, or issues stemming from degeneration affect the nerves in an asymmetric fashion. Degenerative changes, known as normal wear and tear, typically occur in this fashion. Using the previous herniated disc example, the material that leaks from the disc structure tends to travel in one direction. When this is the case, the symptoms tend to be experienced on the side where the nerve root makes contact with the disc material, but not the other side. (American Association of Neurological Surgeons, 2023)

Radiculitis

• Radiculitis is a form of radiculopathy but it is about inflammation and not compression. (Johns Hopkins Medicine, 2023)
• Radicu- refers to the spinal nerve root.
• The suffix  - itis refers to inflammation.
• The word refers to a spinal nerve root that is inflamed and/or irritated rather than compressed.
• In disc herniations, it is the gel substance that contains various chemicals that is inflammatory.
• When the gel substance makes contact with nerve roots, an inflammatory response is triggered. (Rothman SM, Winkelstein BA 2007)

Radiating or Referred Pain

• Radiating pain follows the path of one of the peripheral nerves that transmit sensory information like heat, cold, pins and needles, and pain.
• The most common cause of radiating pain is impingement/compression of a spinal nerve root. (American Academy of Orthopaedic Surgeons. OrthoInfo)
• Referred pain is experienced in a different area of the body that is away from the pain source which tends to be an organ. (Murray GM., 2009)
• It can be brought on by myofascial trigger points or visceral activity.
• An example of referred pain is symptoms in the jaw or arm when an individual is having a heart attack. (Murray GM., 2009)

Radicular

• The terms radicular pain and radiculopathy tend to get confused.
• Radicular pain is a symptom of radiculopathy.
• Radicular pain radiates from the spinal nerve root to either part or all the way down the limb/extremity.
• However, radicular pain does not represent the complete symptoms of radiculopathy.
• Radiculopathy symptoms also include numbness, weakness, or electrical sensations like pins and needles, burning, or shock that travels down the extremity. (Johns Hopkins Medicine, 2023)

Neuropathy

• Neuropathy is another umbrella term that refers to any dysfunction or disease that affects the nerves.
• It’s usually classified according to the cause, like diabetic neuropathy, or the location.
• Neuropathy can occur anywhere in the body - including the peripheral nerves, the autonomic nerves/organ nerves, or nerves that are located inside the skull and innervate the eyes, ears, nose, etc.
• An example of peripheral neuropathy is carpal tunnel syndrome. (American Academy of Orthopaedic Surgeons. OrthoInfo. 2023)
• One spinal condition that is known to cause peripheral neuropathy is spinal stenosis. (Bostelmann R, Zella S, Steiger HJ, et al., 2016)
• In this condition, changes in the foramina have a narrowing effect on the space that begins to compress the nerves as they exit.
• Neuropathy can affect just one nerve or many nerves simultaneously.
• When multiple nerves are involved it is known as polyneuropathy.
• When it’s just one, it's known as mononeuropathy. (Cleveland Clinic. 2023)

Neuritis

• Neuritis is a type of neuropathy that indicates nerve inflammation. (American Association of Neurological Surgeons)
• Neuritis describes inflammation of peripheral nerves after they have exited the spinal column. (National Institutes of Health. U.S. National Library of Medicine. Medline Plus. 2022)
• Peripheral nerves are the long, thin strands that supply sensation, feeling, and movement impulses to all areas of the body located outside the central nervous system.
• Neuritis can lead to radicular pain, as well as other nerve symptoms. (National Institutes of Health. U.S. National Library of Medicine. Medline Plus. 2022)

Sciatica

• Sciatica describes symptoms that include radiating pain and sensations that travel into the hip, buttock, leg, and foot.
• One of the most common causes of sciatica is radiculopathy.
• Another is spinal stenosis. (Cleveland Clinic. 2023)
• Piriformis syndrome is where a tight buttock/piriformis muscle constricts the sciatic nerve, which runs underneath. (Cass SP. 2015)

Chiropractic

Chiropractic adjustments, non-surgical decompression, MET, and various massage therapies can relieve symptoms, release stuck or trapped nerves and restore function. Through the treatments, the chiropractor and therapists will explain what is happening and why they are using a specific technique. Knowing a little about how the neuromusculoskeletal operates can help the healthcare provider and the patient in developing and adjusting effective treatment strategies.

