Chronic Pain Relief | Sciatica | Sciatic nerve pain | Piriformis syndrome | Sacroiliac Dysfunction | Illiopsoas Dysfunction | Lower cross syndrome | Spinal Nerve Entrapment

Living a happier life:

Understanding how to overcome Sciatic Nerve Discomfort and Lower Back Pain

 

 

Overview:

“Sciatica” is a term often used inaccurately to globally refer to pain felt in the lower back, hip, legs and sometimes feet. Not all lower back pain is created  equal, and the cause of pain can differ significantly. Because of this, treatments differ depending on the underlying cause of the problem not just the symptoms.

The good news:

In most circumstances symptoms understood as “Sciatica Pain” are completely treatable without surgery or other invasive options and is completely curable through massage therapy and learning self care. If you are reading this article, you are probably experiencing pain, discomfort , weakness, and or numbness in your lower back, buttock region or legs, in some cases you may be suffering from headaches and in more severe cases be plagued by migraines and/or vertigo.

What you need to know:

The term “Sciatica”, through popular culture and misunderstanding, has become more of a layman’s term than an accurate description of a bodily dysfunction. Due to similarities in symptomatic pain patterns of the lower back, spine, hips and legs, most people lump together several conditions under the umbrella term of “Sciatica”. This inaccuracy leads most people away from the solutions within reach like trigger point therapy and myofascial release massage that could alleviate, and in many cases eliminate, their pain. Precipitating unnecessary discomfort and pain lack of understanding and misinformation create great confusion among most people and sadly lead to radical and often times unnecessary treatments such as surgery, or a life-time plagued by pain leading to a loss of lifestyle forfeiting happiness.

Luckily, not all “sciatica” pain and discomfort is created equal. Most diagnoses are completely unreliable either because of flawed self-diagnosis and/or in many cases due to a flawed interpretation of symptoms by a practitioner who failed to administer the proper tests to identify the actual cause of the dysfunction before rendering their diagnosis.

More often than not “Sciatica” can be non-permanent provided the cause of the discomfort is assessed correctly and treated accurately. Proper stretch techniques and various body work therapies can heal many of these conditions responsible for very similar pain patterns. Although they are most often treated completely differently. and are indistinguishable without the proper knowledge and testing, once identified relief is available. 

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Causes of Sciatic Nerve Dysfunction, Lower Back Pain and “Sciatica” 

 

• Stress

• Age – elasticity is lost as we age, our bone tissue density changes and the result is an alteration in our mobility

• Coughing and bending over can exacerbate this condition

• Poor or collapsed posture, especially due to lack of exercise and repetitive use injury

• Prolonged sitting, especially in environments that perpetuate hyper-lordosis of the lumbar spine (poorly made chairs and bad sitting posture)

• Hernia, or degeneration of vertebral discs leading to nerve entrapment

• Muscle imbalance causing the lower spine to collapse anteriorly or posteriorly

• Forward head posture often associated with prolonged computer usage or careers where leaning forward is constant (for example: Surgeons, Hair Stylists, Dentists, Desk Work, etc.). An imbalance in the Cervical Spine will eventually cause problems in the rest of the spine.

• Impact injuries often caused by sports, falls or vehicle accidents

• Improper lifting, especially when twisting from the hip (This activity can cause severe injury. Always lift correctly!)

• An overactive and shortened iliopsoas (aka. Hip Flexor). This is very common in runners, but also highly common in the 9-5 desk culture due to bad sitting posture. When this is the cause of Sciatic Pain the iliopsoas must be treated for relief to occur. (read more: treating the iliopsoas )

• Obesity

• Spinal Stenosis 

• Scoliosis

• Spondylosis – a condition where the lumbar vertebrae, specifically L5, is defective resulting in diminished weight capacity (Litao, 2015)

• Spondylolisthesis – at the lumbosacracal junction, a disorder where vertebrae becomes anteriorly displaced leading to herniation and nerve entrapment (Werner, 2002)

• Diabetes (source: MayoClinic )

Causes of Sciatic Nerve Dysfunction, Lower Back Pain and “Sciatica” 

 • Stress

• Age – elasticity is lost as we age, our bone tissue density changes and the result is an alteration in our mobility

• Coughing and bending over can exacerbate this condition

• Poor or collapsed posture

• Prolonged sitting, especially in environments that perpetuate hyper-lordosis of the lumbar spine (poorly made chairs and bad sitting posture)

• Hernia, or degeneration of vertebral discs leading to nerve entrapment

• Muscle imbalance causing the lower spine to collapse anteriorly or posteriorly

• Forward head posture often associated with prolonged computer usage or careers where leaning forward is constant (for example: Surgeons, Hair Stylists, Dentists, Desk Work, etc.). An imbalance in the Cervical Spine will eventually cause problems in the rest of the spine.

