Unlocking the Secrets of Rehabilitation: A PT’s Perspective — Michael McKindley, DPT

Sciatica can be like a runny nose – annoying, persistent, and hard to ignore. It can also be the symptom of something else. But just like a runny nose, it’s not enough to just treat the symptoms. To truly get to the root of the pain, a thorough evaluation is essential. Read further to learn more about sciatica from Michael’s perspective about what it is and what it isn’t.

Sciatica is numbness, burning, weakness and tingling down the back of the leg, including below the knee into the foot. If it’s above that, it’s not the true definition of sciatica.

Sciatica can come from a herniated disc in your back, which is what everybody assumes it is, and it’s not always. It can come from a stenosis, a narrowing of the spinal canal or foramen. Typically, spinal stenosis will occur bilaterally so it’s in both legs, so people think they have bilateral sciatica when truly they have stenosis that’s coming from the back.

Sometimes stenosis can occur on one side. It can come from a bone spur in the spine. It can come from a SI Joint Dysfunction and it can come from a pure compression. And sometimes it’s a combination of them.

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The Piriformis Muscle Could be Causing the Pain

The pain can also be attributed to the piriformis muscle that is located in the buttock region. It starts at the lower spine and attaches to the top of the femur bone. The piriformis muscle is responsible for rotating the hip joint and providing stability to the pelvis during movement.

You may hear the term piriformis syndrome. I don’t like to use the word piriformis syndrome because the true definition of piriformis syndrome is that the sciatic nerve, bifurcates or splits through the muscle. It’s actually a birth defect, very rare, but it does happen. The only way really fix it is to cut the piriformis to release the muscle. That is a true definition of piriformis syndrome.

People often get a tight piriformis. For instance if they limp, whether it’s foot pain, knee pain, hip pain, any kind of pain that causes a limp, the piriformis will get tight. People who wear high heels all the time or people who sit with their feet out. Not together, but kind of out wide especially men when they’re sitting with their legs separated. People who have flat they will get a tight piriformis.

The piriformis muscle attaches to the top of the femur bone with the sciatic nerve running through it. Therefore, when the piriformis gets tight or swollen it pushes the sciatic nerve against the femur and that sends numbness, tingling, burning and weakness down the leg including below the knee.

Sometimes, if a person has low back tightness and then they have burning. tingling or weakness below the leg, everybody thinks it’s sciatica, when really, they might have a facet joint or a low back problem, but they actually have another type of common compression at the fibular head that is located in the calf.

The sciatic nerve is one nerve that comes down from the back and when it hits the fibular head it splits into two. One nerve in the split travels below the calf and down to the bottom of the foot and the other goes to the front of the shin, down the leg and interfaces with the top of the foot.

A Compression at the Fibular Head

Sometimes people get shin splints and have numbness, tingling and burning, and they think it’s sciatica where it’s not because the pain is actually coming from the fibular head. The fibular head is located at the upper end of the fibula bone, which is the smaller of the two bones in the lower leg. It is situated just below the knee joint on the lateral or outer side of the leg.

Other causes of compression issues at the fibular head include trauma to the knee or leg, repetitive use injuries (such as running or jumping), poor biomechanics or alignment of the lower extremity, and nerve entrapment syndromes (such as peroneal nerve entrapment). Certain medical conditions, such as diabetes or peripheral neuropathy, can also increase the risk of nerve compression.

Even women wearing high heels all the time can cause a compression of the fibular head and they think it’s sciatica, but it isn’t.

In Conclusion

Regardless of what kind of pain you have or where it is coming from, our goal is always to determine to the root cause of the pain. We start with a detailed health history and evaluation because we value listening to our patients. From there we will discuss an appropriate treatment plan to relieve the pain and restore motion and function getting your back to an active lifestyle.

Our success is based on combining our extensive clinical experience with evidence-based science along with advanced training and continuing education. If you have failed PT elsewhere or not seeing the results that you want, we are always here to help!

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If you have failed PT elsewhere, not seeing improvements or reduction of pain in your current exercise program, or looking to get started and need a little help with setting up a program customized for your situation, give us a call today to schedule an evaluation.

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