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Pseudo Sciatica - Soft Tissue Sciatica

Pseudo Sciatica

I love fitness and being able to move my body when and how I want.

I love challenging it with new loads, movements and activities that build muscle, increase mobility and are fun. This keeps my stress low and energy up while building a foundation of strength and resiliency that I carry with me throughout my day.

Fortunately, I get to treat others like me at AIM. I understand how life altering it can be when you are unable to move and exercise the way you want, when you want. I love getting my patients  moving and feeling better, which in turn allows them to get back to their activities that put a smile on their face and make their days better.

I use Sports Medicine Acupuncture to make that happen.

I’m going to share a recent case of mine to illustrate this. Sports Medicine Acupuncture is different to traditional acupuncture in a couple of ways. One of the first differences you would notice as a patient is the examination incorporates postural and functional movement assessments and muscle strength tests to determine postural issues, dysfunctional movement patterns, and potential weakness of individual muscles.

These factors can compromise proper function and lead to pain and injuries.

Recently, I saw a 47 year old female complaining of pain in her right gluteal region that traveled down the back of her leg and stopped at her knee. The pain was tight, dull and achey with occasional sharpness with certain sudden movements.

The onset was slow over the past two weeks but she finally came to see me when she could no longer run. Running is a huge part of this patient’s life, so being unable to run for the past couple weeks has led her to feel lost and very impatient with her family. The pain then started to show up while at work, which severely decreased her productivity. I understand how hard this type of alteration in lifestyle is, so I was excited to help her get moving and feeling better.

Psuedo Sciatica

Upon examination she tested negative for sciatica symptoms associated with a problem in her spine so we had to do some more digging. Knowing that she is an avid runner, and the symptoms slowly developed while running, I then turned to look to see how well her right hip was able to stabilize her in a single leg position.

In running, we never have both feet on the ground at the same time (its a single leg sport). Couple that with the increased ground forces (6-8 x’s your bodyweight) while running, if she couldn’t balance well on the right leg standing still, she definitely will be struggling to stabilize under the increase load of running. And that’s what we found.

She was unable to stand longer that 5 seconds on her right leg, while on her left, she was good up to a full minute. Manual muscle testing her right hip muscles found her glute minimus, and glute medius weak and painful.

Compressed Sciatic Nerve

Next, I applied deep pressure over the area of her piriformis, which recreated her symptoms. Her hamstrings still had normal range of motion but were exquisitely painful to touch. We also found that the rotation of her hip was also greatly reduced, and painful in external rotation. This led me to conclude that a couple of her hip stabilizing muscles were not providing a strong enough output, (glute medius and minimus) forcing another muscles to overwork (piriformis and hamstrings).

So even though she was having sciatic like symptoms, this is a case of pseudo sciatica were the sciatic nerve is getting compressed in the soft tissue of the body and not at the spine.

Now we knew what tissues to address to get her better.

When I needled into her pirifomis, she reported that the needle was able to ‘touch’ her pain in a way that she had been trying to do with foam rolls, balls and occasionally she would recruit her husband to apply some massage to the area but it was pretty “half- assed” (her words not mine). After the rest of the needling she reported warmth and awareness that she had not felt for awhile.

This is what sports acupuncture does: it provides an input to stimulate blood, oxygen and proprioception (body awareness) to a very specific area of the body.

After the needling, we moved on to soft tissue work to decrease the tension in the hamstrings and gluteal area to allow the tissue surrounding the sciatic nerve to receive new blood and oxygen which in turn will help to decrease the sensitivity of the nerve.

She then went home with a few exercises to increase the stability of her right hip and help solidify the changes we made on the table. She returned to a modified running schedule almost immediately. During a course of treatment, I try and keep my patient’s participating in their activities they love but modify to keep it safe.

We worked to figure out the right dosage of running that left her feeling like she’s progressing without overdoing it. This really helped to mitigate her stress levels because she was back to some running again.

With subsequent follow ups, this patient was back to her normal pacing/ milage within 3 weeks of treatment.