• Impact injuries often caused by sports, falls or vehicle accidents

• Improper lifting, especially when twisting from the hip (This activity can cause severe injury. Always lift correctly!)

• An overactive and shortened iliopsoas (aka. Hip Flexor). This is very common in runners, but also highly common in the 9-5 desk culture due to bad sitting posture. When this is the cause of Sciatic Pain the iliopsoas must be treated for relief to occur. (read more: treating the iliopsoas )

• Obesity

• Spinal Stenosis 

• Scoliosis

• Spondylosis – a condition where the lumbar vertebrae, specifically L5, is defective resulting in diminished weight capacity (Litao, 2015)

• Spondylolisthesis – at the lumbosacracal junction, a disorder where vertebrae becomes anteriorly displaced leading to herniation and nerve entrapment (Werner, 2002)

• Diabetes (source: MayoClinic )

Common symptoms often referred to as “Sciatica”

 

Localized Symptoms and Pain:

· Dull aching or stabbing pain in the lower back, deep hip and/or buttock

· Numbness, burning or a sensation of cold in the lower back, deep hip, buttock, leg and/or groin

· Loss of strength and mobility in the lower back, hip, leg, knee, ankle and foot

· Crunching, grinding or popping in the hip

· Loss of balance and dysfunctional gate issues

 

Satelite / referral (distal) Pain:

· Dull aching or stabbing pain in the lower back, hamstring and in many cases the lower leg and foot

· Middle and Upper Back pain including shoulder discomfort

· Migraines and Headaches

· GI track problems, loss of bowel control, pelvic floor dysfunction

 

The following list, provided by Physio Pedia (2016), details the location of sciatic nerve entrapment and its

corresponding symptoms:

● L4: Compression of the nerve at the L4 vertebrae results in pain, tingling, and numbness in the thigh of the affected side, and extends down to the big toe.

● L5: Compression at the L5 vertebrae will present as pain, tingling, and numbness traveling down to the top and inner portion of the foot and toes on the affected side.

● S1: Compression of the nerve at the S1 level will present as pain, tingling, and numbness traveling down the lateral portion of the leg and foot, including the outer half of the bottom of the foot. Since the sciatic nerve innervates several structures of the lower body, other symptoms include: impaired reflexes, burning sensation, limping on the affected side, and muscle weakness of the affected side. As stated previously, a thorough examination is imperative to create a treatment plan.

 

*Not all symptoms need be present to indicate dysfunction.

 

Anatomy of the Sciatic Nerve and Lumbar Plexus

Overview of Sciatic Nerve Pain:

As shown in the images above, the Sciatic Nerve originates in the spine at the lower Lumbar Vertebrae (aka: the curve found in the small of your back) specifically L4, L5 and the Sacral Foramens (aka: the tail bone) located at S1, S2, & S3.

 

What does this mean and how does it apply to me?

Understanding the difference between the potential causes of your pain can be the determining factor of whether or not you will find the appropriate help you need to feel better, recover, and live with improved quality of life and in many cases live with reduced pain and in many cases pain-free.

Perhaps equally important is knowing what your condition is not so that you can eliminate treatments that are either unnecessary (like surgery in many cases) or ineffective because they are the wrong course of actions for your specific needs.

How can massage therapy and manual release therapies help me?

In many cases, as seen in the conditions listed below, pain is caused by areas of great tension in the body either pulling bones and joints out of place resulting in lack of movement and inhibited range of motion, some form a nerve damage, and/or a circulatory issue. In many cases, relieving this tension through informed touch therapy like massage therapy, for instance by relieving a trigger point that is causing a muscle to inhibit or skew  joint movement can eradicate the associated pain simply by restoring the body’s natural movement.

Getting the correct treatment for the correct condition:

 

If you wouldn’t treat an open wound like you would a bee sting…

…why would you believe all pain is treated identically when it comes to muscle and spinal conditions?

 

Example:

BAD: If you have iliopsoas dysfunction (see below) and you treat it as if you have piriformis syndrome by wrongly strengthening the abdominal muscles (specifically those strengthened in sit-ups, which are not the correct core muscles to be strengthening for iliopsoas dysfunction because these actually enhance postural imbalance) you will actually further tighten the muscle you need to be loosening causing greater compression of the lower vertebrae and thus worsening your condition by impacting the nerves at the spine further causing damage and pain over time.