Sciatica During Pregnancy

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, please contact 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

Michigan Medicine. Upper and Middle Back Pain.

American Academy of Neurological Surgeons. Anatomy of the Spine and Peripheral Nervous System.

Johns Hopkins Medicine. Health Conditions. Radiculopathy.

American Association of Neurological Surgeons. Herniated Disc.

American Academy of Orthopaedic Surgeons. OrthoInfo. Cervical Radiculopathy (Pinched Nerve).

Rothman, S. M., & Winkelstein, B. A. (2007). Chemical and mechanical nerve root insults induce differential behavioral sensitivity and glial activation that are enhanced in combination. Brain Research, 1181, 30–43. https://doi.org/10.1016/j.brainres.2007.08.064

Murray G. M. (2009). Guest Editorial: referred pain. Journal of applied oral science: Revista FOB, 17(6), i. https://doi.org/10.1590/s1678-77572009000600001

American Academy of Orthopaedic Surgeons. OrthoInfo. Carpal Tunnel Syndrome.

Bostelmann, R., Zella, S., Steiger, H. J., & Petridis, A. K. (2016). Could Spinal Canal Compression be a Cause of Polyneuropathy? Clinics and practice, 6(1), 816. https://doi.org/10.4081/cp.2016.816

Cleveland Clinic. Mononeuropathy.

American Association of Neurological Surgeons. Glossary of Neurosurgical Terminology.

National Institutes of Health. U.S. National Library of Medicine. Medline Plus. Peripheral Nerve Disorders.

Cleveland Clinic. Spinal Stenosis.

Cass S. P. (2015). Piriformis syndrome: a cause of non-discogenic sciatica. Current sports medicine reports 14(1), 41–44. https://doi.org/10.1249/JSR.0000000000000110

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

The piriformis is a large and powerful muscle beneath the gluteal/buttocks muscles. It runs from the bottom of the sacrum, where the base of the spine and pelvis converge to the top of the femur. This muscle plays a critical role in running motion; it helps externally rotate the hips and upper leg outward, provides hip flexibility and stability, and stabilizes the pelvis. The sciatic nerve passes next to, over, under, or through the piriformis muscle. When the piriformis contracts or spasms, it can irritate, become entangled and compress the nerve, resulting in painful symptoms. This can lead to various problems and is how piriformis syndrome occurs.

Running Piriformis Syndrome

The proper function of the piriformis muscle is essential for athletes who participate in running sports. Repetitive activities, like running, can fatigue the muscle and irritate and inflame the nerve.

Symptoms

Piriformis syndrome can be challenging to diagnose because it can be confused for a herniated disc, sciatica, a proximal hamstring strain/high hamstring tendinitis, or lower back problems. A few symptoms that can help determine whether the piriformis is the cause include:

Sitting, Stairs, Squatting Discomfort or Pain

• Individuals don't always experience discomfort while running.
• Instead, it's sitting, climbing stairs, and squatting where pain symptoms present.
• Pain while running, specifically an overstretched sensation when going up a hill or increasing speed, is more associated with a proximal hamstring strain.

Tenderness

• The area around the piriformis is tender.
• Applying pressure can cause discomfort or pain around the area and radiate down the leg.

Centered Pain

• Piriformis syndrome is usually felt in the middle of the glutes.
• A proximal hamstring strain typically causes non-radiating pain at the bottom of the glutes, where the hamstrings connect to the pelvis.

Causes

• Pelvic misalignment.
• Pelvic misalignments created by other conditions, like a tilted pelvis, functional leg-length discrepancy, or practicing unhealthy posture, make the piriformis work harder to compensate, which leads to tightness and/or spasms.
• Sudden increases in distance or workout intensity can worsen any weakness in the piriformis and other gluteal muscles.
• Continuing to run, which is possible, can worsen and prolong the condition.
• When running, the muscle's signal transmissions are interrupted by inflammation and/or compression and cannot synchronize with each other.
• The result is the inability to withstand the repetitive strain of running.
• Not warming up with glute-activation exercises increases the risk of running piriformis syndrome.

