Sciatic Nerve Injury

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.

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