GOOD: By contrast, had you worked with someone who knows how to release the iliopsoas through massage, trigger point therapy, PNF stretching, myofascial release and/or other modalities you would begin to heal. Alongside direct soft-tissue release (achieved through massage therapy), utilizing the correct stretches at home in order to lengthen the dysfunctional muscles along with following a strength training program that targets the correct muscles groups of the core, back and hips the likelihood that you would begin to feel better quickly and the condition would lessen even more and heal over time is highly probable.

The Hidden Truth

Similar Symptoms: Totally Different Conditions

 

“Sciatica” is often used in laymen’s terms to inaccurately describe a dysfunction by a set of symptoms belonging to multiple other conditions, which exhibit similar discomfort to one another. Therefore, these conditions created similar pain and discomfort, however, they are not the same.

 

Let’s take a deeper look:

Massage Back Pain Relief

Piriformis Syndrome

Compression of the Sciatic Nerve in the deep hip by the external rotator.

TFL and IT Band Dysfunction

TFL and IT Band Dysfunction

Common in runners, causing knee instability, pain & weakness in hip. 

Meditation Classes Guided Meditation Reiki

Sacroilliac Dysfunction

Misalignment of hips at the Sacro-Iliac Joint. 

Private Yoga Instruction Yogic Massage

Lower Cross Syndrome

Pattern of weakness and over-tight muscle groups due to postural imbalance.

Private Yoga Instruction Yogic Massage

Illiopsoas Dysfunction

Chronic tightness in the “hip flexor” causing Lumbar Vertebrae compression.

Meditation Classes Guided Meditation Reiki

Spinal Nerve Entrapment

Impacted Spinal Nerves due to joint dysfunction. 

*While the dysfunctions above do not illustrate all possible conditions of the lower back, these were chosen because of their common nature and generally treatable potential.

Piriformis Syndrome

Most often referred to as “Sciatica”, this may in-fact be the most commonly misdiagnosed version of lower back pain and is generally very easy to cure providing the correct actions are taken.

What is the piriformis muscle and what causes Piriformis Syndrome?

The Piriformis is a pear shaped muscle in the deep hip. Responsible for rotating the leg and foot outward, It is one of the deepest muscles of the hip, meaning that it is found beyond the Gluteal muscles. Understanding the piriformis muscles is important because of it’s location and relation to the Sciatic Nerve, which happens to pass directly under the piriformis and in rare occasions directly through the piriformis. This relationship in space within the body is why the Sciatic Nerve gets affected so easily when there is a dysfunction in this muscle and the surrounding muscle groups.

 

Symptoms related to Piriformis Syndrome

This muscle often times becomes problematic in people causing:

    • Sharp pain that radiates upward into the the small of the lower back
    • Deep prolonged aching in the buttock region
    • Discomfort associated with nerve pain down into the hamstring and even the foot.
    • Often times when someone complains of “their lower back going out” it is not a spinal issue and is actually related to the piriformis aggravating the sciatic nerve causing the entire region’s muscles and soft tissue to seize causing extreme pain and loss of mobility.

Causes of Piriformis Syndrome

    • Prolonged sitting and driving exacerbated by poor posture
    • Running, squats and other activities where extension of the leg at the hip occurs
    • Stress
    • Emotional duress especially surrounding trauma
    • PTSD due to fight or flight response within the pelvic floor
    • Impact injuries
    • Poor shoes, gate issues and high heels
    • Repetetive usage injuries
    • Inapporpriate lifting while bending at the hips

Overview of Piriformis Syndrome

These symptoms mimic genuine sciatica in a near identical manner, causing common misdiagnosis and confusion to many people due to the fact that the piriformis muscle aggravates the sciatic nerve near it’s root at the spine resulting in pain along the entire nerve pathway. However, this is very different than having a spinal dysfunction as the cause of the nerve aggravation is due to compression of the nerve due to a spastic muscle imbalance and not nerve entrapment between the vertebrae.

A common misconception would be to compare piriformis syndrome with the rupture of a vertebral disc or advanced spinal stenosis, where treatments would vary signifigantly but symptoms could be near identical. Getting multiple professional oppinions on the cause of your discomfort and pain is highly recommended.

 

Sacroilliac Joint Dysfunction

A common condition where pain is often felt in the small of the back, at the sacrum aka. tailbone due to an imbalance in the tension placed on the joint between the pelvis and the spine.