Chiropractic Treatment

Resting may not be enough to alleviate piriformis syndrome. This is especially true if the problem involves spine and pelvic misalignment. Chiropractic can provide significant relief from running piriformis syndrome. A combination of spinal, pelvic, and extremity adjustments, therapeutic massage, MET, decompression, stretches, and anti-inflammatory nutrition will take the pressure off overly tight areas, realign the body, and maintain nervous system function.

• Running form could be evaluated and checked for leg-length discrepancies and muscle-strength imbalances.
• Running can continue if the individual can do so without pain or symptoms.
• But it is recommended to avoid slanted surfaces, which increase the risk of pelvic misalignment.
• Avoid long runs, which increase the chance of overload and fatigue.
• The goal is to relax and release the piriformis.
• If it’s impinging on the sciatic nerve, loosening and releasing the muscle will significantly lessen radiating pain.
• Orthotics may be recommended for excessive overpronation or inward movement of the foot when landing.

Other treatments to stop piriformis spasms.

• Ice and take over-the-counter anti-inflammatory medications can be used during acute phases when the area is tender.
• Work out tight spots using a foam roller or percussive massager.
• Stretching and loosening the muscle before and after runs can help it relax and increase blood flow.
• Stretches like pigeon pose and standing figure four and exercises like side planks with a leg lift are recommended.

Building a Stronger Body

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

Ahmad Siraj, Sidra, and Ragini Dadgal. “Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release.” Cureus vol. 14,12 e32952. 26 Dec. 2022, doi:10.7759/cureus.32952

Chang A, Ly N, Varacallo M. Piriformis Injection. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Heiderscheit, Bryan, and Shane McClinton. “Evaluation and Management of Hip and Pelvis Injuries.” Physical Medicine and rehabilitation clinics of North America vol. 27,1 (2016): 1-29. doi:10.1016/j.pmr.2015.08.003

Julsrud, M E. “Piriformis syndrome.” Journal of the American Podiatric Medical Association vol. 79,3 (1989): 128-31. doi:10.7547/87507315-79-3-128

Kraus, Emily, et al. “Piriformis Syndrome With Variant Sciatic Nerve Anatomy: A Case Report.” PM & R: the Journal of Injury, Function, and Rehabilitation vol. 8,2 (2016): 176-9. doi:10.1016/j.pmrj.2015.09.005

Lenhart, Rachel, et al. “Hip muscle loads during running at various step rates.” The Journal of Orthopedic and sports physical therapy vol. 44,10 (2014): 766-74, A1-4. doi:10.2519/jospt.2014.5575

Sulowska-Daszyk, Iwona, and Agnieszka Skiba. “The Influence of Self-Myofascial Release on Muscle Flexibility in Long-Distance Runners.” International Journal of environmental research and public health vol. 19,1 457. Jan 1, 2022, doi:10.3390/ijerph19010457

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

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

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:

• Insufficient water/hydration levels.
• An unhealthy diet.
• Vitamin deficiency.
• Stress.
• Little to no physical activity.
• Sporadic and unhealthy bowel movements.
• Overuse of laxatives or enemas.

Other causes of constipation include:

• Medication reactions.
• Antacids that contain aluminum or calcium.
• Calcium channel blockers.
• Iron supplements.
• Pain medications, especially narcotics.
• Sedatives.
• Antispasmodics.
• Antidepressants.
• Anticonvulsants.

Symptoms

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

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 contact 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

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

When sciatica or other radiating nerve pain presents, can learning to distinguish between nerve pain and different types of pain help individuals recognize when spinal nerve roots are irritated or compressed or more serious problems that require medical attention? 

Spinal Nerve Roots and Dermatomes

Spinal conditions such as herniated discs and stenosis can lead to radiating pain that travels down one arm or leg. Other symptoms include weakness, numbness, and/or shooting or burning electrical sensations. The medical term for pinched nerve symptoms is radiculopathy. (National Institutes of Health: National Institute of Neurological Disorders and Stroke. 2020) Dermatomes could be contributing to irritation at the spinal cord, where the nerve roots are causing symptoms in the back and limbs.

