A person who has experienced sciatica known the condition is disruptive and painful. Markedly, the condition stops a person from doing basic things such as bending, running, walking, sleeping or even sitting among many more. Sciatica represents a group of symptoms that occur when sciatic nerve located on the lumbar part of the spinal cord turn out to be irritated. Notably, diagnosis of sciatica or the sciatic nerve irritation happens due to the impingement or compression of the multiple or single nerve roots that is caused by disc herniation or ordinary spinal degeneration with the person's age that occurs after an injury. Notably, the bulging of the discs represents a kind of gel getting nearby the disks. As a result, these discs get compressed hence making them be pushed back to the nerve thus irritating the nerve path. There are many causes of sciatica such as lumbar spinal stenosis, spondylolisthesis, pregnancy, and many others. This essay focuses emphasizes sciatica running by looking on detailed aspects of the injury such as anatomy, mechanisms, diagnostic procedures, symbols, and symptoms, the healing process, rehabilitation or surgery that is needed to be done in order for the athlete to return back to play.
Piriformis SyndromeLobby (2014) postulates that one among the many conjoint injuries runners are encountering are related to nerve pains. As aforementioned earlier, sciatic nerve injury denotes to numbing, and a sharp sensation that stretches to the nerve. The complication starts from the low back via the buttock and finally to the legs. Figure 1.0 shows the sciatica nerve containing the associated muscle (Piriformis muscle) that is predisposed to injury.
Sciatica Common Mechanisms of Injury
Sciatic nerve sting takes place on the anterior towards the posterior or piriformis muscle, then downwards Gemelli-obturator internus multifarious at the close to the ischial tuberosity. They are the primary causing agents leading to the stressing of the piriformis muscle take place a result of deprived body mechanics in an acute injury or chronic condition using vigorous internal alternation of the hip. Lobby (2014) reveals that there are also cases of anatomic anomalies driving the force of compression that lead to a direct tumor invasion, tumor invasion, bipartite piriformis, and anatomical variations.
A study by Jung Kim and Hyun Park (2014) postulates that irritation or compression of the nerve is the main causing agent leading to the occurrence of piriformis syndrome. However, several conditions can also subsidize to this irritation or compression such as poor posture, muscular imbalances, deposition of scar tissues nearby nerve root, lumbar disc herniation and obesity. In furtherance, readings by Kim and Park (2014) outline trauma experienced from occupational undertakings such as lifting and twisting, car accidents, injections and extended period of sitting as potential factors leading to sciatica.
Anatomy of the Sciatic Piriformis Syndrome
Notably, the sciatic nerve develops from the frontal and posterior divisions of the L4, L5, S1, and S2 spinal nerves. Moreover, it is formed from the anterior partition of S3 spinal nerve. According to (Akter, 2014), the anterior partition of sciatic nerve forms the tibial partitions. On the other hand, the posterior detachments make up the peroneal division. The anterior and posterior divisions run hand in hand in the pelvis from where they pass piriformis muscle from beneath. From the tibial division, the peroneal division lies lateral.
According to Kim and Park (2014), almost 4% of piriformis syndrome victims display immediate symptoms with 6% experiencing delayed onset symptoms. The piriformis muscle is usually pyramidal-shaped, oblique and flat. The muscle originates from the anterior to the vertebrate (S2 to S4) which is the loftier margin of the larger sacrotuberous ligament and sciatic foramen. In furtherance, piriformis muscle then intersects via the greater sciatic notch before hooking to the superior trochanter of the human hip bone. When the hip undergoes an extension, the muscle tends to perform as the external rotator. However, when the hip undergoes inflection, the muscle tends to act as a hip conductor. According to Kim and Park (2014), the piriformis muscle gets innervation from the other nerve subdivisions originating from L5, S1, and S2. As a result of the muscle getting overused, it starts getting inflamed or irritated causing the exasperation of the adjacent nerve (sciatic) due to its closeness to the center of the muscle. This is explained from figure 2 attached in the appendix showing piriformis
The marginal differences are due to the locus of administered injection. Notably, placement in the central diffusion is the most critical because over time it damages the fascicles (Akter, 2014). Usually, a patient with sciatic nerve injury experiences causalgia, paresthesia and pain in the nerve pathways. According to Mishra and Stringer (2010), the injury is associated with pain which is a burning sensation and severe shooting. Due to the peroneal division repeatedly involved, the motor functions of the body are severely affected compared to the neurosensory functions. As a result, the patient experiences scarcity of eversion and dorsiflexion presenting a paralytic food drop.