In a study conducted by Werner, in 2002, sacroiliac joint dysfunction was considered to be  a degenerative arthritic condition. However, other studies show that this condition may not always be due to degeneration of the cartilage and chronic injury to the ligaments of the affected area and may be due to muscle imbalance allowing for healing to occur with the proper lifestyle changes and myofascial release therapy (Steven Finando, PhD and Janet Travell, M.D.).

 

What is the Sacroilliac Joint and what causes this dysfunction?

The sacroilliac joint is the junction where the sacrum and the spine meet creating the fulcrum, or point of balance, where the lower body attaches to the torso effectively joining the hips and legs to the upper body. Dysfunction, and the associated pain and discomfort is most often caused by an imbalance in the muscles responsible for stabilization of the hip (primary) and weakness in the core muscles (secondary). When these imbalances are present undue pressure and strain are placed on the joint’s ligaments causing sensations of metaphorically “ripping” the hips from the spine.

Symptoms related to Sacroilliac Joint Dysfunction

    • Pain located in the middle of the lower back, aka. the small of the back and the base of the tail bone
    • Pain wrapping around the back of the hip unilaterally
    • Pain located on the outside of the hip and often descending along the outside of the leg along the Illiotibial band (aka. IT Band) unilaterally
    • Different leg lengths and imbalance while running/walking
    • Limited range of motion in adduction
    • Discomfort laying on one’s side without something between the knees to in order to expand the space between the legs thus removing pressure from from the sacroilliac joint

Causes of Sacroilliac Joint Dysfunction

    • Poor sitting posture, especially when both feet are not flat on the floor where the hip and ankles roll outward
    • Injuries due to running, skiing, snowboarding, dancing, and any other physical activity where balance is a key focus
    • Piriformis Syndrome
    • Weakened core support muscles
    • Poor gate especially in relationship to flat feet and collapsed arches
    • Knee injuries
    • Stress
    • Overly tight soleus muscle

Overview of Sacroilliac Joint Dysfunction

These symptoms differ signifigantly from sciatic nerve aggrevation simply because the muscles and joints associated have little to nothing in common with the sciatic nerve, unless the imblance in the hips is so signifigant that nerve entrapment occurs in the lumbar spine due to hyper lateral flexion of this hip causing the intervertebral space to narrow to a point that it would impact the nerves at their roots, which is uncommon but not unheard of.

More often than not this issue is experienced by runners and other athletes, and in those who sit at a desk for extended periods of time while rolling their ankle out through poor lower body posture. In the latter, this is caused by not sitting in a balanced way with both feet flat on the ground for extended periods of time habitually. In the former, this is often caused by gate imbalance leading to dysfunction. A common culprit of this condition is a muscle known as the Tensor Fasciae Latae, and the dysfunction occurs when this is overly active on one side, often times in association with an overly taught iliotibial band of the same leg.

 

 

Illiopsoas Dysfunction

Often times the main culprit in chronic pain of the lower body is overlooked, the iliopsoas. This muscle group, the literal and figurative core muscle of the body, has one of the largest roles in our body relating to mobility and posture effecting every muscle of the body either directly or indirectly through it’s relationship to the spine. Through our movements associated with walking, sitting, standing, and even laying down the iliopsoas can cause conditions that cannot be resolved if this muscle group is not treated properly and effectively.

The illiopsoas is commonly referred to as “the hip flexor” and is often times inaccurately thought to be addressed solely through activities that treat the Quadricep muscle group through bending of the leg at the knee. However, the iliopsoas is unique because of it’s attachments along the spine, the internal hip fissure and finally it’s insertion point at the top of the femur. When this muscle is imbalanced through being overly tight and thus shortened, the illiopsoas can exacerbate hyper lordosis causing nerve impingement in the lower spine, while also causing discomfort in the mid-lower back and often times down into the upper leg.

Most often people attempting to lengthen the illiopsoas through stretching fail to do so because of a misunderstanding of the relationship between the spine, hip and leg and the necessary angles that must occur between these structures in order to facilitate greater mobility of this muscle group.

 

What is the Illiopsoas and how does it function?

First of all, the illiopsoas is not one muscle at all. In most humans this muscle group is comprised of three muscles! The iliacus, psoas major and psoas minor, commonly referred to as “iliopsoas” or “psoas” and in laymen’s terms referred to as the “hip-flexor” are a group of muscles that work together on both sides of the body found in the deep abdominal cavity effecting the lower back, hips, legs and spine. The Psoas originates at the spine, passing through the hips, and inserting at the head of the femur near the groin. When working properly these muscles are responsible for flexion at the hip (both raising your legs independently or bilaterally toward your torso or allowing you to move your torso toward your legs when sitting up). When improperly functioning, due to postural misalignment, loss of elasticity, and muscle shortness, the iliopsoas causes a plethora of conditions leading to chronic pain and discomfort. Iliopsoas dysfunction is often the cause for deep lower back aching, in conjunction with the Piriformis, Iliotibial Band (IT Band) and the Tensor Fascia Latae (TFL).