Anatomy

The spinal cord has 31 segments.

• Each segment has nerve roots on the right and left that supply motor and sensory functions to the limbs.
• The anterior and posterior communicating branches combine to form the spinal nerves that exit the vertebral canal.
• The 31 spine segments result in 31 spinal nerves.
• Each one transmits sensory nerve input from a specific skin region on that side and area of the body.
• These regions are called dermatomes.
• Except for the first cervical spinal nerve, dermatomes exist for each spinal nerve.
• The spinal nerves and their associated dermatomes form a network all over the body.

Dermatomes Purpose

Dermatomes are the body/skin areas with sensory input assigned to individual spinal nerves. Each nerve root has an associated dermatome, and various branches supply each dermatome off that single nerve root. Dermatomes are pathways through which sensational information in the skin transmits signals to and from the central nervous system. Sensations that are physically felt, like pressure and temperature, get transmitted to the central nervous system. When a spinal nerve root becomes compressed or irritated, usually because it comes into contact with another structure, it results in radiculopathy. (National Institutes of Health: National Institute of Neurological Disorders and Stroke. 2020).

Radiculopathy

Radiculopathy describes symptoms caused by a pinched nerve along the spine. Symptoms and sensations depend on where the nerve is pinched and the extent of the compression.

Cervical

• This is a syndrome of pain and/or sensorimotor deficiencies when nerve roots in the neck are compressed.
• It often presents with pain that goes down one arm.
• Individuals may also experience electrical sensations like pins and needles, shocks, and burning sensations, as well as motor symptoms like weakness and numbness.

Lumbar

• This radiculopathy results from compression, inflammation, or injury to a spinal nerve in the lower back.
• Sensations of pain, numbness, tingling, electrical or burning sensations, and motor symptoms like weakness traveling down one leg are common.

Diagnosis

Part of a radiculopathy physical examination is testing the dermatomes for sensation. The practitioner will use specific manual tests to determine the spinal level from which the symptoms originate. Manual exams are often accompanied by diagnostic imaging tests like MRI, which can show abnormalities in the spinal nerve root. A complete physical examination will determine if the spinal nerve root is the source of the symptoms.

Treating Underlying Causes

Many back disorders can be treated with conservative therapies to provide effective pain relief. For a herniated disk, for example, individuals may be recommended to rest and take a nonsteroidal anti-inflammatory medication. Acupuncture, physical therapy, chiropractic, non-surgical traction, or decompression therapies may also be prescribed. For severe pain, individuals may be offered an epidural steroid injection that can provide pain relief by reducing inflammation. (American Academy of Orthopaedic Surgeons: OrthoInfo. 2022) For spinal stenosis, a provider may first focus on physical therapy to improve overall fitness, strengthen the abdominals and back muscles, and preserve motion in the spine. Pain-relieving medications, including NSAIDs and corticosteroid injections, can reduce inflammation and relieve pain. (American College of Rheumatology. 2023) Physical therapists provide various therapies to decrease symptoms, including manual and mechanical decompression and traction. Surgery may be recommended for cases of radiculopathy that don't respond to conservative treatments.

Injury Medical Chiropractic and Functional Medicine Clinic care plans and clinical services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. We focus on restoring normal body functions after trauma and soft tissue injuries using Specialized Chiropractic Protocols, Wellness Programs, Functional and integrative Nutrition, Agility, and mobility Fitness Training, and Rehabilitation Systems for all ages. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition. Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers to bring El Paso, the top clinical treatments, to our community.

Reclaim Your Mobility: Chiropractic Care For Sciatica Recovery

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 studies or studies supporting our posts. We provide copies of supporting research studies that are 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 contact 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

National Institutes of Health: National Institute of Neurological Disorders and Stroke. (2020). Low back pain fact sheet. Retrieved from https://www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf

American Academy of Orthopaedic Surgeons: OrthoInfo. (2022). Herniated disk in the lower back. https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back/

American College of Rheumatology. (2023). Spinal stenosis. https://rheumatology.org/patients/spinal-stenosis

Can non-surgical treatments like acupuncture and spinal decompression provide relief to individuals dealing with sciatica?

