The Sciatic Nerve

I’ve had many clients come to me over the years requesting help with sciatic-type pain; either after having been diagnosed with “sciatica” or from assuming that it could be such. Unfortunately, it’s been made very clear to me that many people—the healthcare industry included—aren’t aware that discrepancies in certain muscles could mimic sciatica. I’m not at all saying that true sciatica couldn’t be the case, but my goal is to provide you with additional information to consider when it comes to the sciatic nerve, the muscles around it, and how PNMT can help you to become pain-free. First I’ll start off with the anatomy and then I’ll go into other details.

The sciatic nerve, which is the longest nerve in the body, is actually comprised of two nerves—tibial and common fibular (a.k.a. common peroneal)—which splits into two divisions, usually at the knee. Per Tortora & Derrickson (11th Edition), the nerve root origin is as follows…

  • Sciatic: L4, L5, S1, S2, S3
  • Tibial: L4, L5, S1, S2, S3
  • Common Fibular: L4, L5, S1, S2
    * (Click here for a dermatome chart: dermatome meaning the area of skin that provides sensory input to the central nervous system.)

As the sciatic nerve descends down the thigh, it sends branches to the hamstring muscles and the adductor magnus. At the knee, the distribution to additional muscles is as follows…

  • Tibial: Gastrocnemius, plantaris, soleus, popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus. It then divides into the medial plantar and lateral plantar branches:
    – Medial Plantar: Abductor hallucis, flexor digitorum brevis, and flexor hallucis brevis.
    – Lateral Plantar: Quadratus plantae, abductor digiti minimi, flexor digiti minimi brevis, three lateral lumbricals, dorsal interossei, plantar interossei, and adductor hallicus.
  • Common Fibular: Divides into the superficial fibular and deep fibular branches:
    – Superficial Fibular: Fibularis longus and fibularis brevis.
    – Deep Fibular: Tibialis anterior, extensor halluscis longus, fibularis tertius, extensor digitorum longus, and extensor digitorum brevis.

What could happen when the sciatic nerve is affected? Well, here’s what Tortora & Derrickson stated in their 11th Edition book…

Sciatic nerve injury, the most common form of back pain, is caused by compression or irritation of the sciatic nerve. Pain may extend from the buttock down the posterior and lateral aspect of the leg and the lateral aspect of the foot. It may be injured because of a herniated (slipped) disc, dislocated hip, osteoarthritis of the lumbosacral spine, pressure from the uterus during pregnancy, inflammation, irritation, or an improperly administered gluteal intramuscular injection.

To take it a step further and per my Precision Neural Mobilization training manual, a normal response from the sciatic nerve during a deep stretch, for example, could result in a sensation down the posterior thigh which may extend into the calf and foot. On the other hand, there are indications and causative factors that could result in abnormal responses. They are as follows…

Now back to some muscles and PNMT….

The gluteus minimuspiriformis, and hamstrings are a few muscles that can mimic sciatica. Trigger points (click here and here for previous posts on TrP’s—and please note that the muscles below, in bold, link to webpages that show TrP referral patterns) in the gluteus minimus can refer pain all the way down the side of the leg; usually stemming from the anterior fibers. TrP’s in the piriformis can send pain from the buttocks down the back of the thigh; however, the pain doesn’t go past the knee—it is also well known for its ability to entrap the sciatic nerve, so any tightness will produce sciatic symptoms. TrP’s in the hamstrings can also send pain down the back of the thigh. Travell reports that there are “rare” cases where the sciatic nerve is entrapped between two heads of the hamstring attachments on the ischial tuberosity; however, this study by Kari Saikku, Jarkko Vasenius, and Pekka Saar from the University Central Hospital in Helsinki, Finland found that this sort of entrapment “is not extremely rare.”

At the end of the day, muscular discrepancies within the muscular-skeletal system can in fact mimic sciatic-type symptoms—and I want you to be aware of this, especially if you have tried every other option out there to no avail. There are more holistic and non-invasive approaches to treating pain and dysfunction, and PNMT is a prime example. By taking just a few measurements to see how a person’s body is aligned, a trained therapist can ascertain what muscles are pulling where, and treat the affected muscles to help the individual to become pain-free again.

Sounds awesome, doesn’t it?

As always, I hope you find this information informative… And more importantly, HAPPY NEW YEAR!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

 

Do You Clench And/Or Grind Your Teeth?

Back in June of this year, I wrote a post on TMD: Temporomandibular Disorder, specifying causes and symptoms related to temporomandibular joint pain and dysfunction. This post will be about clenching and grinding, and the effects it can have on your jaw and teeth. Keep in mind that I am obviously not trained in dentistry, which is why I will publicize a top-notch dentist in my area; one that I have been going to for years, and refer my clients to when the need arises. More on him later though.