Before we can understand how this dysfunction occurs and how to treat it, first we must understand how this differs from the muscles of the upper leg known as the Quadriceps.

Within the group of muscles referred to as “the psoas” each muscle has it’s own responsibility during hip flexion and activates during certain ranges of motion depending on the extent of flexion required and which structure (the spine or leg) is being pulled toward the other. This can be better understood through examples of isolated movement with the purpose of targeting selected muscle tissues at specific times (see: treating the illiopsoas).

Because so many people mistakingly believe they must solely stretch their quads to address the hip-flexor, or they simply do not understand the required relationship of angles between the leg and hip to achieve a true stretch of the hip-flexors a full stretch never occurs.  Now, let’s look at why this is wrong. Of the four muscles that comprise the quadriceps (quad = four), only one (Rectus Femoris ) of these muscles actually assists in flexing the hip. “Assists” is the key word here and in strark contrast to the psoas, which fully flexes the torso through the hip, the rectus femoris only works hip flexion with relationship between the pelvis and femur. The psoas muscles flex the hip similarly to the rectus femoris with the addition of also working though the entire pelvic-fossa and the spine while pulling on each vertebrae between T12-L5. The Psoas Major, Minor and Illiacus are the leaders where the Rectus Femoris is the helpful assistant.

 

 

 

 

 

A visual guide to  the Psoas Major, Psoas Minor and Iliacus

 

What is hip flexion?

Hip flexion occurs in two ways. Let’s explore and look at what hip flexion actually is:

1) Moving your torso toward your legs

2) Moving your legs toward your torso

While these two actions may seem identical (because they are generally), they differ because they actually occur during completely different activities and can be looked at as separate actions due to their relationship in space and the amount of boney structures moved during either action.

For example, the first action occurs when you are laying down and attempt to sit up (concentric contraction) and can occur using one or all of the illiopsoas muscle groups depending on how you decide to sit up. However, during prolonged sitting upright- especially with poor posture this muscle group is forced to work eccentrically, isometrically and concentrically continuously. Acting as a postural muscle is not the primary function of this muscle group forcing it to work not as intended often times leading to dysfunction. The illiopsoas muscles are power muscles not  postural muscles (see: fast twitch vs slow twitch muscle fibers).

The second action occurs when we walk, jump, and run for example because of our need to pull the leg up from the ground, not the torso down toward the leg.

 

Symptoms of Illiopsoas Dysfunction

Because the Illiopsoas attaches at so many points along the spine, within the hip and at the leg, symptoms can vary significantly depending on where within the muscles the dysfunctions are most prevalent, and to what degree the dysfunction has advanced to. Some possible symptoms are:

    • Tightness and aching in the lower abdomen in the front of the body (anteriorly) deep to the internal and external obliques and other abdominal muscles
    • Aching in the hip-crease
    • Aching and or a feeling of soreness within the internal hip
    • Dull aching pain in the mid-lower back, specifically within the bodies of the Quadrates Lumborum (QL)
    • Pain in the lower back near the spine that persists after most stretching, massage, and/or spinal adjustments
    • Headaches and migraines
    • Knee pain, weakness and imbalance
    • Difficulty breathing in fully
    • Aching in the mid-thoracic back near the base of the shoulder blades and below
    • Easily experienced fatigue when attempting to sit upright, walk, or use stairs
    • Discomfort lying down with legs fully extended often accompanied by a need to sleep with ones legs in fetal position
    • A deep sense of anxiety generally felt physically within the core region of the body

Causes of Illiopsoas Dysfunction

    • Poor posture especially with relationship to upper cross syndrome and forward head posture
    • Running, jumping, dancing, intimate interactions, and any other activity where one must powerfully lift the legs
    • Prolonged sitting or standing without proper rest and stretching
    • Weakened core muscles, especially those responsible for supporting the spine in addition to the muscles responsible for extension of the spine being weakened and thus overly stretched
    • High heels
    • Stress and trauma especially in relationship to loss where the body collapses forward
    • GI Track issues

 

Treatment

  The Psoas is stretched unilaterally, using specialized movements while stabilizing the hips using PNF stretching to safely create length without risk of strain on the tendons or muscle tissue. In addition, direct deep tissue massage is used in the pelvis and while working through the abdomen in order to reach the attachments of the anterior face of the spine at each vertebrae. While using direct pressure through trigger point therapy at each vertebrae and within the pelvis, you will be asked to do specific movements in order to pass the muscle fibers under the pressure of massage therapist causing a myofascial release. This technique minimizes discomfort making the treatment much more enjoyable and providing lasting results that are exceptional.