Introduction

When many individuals start to feel pain running down their legs after a long day of activities, it causes them to have limited mobility and difficulty finding a place to rest. Many people think that they are just dealing with leg pain, but it can be more of an issue as they realize that it’s not just the leg pain they are experiencing but it is sciatica. While this long nerve comes from the lower back and travels down to the legs, it can succumb to pain and discomfort when herniated discs or muscles compress and aggravate the nerve. When this happens, it can impact a person’s mobility and quality of life, thus causing them to seek out treatment to reduce the pain from sciatica. Fortunately, alternative therapies like acupuncture and spinal decompression have been utilized to not only minimize sciatic pain but also provide positive, beneficial results. Today’s article looks at sciatica, how spinal decompression and acupuncture can relieve sciatica, and how integrating these two non-surgical treatments can lead to beneficial results. We talk with certified medical providers who consolidate our patients’ information to assess how sciatica can significantly impact a person’s well-being and quality of life. We also inform and guide patients on how integrating acupuncture therapy and spinal decompression can positively reduce sciatica. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating non-surgical treatments into a wellness routine to relieve sciatica and its referred symptoms. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

Understanding Sciatica

Do you often experience numbness or tingling sensations from your lower back to your legs? Do you feel like your gait is feeling off balance? Or have you stretched your legs after being seated for a while, which provides temporary relief? While the sciatic nerve plays a pivotal role in motor function in the legs, when various factors, such as herniated discs and even pregnancy, start to aggravate the nerve, it can cause pain. Sciatica is a deliberating pain condition often mislabeled as low back pain or radicular leg pain due to these two musculoskeletal conditions. These are comorbidities and can be exacerbated by simple twists and turns. (Davis et al., 2024)

Additionally, when many individuals are doing repetitive motions or dealing with degenerative changes in the spine, the spinal discs are more prone to herniation. They may press on the spinal nerves, causing the neuron signals to invoke pain and discomfort in the lower extremities. (Zhou et al., 2021) At the same time, sciatica can be both spinal and extra-spinal sources in the lumbar spinal region, which causes many individuals to be in constant pain and looking for relief. (Siddiq et al., 2020) When sciatica pain starts to affect a person’s lower extremities, causing mobility issues, many people seek treatments to reduce the pain-like effects of sciatica. 

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*

Can the effects of electroacupuncture reduce sciatica in individuals dealing with low back pain to restore their mobility?

Introduction

When many people start to overuse their muscles in the lower quadrants, it can lead to numerous issues that cause pain and discomfort. One of the most common pain issues in the lower quadrants of the musculoskeletal system is sciatica, which is associated with low back pain. This pain duo can affect a person’s daily routine and lead them to pain and discomfort. This musculoskeletal condition is common, and when it affects one of the legs and lower back, many people state that it’s a radiating shooting pain that doesn’t go away for a while. Luckily, there are treatments like electroacupuncture to reduce sciatica associated with low back pain. Today’s article looks at the sciatica-low-back connection, how electroacupuncture reduces this pain connection, and how electroacupuncture can restore mobility to the individual. We talk with certified medical providers who consolidate our patients’ information to assess how to reduce the sciatica-low-back connection with electroacupuncture. We also inform and guide patients on how electroacupuncture therapy can be combined with other therapies to restore mobility to the body. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating electroacupuncture therapy as part of their routine to reduce sciatica associated with low back pain. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

The Sciatica & Low Back Connection

Do you feel muscle aches or pain in your lower back or your legs? Do you experience radiating, throbbing pain in your legs that affects your walking ability? Or have you noticed that your legs and lower back ache more when carrying a heavy object? Many of these scenarios are associated with sciatica, which correlates with lower back pain. Now, sciatica is often characterized by aggravating pain traveling along the sciatic nerve from the lower back region, impairing a person’s quality of life. In the musculoskeletal system, the sciatic nerve plays an important role by providing motor function to the legs. (Davis et al., 2024) Now, when the sciatic nerve, the lumbar region also has a pivotal role. The lumbar region in the musculoskeletal region also has a crucial role in providing support, strength, and flexibility to the body. However, both the sciatic nerve and lumbar spinal region are more prone to stress and injuries from traumatic injuries and environmental factors that can impact the lumbar spinal discs and the sciatic nerve.