Clenching and grinding, also known as bruxism, has caused some problems for me over the years. Not only has it seriously affected the musculature around my jaw, it has also given rise to non-natural contours and slight fracturing in my teeth.

Bruxism can be defined as either diurnal or nocturnal: diurnal is during the day, often stress related and easier to treat; nocturnal is at night, not under conscious control, which in turn can be a devastating habit causing great pain in the TMJ and also ruin the teeth.

Sleep bruxism often exerts remarkably powerful forces on teeth, gums, and joints. One estimate puts it at three times the forces generated during chewing (Castaneda, 1992, p. 46), while another puts it at ten times, powerful enough to crack a walnut. — Dr. Moti Nissani, 2000

According to the link directly above, Dr. Nissani also states that bruxism may lead to the following…

  • Sensitive, worn-out, decayed, fractured, loose, or missing teeth (McGuire and Nunn, 1996).
  • Broken down enamel, and in long-term bruxers, may reduce teeth to stumps.
  • Yellowish and softer dentin as opposed to white enamel cover.
  • The back teeth losing their cusps and natural contours; instead of appearing flat, they look as if they were worked over with a file or sandpaper.
  • Bridges, crowns, root canals, implants, partial dentures, and even complete dentures.

By 40 or 50 years of age, most bruxers . . . have worn their teeth to the degree that extensive tooth restorations must be performed. — Christensen, 1999

Now back to the AWESOME dentist I briefly mentioned at the beginning of my post. Dr. Alex M. Della Bella has been my dentist for 10+ years; helping me with anything from shaping my somewhat jagged-edged front teeth to making an occlusal guard for the clenching and grinding. In addition to me treating my own “adaptively shortened” jaw muscles intra-orally to help with TMD related pain (I’m trained in that), I can’t express enough how much an occlusal guard has helped me in preventing further damage to my pearly whites—those coming to fruition via the ZOOM! In-Office Whitening process.

Dr. Alex Della Bella: The official dentist to the Cincinnati Red’s

If you live in Cincinnati, Ohio—or the surrounding areas—and feel you suffer from bruxism, I highly recommend you contact Dr. Della Bella’s office at 513.793.1977 for support in getting things under control. You can also request an appointment directly through this link. If you’re looking for other dentistry services, Dr. Della Bella also specializes in the following…

  • Cosmetic Dentistry – Tooth Bonding, Porcelain Veneers, Whitening, Tooth Jewelry, ZOOM! In-Office Whitening
  • Restorative Dentistry – Crowns, Partial Crowns, Tooth Colored Resin Restorations
  • Preventative Dentistry – Athletic Mouthguard, Fluoride, Fluoride Varnish, Occlusal Guard, Oral Hygiene Instruction, Routine Maintenance, Sealants, Velscope Oral Cancer Examination
  • Sports Dentistry – Athletic Mouthguard, Injury Management Card, Pro Football Program, Traumatic Injury Management, Under Armour Performance Mouthwear
  • Sleep Disorder Management – Tap Appliance, Somnomed Appliance
  • Reconstructive Dentistry – Fixed Replacement of Missing Teeth (Bridges), Full and Partial Removable Dentures, Implants
  • Orthodontics – Invisalign
  • Periodontal Therapy – Arestin, Oraqix, Scaling and Root Planing, Soft Tissue Management

In closing, between Dr. Della Bella’s 25+ years in the dental field, and mine—hmmm… only about five years ;-)—in advanced soft tissue therapy for TMJ pain and dysfunction, I feel we make a great team in helping people manage their pain and dysfunction related to TMD. Here’s what he has to say…

Temporomandibular joint pain and dysfunction is best handled in a very conservative manner by competent, experienced professionals.  When an experienced dentist teams up with an experienced therapist, like Nicole, the level of success attained is usually enhanced because the problem can be addressed using various, conservative methods.

As always, I hope you find this information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Some Info On Whiplash From Automobile Accidents

According to an estimate of the National Safety Council, there were 11,900,000 motor vehicle accidents in the United States in 1993. Of these, 2,750,000 were rear-end collisions. Although the precise number of whiplash injuries per year cannot be determined, a rather rough estimate is more than one million. Nearly one-third of all motor vehicle accidents are rear-end collisions, and it is this type of accident that is responsible for most whiplash injuries. — RW Evans

A couple of years ago, I completed a Distance Education course from “The Complete Guide to Whiplash” written by Michael R. Melton, owner of BodyMind Publications and founder of ChiroHosting, and learned what factors and variables—among many other things—are used when determining the difference between an accident with no injury and an accident with serious injury. They include…

  • The angle of the collision
  • The speed and size of the rear car
  • The speed and size of the front car
  • Road conditions
  • Occupant head position
  • Gender
  • Occupant awareness
  • Head restraints
  • Safety belts
  • Secondary collisions
  • Direct body impact
  • Loss of consciousness
  • Medical history
  • Pain onset

As you can see there are many variables involved, and believe it or not, each crash possesses its own characteristics.