In addition to the above, all synergetic muscle groups will be addressed as well. From the lower back, hip, and buttocks region, to the extensors of the spine and head, and finally with the core stabilizing muscles and hip stabilizing muscles.

Often times treatment of the neck and upper torso including the chest and shoulders may be required as forward head posture is often directly associated to iliopsoas dysfunction as the head is naturally connected to the spine. To heal an issue in any part of the spine generally requires the entire spine to be addressed as it is all part of the same system.

 

Overview of Illiopsoas Dysfunction

This muscle group, because of it’s attachment sites at the vertebrae and the intended function of the muscles can exacerbate discomfort associated with the sciatic nerve because of the force applied to the spine by pulling the vertebral column forward (anteriorly) thus limiting the intervertebral space where the sciatic nerve and other nerves exit the spinal column. Imbalances between the core muscles responsible for core stabilization, not the core muscles responsible for core flexion (Rectus Abdomonis aka. “the six pack muscles”) and over tightness of the psoas can lead to great discomfort solvable only by correcting this imbalance.

An important note often times overlooked and largely misunderstood is that “core strengthening exercises fix lower back pain”. This is only true when the correct core exercises are done while working the wrong muscles of the core can actually lead to greater discomfort in the lower back due to the fact that certain exercises activate the illiopsoas more forcing it to shorten further while leading to greater postural collapse. (The most common misconception is found in believing that traditional sit-ups strengthen the correct core muscles by stabilizing the spine against the force created by the psoas muscles, when in reality this exercise is the opposite of what needs to be done and will only further the dysfunction’s development.) The old addage, practice makes perfect is only true when said practice is perfect. Perfect practice makes perfect, incorrect practice just makes you worse.

 

 

TFL and IT Band Dysfunction (aka: iliotibial band syndrome)

The TFL together with the large tendinous sheath that extends from the ilium, or hip, to the knee (known as the IT Band) is one of the most important groups of connective tissue for runners. While many people know the importance of a healthy IT Band it is quite common for athletes and their healers to overlook the TFL when someone experiences hip and knee pain instead focusing solely on the tendon of the ITB and the deep hip area where the gluteal and piriformis muscles exist. 

What is the TFL and IT Band and what causes this dysfunction?

The Tensor Fasciae latae (TFL) and the Iliotibial Band (IT Band) work together in stabilization of the hip and knee. This occurs through flexion, abduction and internal rotation of the thigh (actions of the TFL) while working together with another muscle known as the Gluteus Minimus who’s actions are nearly identical to TFL but serves a greater purpose in hip stabilization during movement. Stabilization of the knee is the main function of the IT Band.  When this dysfunction occurs both the knee and the hip can be effected in addition to causing satellite pain in the buttock region, lower back and lower leg. Commonly when there is an issue with the TFL and IT Band there are also issues in the deep hip, iliopsoas, and lower leg in the shin (experienced as “shin splints”) due to tension in the anterior tibialis and surrounding tissue.

 

Symptoms related to TFL dysfunction and IT Band Syndrome

    • Pain in the knee and hip, specifically the external hip while referral pain is often felt in the rear and the front of the thigh
    • Satelite pain in the lower back
    • Buckling of the knee
    • Weakness in the effected leg
    • Pain in the mid-lower-back opposite of the effected leg
    • Discomfort when resting in the hip, knee and often times lower back
    • If left untreated this issue can persist to a point that the cartilage of the knee is damaged due to the improper tracking of the patella causing permanent joint damage
    • Due to the relationship of the gluteus minimus and the TFL in sharing the IT Band, limping can occur because of the pain caused by the gluteus minimus

Causes of TFL dysfunction and IT Band Syndrome

    • The most common cause of this issue is found in runners, cyclists and other athletes due to repetitive use and improper self-care and maintenance
    • This issue can also come about with sacroiliac dysfunction as these two dysfunctions are closely related due to the relationship in hip stabilization
    • In runners: bad shoes
    • In cyclists: improper posture due to poor bike setup and less than optimal biking mechanics (the way the cyclist holds themselves as they ride)
    • High heels
    • Weak core stabilization muscles
    • Iliopsoas dysfunction can amplify these issues