Repetitive motions, obesity, improper lifting, degenerative spinal issues, and musculoskeletal conditions are a few causes and risk factors contributing to the development of sciatica associated with the lower back. What eventually happens is that the water content and the progressive loss of the proteoglycans of the spinal discs break down between the vertebrae and protrude out to press on the sciatic nerve, which then can become irritated and cause referred radiating pain in the legs and lower back. (Zhou et al., 2021) The combination of sciatica and lower back pain can become a socio-economic issue depending on the severity of the pain that the sciatic nerve is causing and can make individuals miss out on any activities they are participating in. (Siddiq et al., 2020) While sciatica pain-like symptoms often correlate with the lumbar region, many individuals can find the relief they are looking for through various treatments.

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*

Can individuals dealing with sciatica pain find the relief they need from acupuncture to restore low back mobility?

Introduction

The body’s lower extremities provide stability and movement to the individual as they are moving from one location to another without pain or discomfort. The lower extremities consist of the hips, lower back, legs, thighs, pelvis, knees, and feet; each has various muscles, nerve roots, and ligaments with a specific job to each muscle quadrant. The spinal column in the musculoskeletal system helps provide proper posture while protecting the spinal cord from injuries. However, more often than not, the lower extremities can succumb to injuries as many individuals incorporate repetitive motions that can compress the nerve roots that are spread out to the lower extremities, which can invoke pain. The most common pain that seems to affect the lower back and legs is sciatica, and when not treated, it can cause overlapping risk profiles to the lower extremities. Today’s article examines how sciatica is correlated with the lower back and how non-surgical treatments can help reduce the effects of sciatic pain. We talk with certified medical providers who consolidate our patients’ information to provide numerous treatments to relieve sciatica pain affecting their lower extremities. We also inform and guide patients on how non-surgical treatments can help reduce sciatica pain from the lower musculoskeletal extremities. We encourage our patients to ask their associated medical providers intricated and important questions about the pain-like symptoms they are experiencing from sciatica that are causing them pain. Dr. Jimenez, D.C., incorporates this information as an academic service. Disclaimer.

How Does Sciatica Correlate With The Lower Back?

Do you often experience numb or tingling sensations running down your leg that cause your leg or foot to lose sensation briefly? Do you feel shooting pain in your lower back after excessive sitting at your desk? Or do you find that stretching your legs or back temporarily relieves the pain, only for it to come back? Many individual who are experiencing shooting pain running down their legs are dealing with sciatica. When it comes to the lower extremities in the musculoskeletal system, many individuals make repetitive motions on their spine that can cause the spinal discs to become compressed and herniated under pressure. When the spinal disc is herniated in the lumbar spine, that disc will start to press on the surrounding nerve roots, thus sending radiating pain down the legs. Sciatica is defined as when individuals are experiencing pain coming from the lumbosacral nerve root and causing either a burning, heaviness, or tightness sensation. (Aguilar-Shea et al., 2022) Sciatica can range from mild to severe, forcing many individuals to think their foot is asleep. However, the sciatic nerve root is compressed, trapped, stuck, or pinched, which causes muscle spasms within the lower back, buttock, or legs. Hence, many individuals will explain that they are experiencing low back or leg pain when it is sciatica. 

Since the sciatic nerve is a long, thick nerve in the human body, it travels from the lumbar region down to the knee and connects to other nerves to reach the foot. Sciatica pain can be two conditions with the same pain-like symptom effects known as true or sciatica-like conditions. True sciatica is where an injury is directly affecting the sciatic nerve. This can relate to a slipped disc caused by environmental factors like lifting a heavy object, aggravating the sciatic nerve root, and causing pain that worsens. (Siddiq et al., 2020) For sciatica-like conditions, this is where other musculoskeletal conditions are causing sciatic pain-like symptoms on the lower extremities. Musculoskeletal conditions like piriformis syndrome can cause sciatica pain-like symptoms where the piriformis muscle is irritated or inflamed, pressing on the sciatic nerve, which causes many people to report pain along the gluteal region that may shoot a burning, aching sensations down the back of the legs. (Hicks et al., 2024) However, there are ways to treat sciatica and reduce the pain-like effects causing mobility issues.