According to an equation related to the physics of acceleration, the less a car is damaged or crushed in a collision, the higher the acceleration of the struck vehicle and the greater the risk of injury. — MC Robbins

That being said, it is crucial that a complete history be examined in order to help a whiplash patient recover quickly and easily. Following are some physical and psychological symptoms also found in The Complete Guide to Whiplash…

PHYSICAL

PSYCHOLOGICAL

  • Anxiety
  • Depression
  • Anger
  • Substance abuse

Per Michael’s book, one of the most common claims made by insurance companies is that whiplash injuries heal within six weeks and that care after that time is unnecessary. While many patients do recover within this six-week period, many studies show that between 20-30% have symptoms that last one year or more. In addition, studies also show that some symptoms may even take days or weeks to develop after an accident; however, insurance companies will often attempt to discredit a patient’s symptoms if they aren’t reported at the time of the accident; as if malingering.

It is very difficult for an ingenuine individual to fake a profile typical of a whiplash patient. — BJ Wallis

I wanted to write this post because I have had several clients over the years, whom suffered from whiplash as a result of an automobile accident, and eventually became pain-free using Precision Neuromuscular Therapy (PNMT) techniques. Although PNMT won’t necessarily treat every single symptom that was mentioned above, it can help with muscular-skeletal imbalances, which can cause many that were mentioned.

Here are some other great resources related to whiplash from automobile accidents:
The Neck Disability Index (NDI) Study
T
he NDI Questionnaire
The Crash Pulse in Rear-End Car Accidents
The National Crash Analysis Center
Motor Vehicle Accident Reconstruction and Biomechanical Physics

As always, I hope you found this information to be informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

The QL: Another Player In Back Pain

In a previous post, I went over the psoas major and how it is a major player in back pain, so today I thought I would go over the QL—the quadratus lumborum, which is a common source of low back pain. Before I go on though, let’s go over the anatomy…

THE ANATOMY (per Tortora & Derrickson, 11th edition)
Origin: Iliac crest and iliolumbar ligament.
Insertion: Inferior border of 12th rib and first four lumbar vertebrae.
Action: Acting together, pull 12th ribs inferiorly during forced exhalation, fix 12th ribs to prevent their elevation during deep inhalation, and help extend lumbar portion of vertebral column; acting singly, laterally flex vertebral column, especially lumbar portion.
Innervation: Thoracic spinal nerve T12 and lumbar spinal nerves L1-L3 or L1-L4.

The QL is a very strong lateral flexor and lateral stabilizer of the trunk; working synergistically with the psoas—on the same side—in lateral stabilization. It also assists the multifidi, erector spinae, and serratus posterior inferior in extension.

So, how do you know when the QL could be influencing back pain? Well, here are a few indicators for treatment…

  • Persistent pain, even at rest
  • Back pain after a violent sneeze or cough
  • Great pain when turning from one side of the body to the other while in bed
  • Excruciating pain when laterally bending or during forward flexion
  • Pain when standing; however, putting bilateral pressure above both iliac crests lessens the pain
  • Hyperlordosis is present.

If you experience one or more of the aforementioned, there is a good chance the QL is a player in your back pain—low back, specifically.

As always, I hope you find this information to be informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Headaches And Pain… Oh, My!

For me, the pain associated with headaches could be debilitating at times. So much so, I would sometimes just want to crawl in bed and cry like a baby until I fell asleep; however, when I first experienced PNMT, I quickly realized that there were other options out there aside from mainstream treatments. More on that later!

Before I go over the different types of headaches though, I feel it’s important that I share some RED FLAGS that I learned through becoming certified in PNMT:

  • See a physician to have other possible causes ruled out if the headaches are a new occurrence—the number of serious problems that have headaches as a side-effect is numerous.
  • See if physician immediately if you have any other global health declines.
  • See a physician if you’ve had headaches in the past but they are different in frequency, intensity, and/or location.
  • See a physician if you’ve had headaches for a long time but now they are daily; accompanied by GI symptoms, restlessness, anxiety, irritability, memory problems, difficulty in intellectual concentration, and depression. This could be considered analgesic rebound; analgesic overuse being very common.