Overview of TFL Dysfunction and IT Band Syndrome

While reasonably easy to resolve if treated properly through massage therapy, trigger point therapy, myofascial release and stretching, pro athletes, amateurs and hobbyist alike can become lame due to TFL dysfunction and IT Band syndrome completely destroying their ability to continuously enjoy their chosen activities if these issue are not addressed in the early stages of dysfunction. “Powering through” the pain of these dysfunctions will almost always end in greater damage to the connective tissue, mainly the cartilage of the knee and eventually can lead to injuries of the spine, due to imbalanced impact caused by the hips and legs not flowing properly together. These injuries often then lead to a myriad of other issues including back pain, neck pain, and depression to name a few.

Often times knee and hip surgeries could have been avoided or at least delayed provided these issues were dealt with properly in a proactive manner. Many people, with proper maintenance, can enjoy their chosen activities relatively pain-free and without risk of degenerative injuries providing they learn how these structure work together, and how to prevent chronic dysfunction. 

Pain is good in that it lets you knew something is wrong that must be addressed and resolved. Pain ignored is dangerous in most cases and especially with relationship to the hip and knee.

 

 

Lower Cross Syndrome

Spinal Nerve Entrapment

  Most often caused by the Sciatic Nerve being impacted between vertebrae often due to degeneration, rupture, or hernia of the intervertebral disc(s) and can be caused by genetic malformation, trauma, or postural dysfunction, among other attributing factors, therefore resulting in the vertebrae compressing the nerves between the bones. This results in chronic conditions that are often debilitating painful and difficult to remedy.

Sciatica is a nerve condition where the sciatic nerve is either impinged or damaged due to trauma, chronic improper use, or genetic malformation causing pain, weakness and neuropathy down the leg and into the foot. In many cases Sciatica can become debilitatingly painful and can even lead to different levels of paralysis. Without surgical intervention sciatica is generally permanent and can not be repaired, though the pain can often times be reduced through holistic means and even abated. While true sciatica can be considered a chronic disease, there are methods of non-surgical chronic pain treatments that can ease the chronic pain if the condition has not advanced too far.

Massage therapy and other wellness practices such as pilates, yoga, diet, and exercise have been noted to assist with lessening the chronic pain of some people that suffer from sciatica. If you are suffering from genuine sciatica you may experience increased and often debilitating levels of pain when attempting to use the effected limb.

Ouch! Some days are worse than others. What gives?

Pain and inflammation in the body are affected by many things ranging from diet, lack of sleep, stress, humidity, worry and grief, not to mention repetitive use and poor body maintainance.

Sciatic Pain Syndrome, Piriformis Syndrome, Sciatica… What’s the difference?

Question: Why work with a sciatic pain relief specialist?


Answer: Different names for very similar symptoms – the main difference being Nerve Entrapment vs. Nerve 
Impingement

The two most dramatic differentiating factors between these two conditions are:
1) impingement of sciatic nerve at it’s roots from the spine (ref: sacral plexus) , as in the cases of “herniated discs” or “spinal stenosis” (sciatica), vs.
2) muscular conditions causing nerve compression, or nerve compression due to poor posture (sciatic pain syndrome).

Sciatic Pain Syndrome aka. Piriformis Syndrome is highly treatable with non-surgical intervention in most cases.</h5

Sciatic Pain Syndrome is generally caused by muscular conditions which compress the sciatic nerve thus mimicking the symptoms of sciatic nerve entrapment (true Sciatica). Sciatic Pain Syndrome is most often caused by inflammation and aggravation of the sciatic nerve due to spastic muscles conditions (very often the Piriformis Muscle), poor posture, injury due to impact and or chronic use injuries and hip displacement.

Sciatic Pain Syndrome is almost always treatable and commonly completely curable without surgery. Massage Therapy, specifically through a combination of trigger point therapy, myofascial release, and PNF stretching, properly applied by a specialist, or a team of specialists, can provide profound healing results. Relief is possible and within reach for you.