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*

Can spinal stenosis physical therapy improve quality of life and decrease pain symptoms for individuals dealing with the degenerative condition?

Spinal Stenosis Physical Therapy

Spinal stenosis causes narrowing of the openings of the vertebrae. The affected openings are either:

• The central spinal canal - where the spinal cord sits.
• Foramen - the small openings on the sides of each vertebra where nerve roots branch off from the spinal cord.
• Spinal stenosis is most common in the lumbar spine/lower back.
• It can also occur in the cervical spine/neck. (Jon Lurie, Christy Tomkins-Lane 2016)

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:

1. Decreasing pain and joint stiffness.
2. Relieving nerve compression.
3. Reducing tightness in the surrounding muscles.
4. Improving the range of motion.
5. Improving postural alignment.
6. Strengthening the core muscles.
7. 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

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 studies 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 discuss the subject matter above further, please contact 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

Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. https://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. https://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. https://doi.org/10.2522/ptj.20120379

For individuals dealing with chronic sciatica, when pain and other symptoms significantly impact daily activities and the ability to walk, can a musculoskeletal healthcare provider help relieve and manage symptoms through a multidisciplinary treatment plan?

Chronic Sciatica

Sciatica is a common condition that results from compression of the sciatic nerve in the lower back or leg. Chronic sciatica occurs when symptoms last for 12 months or longer.

Advanced Sciatica Symptoms

Advanced or chronic sciatica usually produces pain that radiates or travels down the back of the leg. Long-term sciatic nerve compression can result in:

• Leg pain
• Numbness
• Tingling
• Electrical or burning sensations
• Weakness
• Weakness
• Instability of the legs, which can impact the ability to walk.

1. Severe nerve compression can progress to leg paralysis if the nerve is significantly damaged from chronic compression. (Antonio L Aguilar-Shea, et al., 2022)
2. Sciatica can progress to nerve damage of the smaller nerves and travel into the legs and feet. Nerve damage/neuropathy can result in pain, tingling, and loss of sensation. (Jacob Wycher Bosma, et al., 2014)

Disabling Sciatica Treatment Options

When sciatica becomes disabling, affecting an individual's ability to walk, more involved treatment is needed to bring relief. Many cases of chronic and disabling sciatica are caused by problems with the lumbar spine. Compression of the nerve roots that form the sciatic nerve can occur from bulging or herniated discs or spinal stenosis. If symptoms of sciatica persist beyond 12 months with little or no relief from physical therapy, non-surgical mechanical decompression, stretches and exercises, or pain management techniques, surgical procedures may be needed. (Lucy Dove, et al., 2023)

Lumbar decompression surgery encompasses several procedures to create more space in the lumbar spine and relieve nerve compression. Lumbar decompression surgery can include: (Mayfield Clinic. 2021)

Discectomy

• This procedure removes a portion of a damaged disc between vertebrae to alleviate root compression from a bulging or herniated disc.

Laminectomy

• This procedure removes the lamina, a portion of the vertebrae causing nerve compression, especially if there is a bone spur due to arthritic and degenerative changes in the spine.

Foraminotomy

• This procedure widens the foramina, the openings in the vertebrae where the nerve roots exit to relieve compression.

Spinal Fusion

• This procedure takes two or more vertebrae fusing them together with metal rods and screws for stabilization.
• The procedure can be performed if:
• An entire disc is removed.
• Multiple laminectomies were performed.
• One vertebra has slipped forward over another.

Daily Relief Management for Advanced Sciatica

Achieving relief from advanced sciatica symptoms at home can include regularly practicing methods like taking a hot bath or shower massage, and applying a heating pad to the lower back or glutes to relax tight muscles to help release the tightness surrounding the sciatic nerve.

