Originally Posted by
goswannies
Sorry havenât checked in for a couple of days
Pretty good Deja!
Ok, a while ago, a common diagnosis on player omission was âback related hamstring issuesâ. Essentially this was sciatica - tension on the sciatic nerve. Symptomatically, it presents as discomfort and/or tightness along the distribution of the sciatic nerve ... which traverses the back of the thigh ... the hamstring region.
The sciatic nerve is the largest nerve in the body, comprised of the union of 5 nerve roots originating from the lumbar spine. It traverses deep in the buttock region, down the back of the thigh, to the heel and sole of the foot, supplying the skin and posterior muscles of the leg (the hamstrings being prominent).
The conundrum is that the sciatic nerve can be irritated in a number of regions. The neural pathway essentially extends from the lumbar spine to the foot. It can be encroached upon by disc protrusion or narrowing of the foramen (the holes between the vertebrae from which the nerve roots emerge) causing mechanical compression of the sciatic nerve at these levels. Then the sciatic nerve passes through the muscular buttock region either deep to the piriformis muscle or in a proportion of people through the piriformis muscle - in either instance piriformis can cause compression of the sciatic nerve. Then, as the nerve traverses the leg, any relative tightness of the nerve relative to the leg length will apply tension to the sciatic nerve - again yielding discomfort at the back of the thigh.
Add to this, while the sciatic nerve emerges from the lumbar spine, the spinal column extends up to the head potentially there can be a proximal component at the head.
The advantage of such a lengthy nerve that supplies a specific region is that this very feature can be used to differentially diagnose the probable level of the irritating region. This is called the slump test. When you sit with your knee straight, ankle dorsiflexed (bent up), thorax flexed, and neck flexed (chin to chest) - the sciatic nerve is on full stretch (itâs a wee bit more complicated than that, but thatâs the basics). It will almost always recreate the symptoms in the case of sciatica. Then by releasing different elements (eg straighten the thorax; extending the neck; bending the knee; plantar flexing the ankle) the symptoms may be relieved indicating at which region the sciatic nerve might be problematic.
In the case of piriformis, deep palpation will likely elicit symptoms (usually comparing sides). The discs are assessed by symptoms & mobilising the lumbar spine. Facet joints by a different type of spinal mobilising.
Thereâs more to it than that but itâs a start.
Right, that should give you an idea that treatment becomes a complicated issue, as it really depends on where the pathology is. Neural stretches and mobilising, piriformis stretching and massage (itâs a very specific stretch), traction may help if these is a doscogenic component, lumbar mobilising for facet joint involvement.
Also, while the sciatic nerve pain is neural in nature, there can be a genuine hamstring component. If the sciatic nerve is causing pain, the body might respond by limiting movement to reduce pain. This can result in muscles becoming tight in their own right. Again, we need to differentiate between hamstring tightness and muscle tears (a hamstring stretch with neck and ankle dorsiflexion assists this differentiation.
These are general manual tests. Scans are also very helpful.
While hamstring damage and sciatica can be mutually exclusive, they can also be interrelated, and treatment is modified accordingly. It can be effectively treated, however, this can be time consuming and require diligence. Quick fixes are (IMO) unlikely as if exacerbated before it is âfixedâ it tends to set the player back. Additionally, often treatment can make the player asymptotic with general low intensity movement, however, extreme movements (end range kicking, long strides or ballistic contraction with running) can be the actions that will exacerbate the sciatica. Iâd hope/expect that a well managed sciatic condition could/should have a positive outcome both short & long term. Getting onto it early can definitely help.
Disclaimer: general information not medical advice
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