Spinal Nerve Impingement in the deep hip and buttock region aka: Piriformis Syndrome

A completely different condition that can exist both acutely and chronically, and is often misdiagnosed as the above (See: Spinal Nerve Entrapment below). Commonly, impingement of the sciatic nerve is completely curable as it is caused by soft tissue dysfunction, either through being compressed by the Piriformis Muscle as is the case in the condition known as Piriformis Syndrome, or other similar conditions like Iliopsoas Dysfunction, which causes the lower spine (the Lumbar Vertebrae) to over extend causing a condition known as hyperlordosis. The latter would be an example of impingement of the Sciatic Nerve through a mechanical imbalance that mimics the nerve entrapment described above but that can be alleviated through a rebalancing of the connective tissue and lengthening of the Iliopsoas muscle while strengthening the decompensated and thus weakened muscles meant to support healthy spinal posture and function. The former, Piriformis Syndrome, is often treated easily through myofascial release, trigger point therapy, P.N.F. stretching and some strength and stretch training you can do at home.

 

Pain is good. By listening to what our body is telling us, we we improve our chances of avoiding greater injury and eventually breaking down.

All of the conditions above range from uncomfortable to incredibly painful regardless of which underlying condition you actually have. Often times the primary condition can cause secondary conditions to follow. Like a line of dominos, once the first falls, the rest are soon to follow. Unlike dominos, heal the primary injury and the rest of the body can return to balance. There are tests that can be done that have a high level or accuracy in determining which condition you are actually suffering from so that you can be properly treated.

While new research in pain has found that some pain that is felt is completely arbitrary due to malfunctions in our nervous system, this is not the case with most discomfort we feel. More of than not, pain is our body’s way of telling us we need to address something before it’s too late. Using chemicals, such as pain killers, to numb chronic pain without taking the necessary actions to fix the underlying problem does not heal the cause of the pain, but instead masks your discomfort giving you a false sense of wellbeing by deadening your body’s alarm system. Thousands of years of evolution has resulted in an incredibly thorough and accurate self-maintenance and repair system to protect us from further injuring ourselves as long as we head-the-call.

Pain is relative. Each person’s tolerance and experience may be different but should not be ignored.

Just like the “check engine” light in a car, ignoring pain and medicating instead of addressing and fixing the issue can lead to greater discomfort easily3avoidable, and in some cases, complete system failure. Learn to heal yourself to today so that you don’t need to take more drastic measures later.

Treatments

More often than not, the person who wishes to overcome any of these conditions permanently needs a mixture of direct manual manipulation of the soft tissue through massage, trigger point therapy, PNF stretching and myofascial release in addition to implementing self-healing techniques on a regular basis. We can teach you the techniques and give you the knowledge so that you can start feeling better immediately. Knowledge is power and learning the proper techniques that you can do at home or in the office is generally quite easy providing you learn the right skills. Once the underlying condition is being treated, the symptoms naturally dissipate leading to the dysfunction being healed and the pain disappearing.  

 

References

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3. Litao, A., MD, Medscape (2018). Lumbosacral Spondylolysis. Retrieved from the Medscape website: https://emedicine.medscape.com/article/95691-treatment

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18. EurSpine, J., PubMed (2016). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Retrieved from the PubMed website: https://www.ncbi.nlm.nih.gov/pubmed/26006705 

19. Litao, A., MD. Medscape. (2015). Lumbosacral spondylolysis: presentation. Retrieved from the Medscape website: https://emedicine.medscape.com/article/95691-overview

20.  National Institute of Neurological Disorders and Stroke. (2015) Low back pain fact sheet. Retrieved from the National Institute of Neurological Disorders and Stroke website: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

21. Kishner, S., MD, MHA. Medscape. (2015). Lumbar spine anatomy. Retrieved from the Medscape website: https://emedicine.medscape.com/article/1899031-overview 

22. Fritz, S., MS, NCTMB. (2015). Mosby’s massage therapy review/4th ed. St. Louis, MO: Elsener, Inc.

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25. Vokshoo, A., MD. Medscape. (2014). Spondylolisthesis, spondylolysis, and spondylosis. Retrieved from the Medscape website: https://emedicine.medscape.com/article/1266860-overview

26. Ombregt, L. (2013). The ligamentous concept from a system of orthopaedic medicine/3rd ed. St. Louis, MO: Elsener, Ltd. Retrieved from the Orthopaedic Medicine Online website: https://www.elsevier.com/books/a-system-of-orthopaedic-medicine/9780702031458

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30. O’Neill-Boyajian, L. DO, McClain, R.L., DO., Coleman M.K., DO., & Thomas, P.P., PhD. (2008). Diagnosis and management of piriformis syndrome: an osteopathic approach. The Journal of the American Osteopathic Association. Retrieved from the Journal of the American and Osteopathic Association website: https://jaoa.org/?articleid=2093614

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33. Stone, R.J. & Stone J.A. (2003). Atlas of skeletal muscles/4th ed. New York, NY: McGraw Hill

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