• Corrective or therapeutic exercises like sciatic nerve glides can help reduce tension along the nerve while low-back exercises that move the spine into forward or backward bending can reduce compression. (Witold Golonka, et al., 2021)
• Medications like nonsteroidal anti-inflammatory drugs/NSAIDs, muscle relaxants, or nerve-pain medications may be recommended. (Antonio L Aguilar-Shea, et al., 2022)
• Advanced sciatica may not be as responsive to conservative treatment methods, as the injury has set in and the nerve and surrounding tissues have become significantly restricted.
• Sciatica symptoms lasting longer than 12 months require more involved treatment like injections or surgery to address symptoms effectively. (Antonio L Aguilar-Shea, et al., 2022)

Healing Chronic Sciatica

If the underlying cause can be effectively treated then chronic sciatica can be healed. Chronic sciatica often results from spinal conditions like herniated discs or lumbar spinal stenosis. These conditions narrow the space around the nerve roots that exit from the spinal cord and merge to form the sciatica nerve. Surgery is performed to open the space in the spine. (Mayfield Clinic. 2021) Sometimes sciatica is brought on by less common causes like a tumor or a spinal infection. In these cases, symptoms will not resolve until the underlying cause is addressed. Tumors may need to be surgically removed while infections require aggressive antibiotics to prevent spreading to other regions of the body. (Hospital for Special Surgery. 2023)

Pain Specialist Treatment Plan Development

Ongoing pain, numbness, tingling, and weakness are all symptoms that should be addressed with a healthcare provider. A pain specialist can help create a treatment plan that involves: (Hospital for Special Surgery. 2023)

• Physical therapy
• Therapeutic massage
• Chiropractic decompression and spinal adjustments
• Targeted stretches and exercises
• Referrals to specialized healthcare providers 
• Injections
• Medications

Sciatica Causes and Treatments

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 studies 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 contact 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

Aguilar-Shea, A. L., Gallardo-Mayo, C., Sanz-González, R., & Paredes, I. (2022). Sciatica. Management for family physicians. Journal of family medicine and primary care, 11(8), 4174–4179. https://doi.org/10.4103/jfmpc.jfmpc_1061_21

Bosma, J. W., Wijntjes, J., Hilgevoord, T. A., & Veenstra, J. (2014). Severe isolated sciatic neuropathy due to a modified lotus position. World journal of clinical cases, 2(2), 39–41. https://doi.org/10.12998/wjcc.v2.i2.39

Dove, L., Jones, G., Kelsey, L. A., Cairns, M. C., & Schmid, A. B. (2023). How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 32(2), 517–533. https://doi.org/10.1007/s00586-022-07356-y

Mayfield Clinic. ( 2021). Spinal decompression laminectomy & foraminotomy.

Golonka, W., Raschka, C., Harandi, V. M., Domokos, B., Alfredson, H., Alfen, F. M., & Spang, C. (2021). Isolated Lumbar Extension Resistance Exercise in Limited Range of Motion for Patients with Lumbar Radiculopathy and Disk Herniation-Clinical Outcome and Influencing Factors. Journal of clinical medicine, 10(11), 2430. https://doi.org/10.3390/jcm10112430

Hospital for Special Surgery. (2023). Sciatica.

Hospital for Special Surgery. (2023). Pain management.

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.

Symptoms

Paresthesia can cause various symptoms. These symptoms can range from mild to severe and can be brief or long-lasting. Signs can include: (National Institute of Neurological Disorders and Stroke. 2023)

• Tingling
• Pins and needles sensations
• Feeling like the arm or leg has fallen asleep.
• Numbness
• Itching.
• Burning sensations.
• Difficulty contracting the muscles.
• Difficulty using the affected arm or leg.

1. The symptoms typically last for 30 minutes or less.
2. Shaking the affected limb often relieves the sensations.
3. Paresthesia usually affects only one arm or leg at a time.
4. 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:

• Central nervous system conditions - stroke or multiple sclerosis/MS. (National Institute of Neurological Disorders and Stroke. 2023)
• Altered nerve function brought on by a condition, like diabetes.
• Compression or irritation of spinal nerve/s. (American Association of Neurological Surgeons. 2023)
• Tension and traction or pulling on a nerve.

Seeking Medical Assistance

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.
• This is a symptom that diabetes is poorly controlled and needs to be managed appropriately. (National Institute of Diabetes and Digestive and Kidney Diseases. 2018)