Sciatic nerve injury happens from trauma to the nerve and can cause numbness, tingling, loss of muscle power, and pain. The traumatic experience can be a muscle spasm that pulls and/or pinches the sciatic nerve, force/pressure impact injury, over-stretching injury, or a laceration/cutting injury. A slipped disk, or herniated disk, is the most common cause of irritation on the sciatic nerve. A slipped disk occurs when one becomes slightly dislodged, pushing out from the spine. This places pressure/compression on the sciatic nerve.
Sciatic Nerve Injury Causes
Trauma
- Hip dislocation
- Acetabular fracture
- Trauma to the lower back, buttocks, or leg from an automobile accident, sports injury, work injury.
Medical treatment causes:
- Direct surgical trauma.
- Total hip replacement surgery can cause nerve compression and stretch during the procedure, causing damage to the sciatic nerve resulting in dysfunction.
- Faulty positioning during anesthesia.
- Injection of neurotoxic substances.
- Injection injuries via intramuscular injection in the gluteal region. This is a situation where there is a loss of movement and or lack of sensation at the affected lower extremity with or without pain.
- Injection palsy can begin suddenly or hours following damage to the sciatic nerve.
- A misplaced intramuscular injection at the gluteal region is the most common cause of injury. It is attributed to frequent injections or poor techniques resulting from inadequately trained or unqualified staff.
- Tourniquet-Induced Sciatic Nerve Injury.
- Dressings that are too tight.
- Casts that impinge the nerve.
- Faulty fitting orthotics.
- Post radiation treatment can cause acute and delayed muscle damage.
Clinical Presentation Symptoms
The common symptoms are pain and abnormal walking gait. Other clinical symptoms include:
- Muscular weakness/atrophy
- Reflex impairment
- Motor and sensory issues like paraesthesia and numbness
- Foot drop
- External rotation of the hip
- Abduction contracture of the hip
- Equinus deformity
Medical History
- Complaints of radiating pain in the leg, which follows a sensory nerve pattern.
- Pain radiates below the knee, into the foot.
- Complaints of low back pain, which is often less severe than leg pain.
- Report of electrical, burning, numbing sensations.
Diagnosis
A detailed subjective and objective physical examination is necessary to figure out the severity of the sciatic nerve injury. Diagnostic studies include:
- X rays
- Electromyography
- Magnetic Resonance Imaging
Chiropractic and Physical Therapy Management
Conservative treatment is the first-line approach for managing a sciatic nerve injury.
Pain Management
- TENS
- Massage
- Gentle stretching
- Desensitization techniques
Exercise and Stretches
- Chiropractic and physical therapy exercises and stretches improve nerve regeneration after nerve damage.
Electrical Muscle Stimulation
- TENS and Electroacupuncture have been shown to help enhance nerve regrowth.
- Bio-laser stimulation can help with nerve nutrition and regeneration.
Joint or Soft Tissue mobilization
- Helps to retain muscle, nerve, and soft tissue flexibility and prevent deformity.
Balance Training
- Coordination, strength, and flexibility exercises help to restore balance.
Splinting
- In the early stages after a sciatic nerve injury, bracing may be needed to prevent deformity and new injury or re-injury risks.
- Ankle Foot Orthosis - AFO can help prevent foot drop, muscle damage, and falls risk.
Body Composition
Optimize Diet for Fat Loss
Individuals that want to lose fat need to create a calorie deficit. Individuals need to consistently eat less than they need for Total Daily Energy Expenditure - TDEE. The safest way to handle a caloric reduction is to reduce calorie intake in small doses like 200-300 calories, for example. After a week or two, perform a body composition analysis. If Fat Mass numbers begin to drop or not, adjust calorie needs accordingly. Restricting calories is the most common way, a deficit can also be created by increasing calorie needs through exercise.
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Dr.
Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*
email: coach@elpasofunctionalmedicine.com
Licensed in: Texas & New Mexico*
References
Kline, D G et al. “Management and results of sciatic nerve injuries: a 24-year experience.” Journal of neurosurgery vol. 89,1 (1998): 13-23. doi:10.3171/jns.1998.89.1.0013
Schmalzried, TP et al. “Update on nerve palsy associated with total hip replacement.” Clinical Orthopedics and related research,344 (1997): 188-206.
Shim, Ho Yong et al. “Sciatic nerve injury caused by a stretching exercise in a trained dancer.” Annals of rehabilitation medicine vol. 37,6 (2013): 886-90. doi:10.5535/arm.2013.37.6.886
Suszyński, Krzysztof et al. “Physiotherapeutic techniques used in the management of patients with peripheral nerve injuries.” Neural regeneration research vol. 10,11 (2015): 1770-2. doi:10.4103/1673-5374.170299
