A video on Sciatica is available at our office in our lending library.
This article will attempt to discuss various reasons for pain, numbness, and tingling going down the leg, which are very often, in traditional Western Medicine, unknown (or more accurately because doctors are not taught in school, overlooked).
In simple, easy-to-understand terms, I will discuss Nerve Compression and True Sciatica, to Nerve Entrapment, to Trigger Point referred pain, and Pseudo-Sciatica.
Dr. Travell (muscle expert) says that probably 70% of people who get a diagnosis of sciatica do not actually have true sciatica, but have what would be more appropriately diagnosed as pseudo-sciatica which, if treated properly (and in most cases it is not treated at all), is often easily remedied.
Your doctor who is a real expert may explain true sciatica as neurogenically caused pain by nerve root compression in the spine (in other words low back nerves squeezed by bones).
The exact same symptoms however will be caused by a nerve entrapped by a muscle. In other words, a muscle tightens around the nerve - squeezing it. This can happen anywhere in the body, but in the case of sciatica it will likely occur in the hip area. In the buttocks (see illustration), the Piraformis muscle functions to turn the leg outward. If it is tight, it can entrap either of the two parts of the sciatic nerve.
The following chart shows the four possible routes the sciatic nerves can take exiting the pelvis:
A tight, swollen muscle in the hip would effect these four people very differently. A slight muscle tightness would give little trouble to a person in the first group, but would be very painful those in the fourth group. However, very inflamed muscle may even give the person some minor or temporary trouble. All of the above can be helped with Trigger Point Therapy (NMT), releasing the muscle tightness and nerve entrapment.
Another reason for this pain has nothing to do with the nerves... directly. It is trigger point referred pain.
For a practical example, you can run your hand over your buttocks and locate the low area or valley in the muscles, you are probably on the Piraformis muscle. Press in slowly, adding more and more pressure, and see if you feel any discomfort (stop if you do). You can do the same thing in other areas of the buttocks using the charts below as a guide. Some of you, if accurate, will have felt tender spots, while others of you will have created temporary sciatica-like sensations. This is muscle-referred pain caused by trigger points, and NOT true sciatica
These examples are only a few of the possible leg pain referring muscles (highlighted black):
A good therapist will know and have access to Dr. Travell's 1600 page textbooks and be able to look up anything they don't know to help you, or will send you to someone who does.
As you remember (if you read my article on headaches in "November Natural Awakenings"), a trigger point is actually a pool of lactic acid and other waste product chemicals in the muscle. It may feel like the size of a grain of sand, a pea, or a quarter. These trigger points fire high-potency neurological signals into the spinal cord. Before explaining further, I am going to explain what a reflex arc is, so that it's easier to understand the whole picture.
Let's say that you reach out and touch a hot stove. Your hand pulls away automatically; you don't even have to think about it. It just happens. What's happening is that, upon touching the hot stove, a signal travels from your finger, up your arm, to one spinal cord segment in your back and there the signal is amplified and gets sent in many directions. First of all, it fires to your upper arm muscle and causes it to contract, pulling your arm away from the hot stove. A signal from the spinal cord fires into the blood vessels in the arm and tells them to contract so that if, for example, you were cut badly, you wouldn't bleed to death. This signal also fires out of the spinal cord to organs and glands, and it would probably fire to the adrenal glands in this case to give you the boost you need to run out of the building if it were on fire. This is (of course) a good protective mechanism of the body called a reflex arc.
Now when we develop this tender spot in the hip muscles, it starts to fire high-potency neurological signals into the spinal cord and gets into the same circuitry that I just described, and fires to the muscle causing tightening. It also causes restricted blood circulation down the leg, and probably active pain, tingling, or numbness in the leg. I, as a therapist, would put a little pressure on the trigger point for 3 to 12 seconds (what I am actually doing is interfering with the unwanted signals in the spine). The patient will feel the discomfort begin to leave the leg or foot. The blood flow improves in the leg; if any signals were going into the kidneys or any organ in the pelvis these organs will possibly begin to function more normally as well. The implication of unresolved trigger points can be widespread far beyond just pain. That is because any extra nerve stimulation into any organ will begin to hamper or arrest it's function (Scholt's Law).
Why are these muscles tight to start with? I usually do an analysis to see if you have the following conditions that are usually caused by soft tissues pulling and distorting natural bone positions. They often remedy themselves when muscle and ligaments are released:
All of the above will quite likely also cause low, mid, and upper back pain, as well as neck and head pain, since other areas of the body distort around the dysfunctioning pelvis.
A video on sciatica and the proper use of Neuromuscular Therapy treatments is available at our office for viewing, free of charge.
Hopefully in the future, Western medicine will use these non-invasive remedies before using more radical procedures. In fairness to them, part of the problem is a lack of therapists who know how to do the exacting work that doctors can refer out to.
I am pleased to also announce that I am going to start teaching some of these important evaluative and treatment techniques to other interested therapists, using a one-day seminar format so it is both time and cost affordable.