…..I understand that a stretched piriformis, intravertebral disk bulges, and hamstring irritation can elicit some form of sciatic pain. Are there any other dysfunctions that could potentially contribute to this condition that you are aware of that I did not mention?
How would hamstring injury trigger sciatica?
…… Could excessive weight bearing and sitting produce these effects and how??
…… Can migration of the annulus be affected by repetitive spinal motion?
Sciatica is really a garbage diagnosis. I learned this term from Coach Boyle to mean something used typically in the medical world that really can mean a number of different things. Shoulder impingement is another garbage diagnosis. There are like 25 things that can cause impingement and at least half that many different treatment approaches.
For sciatica, all it really means most of the time is that there is pain through the sciatic nerve distribution. It may be more appropriate to mean that the sciatic nerve is irritated and causing pain. There are a number of areas that can cause this irritation via compression. Someare mentioned above in the paraphrased question, but there are others. Finding the location of lesion is where attacking sciatica usually boils down to.
Keep in mind the diagnosis itself, while soft, is often also totally wrong as well. I’ve seen anterior leg pain diagnosed as sciatica, which is ludicrous because the sciatic nerve runs down the back of the leg. Conversely, not all pain going down the back of the leg is sciatic nerve-driven. There are many legitimate trigger points that have referral patterns that mimic sciatic nerve irritation patterns.
I think the most common sciatic nerve local irritations are probably nerve root compression and peripheral entrapments through the lower quarter. Common sites of peripheral entrapments can be the piriformis, the superior gemmelus in some folks, the hamstrings, and/or ADDuctors.
Definitely consider the Glute Minimus as a trigger point referral source. That is not a sciatic nerve irritation, but rather an illusory referral pattern that easily fools dumb physicians and rehab clinicians. There are other trigger points as well that can fool you. Also consider when you do believe that a trigger point is the
Keep in mind that these traditional diagnosis suggest a site (pain down the back of the leg) and a source (compression or trigger point).
But a cause in terms of a movement dysfunction is what is going to ultimately lead you to the sciatica solution. This is where your SFMA or full body evaluation comes into play.
So if say, an ART scanning approach concludes an adhesion between the hamstrings and ADDuctors, it is necessary to treat that local dysfunction, but ultimately some movement disorder caused those muscles to become overworked, and that movement strategy is part of an endless list of contributors and priorities.
Basically what I’m saying is that anything can cause compression or dysfunction anywhere in the body. Call it Anatomy Trains or Chain Reaction or Regional Interdependence or Movement Impairment Syndromes, they all mean the same thing. This is why full-body screening and assessments are the key to uncovering the most underlying issues, regardless if they are painful or non-painful.
There are brilliant methods to get at the site and source of the sciatica, but you need to be in parallel in ignoring the body’s expression and find what the body isn’t telling you right off that bat as well.
In terms of the hamstrings’ involvement in sciatic nerve compression, if the injury scars over and causes adhesions, we should without a doubt attack the local issue, but also look to what led to the muscle strain in the first place.
Consider that synergistic dominance of the hamstrings is almost always tied to glute dysfunction. When the glutes don’t hold up their end of the bargain during hip extension, the hamstrings work overtime and eventually tear. The tear can be frank like a Grade II or III, or it can be the most mild of microtrauma that adds up and adds up and entraps the sciatic nerve if it is in the right place or influence.
The environment of the lower-crossed syndrome has multiple contributions that lead to this environment, and the best general suggestion is to check mobility before stability. If the movement is pain-free, check ASLR as a starting point, but also remember that all the moves of the FMS or SFMA matter equally from the start.
Inefficient weight bearing, yes, can cause spinal dysfunction and threats.
Seating up to 20 minutes will cause posterior bulging of the IV discs. This may or may not be perceived as pain or threatening.
I am not familiar with migration of the annulus in relation to spinal motion. I’m not saying it doesn’t happen, but I have never been under the impression that it is impactful. Certainly pressure from nucleus will cause deterioration of the annulus. That’s a problem, but I don’t know that the annulus is motile without being pressurized from the nucleus of the disc.
The reference you make may be consistent with Stanley Paris’ suggestion as to why The McKenzie Method works in treating back pain, which is actually very different to how the McKenzie folks believe.
I am confident that flexion yields nuclear migration posteriorly, and anteriorly with extension. I haven’t experienced anything in the literature or real world that would suggest otherwise. It’s the nucleus pulposis that is the player in discogenic back pain. Annular tears can also be perceived as threats, but I don’t think that comes from unbalanced repetitive motions or from environments where there are not bulges or herniations.
Back to sciatica, pressure from the annulus pushing into the nerve root is how you get to this problem.
Without knowing an individual’s presentation, there may be some extra pieces of the puzzle, but the keys are always to stay pain-free and restore mobility prior to stability.
If they are pain-free, trust the FMS and run it through to the terminal fitness exercises. If your client is not pain-free, get them to someone that you can work with and tag team with what you are each skilled at.
There’s 2 ends to this or any rehabilitation. Destroy the local irritation, but also reinvent a new motor pattern and lock it in. This will have nothing to do with the painful diagnosis, but have everything to do with it. Reread the above if that doesn’t make sense.
The local irritation of “sciatica” is reliable to find. Isolate the issue and restore mobility. In this case, mobility can be of the nerve in its sheath. It can be through adhesions of the muscle itself or with others. It can be of the joint. Keep in mind, crap flows up and down. The Joint by Joint will continue to influence neighboring joints especially when the problem is chronic and festering. Reset the system.
The regional problem is probably going to lie in a hip/lumbar spine stiffness issue. Integrate the new mobility with the core. Reinforce the new environment maybe with a supportive sleeve for skin proprioception before you hammer big exercise into the system.
The interregional problem is the big movement that led to all of this in the first place. Functional Movement is going to bring in the upper body with the lower body and the core. Reload to the new skill set and capabilities. Hit save by Breathing at terminal mobility positions.
Reinvent how someone moves.
So there are more than a couple important local issues to cull out what is causing sciatica.
And because of its nebulous definition, it is a good place to learn to appreciate movement disorders.
Treating pain and non-painful movement can very much be run in parallel. Without the SFMA or something like it, this can be very challenging.
There must be an appreciation that everything matters.