Now, onward with different types of headaches. I will include some bullet points and reference the clinical studies, which happens to be where I got most of my information from…

TENSION HEADACHES – In the U.S., these account for 1-4% of all emergency room visits and is the 9th most common reason for doctor visits; being the most common type of chronic recurring head pain. All ages are susceptible, but most are young adults. — Michelle Blanda, MD; Tension Headache Clinical Presentation

  • These are usually associated with a stressful event, poor posture, or depression; and are not aggravated by physical activity.
  • They are of moderate intensity but can have a throbbing quality, are bilateral, and usually present in the occipitofrontal region.
  • They typically last 30-minutes up to 7-days.
  • Muscular tightness or stiffness in the neck, occipital, and frontal regions is common.
  • Cervical muscles, when palpated, may be very tender.
  • Nausea or vomiting is not present.
  • Insomnia is present.
  • Often present upon rising or shortly thereafter.

MIGRAINE HEADACHES – This disorder is one of the most common complaints in medicine. In the U.S., more than 30 million people have one or more migraines per year. — Jasvinder Chawla, MD; Migraine Headache

  • They typically throb or pulsate.
  • The pain is initially unilateral (on one side) and localized to the Temporalis and Frontalis muscles, or over the eye, but can be felt anywhere around the head or neck.
  • The pain typically builds up over a 1- to 2-hour period and then slowly diffuses towards the back of the head.
  • They typically last 4-72 hours; usually subsiding gradually within a day, and after a period of sleep.
  • Intensity is moderate to severe and intensifies with movement or physical activity.
  • Light and sound sensitivity are very common.
  • Nausea occurs in about 80% of migraines; vomiting in about 50%.
  • Other interesting symptoms include:
    – About 60% of people reported prodrome (preheadache) symptoms hours to days prior to the migraine. Postdrome symptoms may persist for 24-hours after the headache.
    – Auras—which can be visual, sensory, motor, or any combination of these—usually develop over 5-20 minutes and lasts less than 60 minutes.

CLUSTER HEADACHES – In the U.S., it is estimated that 2-9% of migraine sufferers experience these, making it relatively uncommon compared to the classic migraine. This condition is more common in males than in females. — Lori K Sargeant, MD; Headache, Cluster

  • No aura exists like they do in migraines.
  • Sudden onset peaks in 10- to 15-minutes; duration lasts 10-minutes to 3-hours per episode; frequency may occur several times a day for 1- to 4-months.
  • Typically, 1-2 cluster periods are experienced per year; each lasting 2- to 3- months.
  • The pain associated with is described as severe; as if the eye is being pushed out.
  • They are often nocturnal—active at night.
  • Triggers in some patients include stress, allergens, and seasonal changes.
  • Alcohol and smoking induce attacks during a cluster but not during remission.
  • Risk factors include: male sex; older than 30-years; small amounts of alcohol; previous head trauma or surgery (occasionally).

CERVICOGENIC HEADACHES – The presence of these headaches in the general population is estimated to be between 0.4% and 2.5%; however, the prevalence is as high as 20% in pain management clinics. This condition is four times more common in women than in men. — David Biondi, DO; Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies

  • This condition is a relatively common cause of chronic headaches that is often misdiagnosed or unrecognized; clinical features may mimic those commonly associated with other headache disorders, making this headache hard to distinguish.
  • They involve head pain that is referred from bony structures or soft-tissues of the neck; TrP’s are usually found in the suboccipital, cervical, and shoulder musculature.
  • These often develop after a head or neck injury, but may also occur in the absence of trauma.
  • They are typically described as a deep—or dull—pain that radiates from the occipital to parietal, temporal, frontal, and periorbital regions.
  • Sufferers will often have restricted cervical range of motion and altered neck posture.
  • Head pain can be triggered or reproduced by active neck movement.
  • Paresthesia and numbness over the occipital scalp are usually present.
  • Many sufferers overuse or become dependent on analgesics; medication, when used alone, does not generally provide substantial pain relief.

As stated earlier in this post, I have suffered from headaches for many years, but not so much over the past five years due to the powerful effects of PNMT. In fact, many of my clients have suffered from them as well—that is until I got my hands on them. 🙂

Believe it or not, muscle involvement—which is stated in some of the above mentioned headache descriptions—can be a huge contributing factor that is definitely worth looking in to. In fact, the SCM, Longus Colli, Trapezius, and the Suboccipital muscles are just a few examples that can mimic or refer headache-related pain. Also note that muscular-skeletal alignment is a key factor as rubbing where it hurts won’t solve the problem.

If this post strikes a cord with you, consider looking for a massage therapist as an alternative option for headache related pain-relief!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me