If the tibial division is impaired, the patient starts to lose a plantar flexion of both toes and foot weakening foot inversion (Akter, 2014). In furtherance, this may extend to complete lesion of the sciatic nerve causing the patient to suffer from a hamstring, impaired knee flexion and flail foot (Kim & Park, 2014). Moreover, depending on the level of the injury, patients may also suffer from limb amputation, claw toes, pressure sores and infections. Besides, the patient may also experience delayed vasomotor alterations which are associated with edema, skin thinning, limb, erythema, and cold sensation. In children, the symptoms include leg-length disfigurements and a decreased amplification of the foot.
Piriformis Syndrome Diagnosis Procedures
Primarily, the diagnosis of the piriformis syndrome is usually one of exclusion and is clinical. During the physical examination, the doctor involves in performing stretching exercises with the aim of the irritating the piriformis muscle. Besides, the practitioner exerts manual pressure within the affected sciatic muscle hence helping in reproducing the onset symptoms. There are several stretches that doctors undertake when conducting a physical examination of the piriformis syndrome. These include FABER (flexion, abduction, external rotation), Freiberg, Pace, Beatty, and FAIR. One of the body stretches used in the diagnosis of sciatica running is Beatty stretches involves a profound buttock itch twisted by a side-lying patient who touches the flexed knee to various inches off the bench (Akter, 2014). FAIR stretches comprise of flexion, adduction, internal and rotation movements. Freiberg movements entail an energetic internal turning of the protracted thigh. Last but not least, Pace maneuvers comprise of repelled seizure and peripheral alternation of the thigh.
Significantly, magnetic resonance helps in detecting post injury neuroma formation. Electromyography is done using various body parts such as gastrocnemius. Tibialis anterior, extensor digitorium and in the femoris muscles. During this diagnosis, doctors use concentric needle electrode which displays acute denervation signs, affirmative spontaneous fibrillation. Besides, it also shows sharp waves containing recruitment and interference carried in the muscles affected. Mishra and Stringer (2010) disclose that the concentric needle electrode that is used for displaying the signs relating to chronic denervation featuring restoration, high amplitude, and recruitment and decreased interference patterns in muscles affected.
After a piriformis syndrome patient undergoes diagnosis, it is recommendable to have a waiting period of around 48 hours. Also, the patients are also recommended to apply NSAIDs, physical therapy and muscle relaxants. However, in severe cases, steroids are used by injecting the patient close to piriformis muscle hence helping in decreasing pain and inflammation. Previous anecdotal reports by Lobby, 2014) reveals that the administration of botulinum toxin can also offer help by relieving pain. Nevertheless, the duration that the patient gets relieved from the pain is seasonal hence requiring repeat injections.
Surgery exploration is the alternative consideration for diagnosing piriformis syndrome's patient. However, this should apply to patients failing a conservative therapy such as body exercises. This is because surgery may play a role in decompressing the nerve in case the exercise faces impairment. Nonetheless, the outcomes of surgical exploration cannot be easily predicted hence the patient may continue feeling the pain.
In numerous cases, many doctors recommend patients suffering from sciatic running injuries to physical therapy. Rehab exercises are also very significant because they aim at glute strength involving the external rotators and abductor of the hip. For sciatica running injuries arising from the lower back problems, rehabilitation process entails strengthening and stretching exercises for back and abs muscles. Inflammation is always a factor in sciatica injury, administering anti-inflammatory drugs such as naproxen and ibuprofen is very useful.
Significantly, many doctors recommend surgery for sciatica running injuries as an alternative for recalcitrant cases. This surgery is very important because it leads to rapid recovery than elected conservative treatment.
To sum up, it is evident that preventing the complication associated with Piriformis Syndrome makes sciatic nerve injury preventable. Avoiding unnecessarily prolonged sitting is the best remedy. However, if the infusion is indispensable, it is significant to ensure it is administered when using the appropriate treatment methods. Therefore, if there is a suspicious feeling of Piriformis Syndrome, the patient should be provided with optimally and onset injury management. As a result, this will play a significant role in reducing sciatic injury as well as maximizing recovery likelihood.
Jung Kim, H., & Hyun Park, S. (2014). Sciatic nerve injection injury. Journal of International Medical Research, 42(4), 887-897.
Akter, M. (2014). Prevalence of low back pain among the clinical physiotherapists at CRP (Doctoral dissertation, Department of Physiotherapy, Bangladesh Health Professions Institute, CRP).
Ropper, A. H., & Zafonte, R. D. (2015). Sciatica. New England Journal of Medicine, 372(13), 1240-1248.
Xu, L., Zhou, S., Feng, G. Y., Zhang, L. P., Zhao, D. M., Sun, Y., ... & Huang, F. (2012). Neural stem cells enhance nerve regeneration after sciatic nerve injury in rats. Molecular Neurobiology, 46(2), 265-274.
Figure 1 Sciatica nerve and piriformis muscle
Figure 2 Piriformis muscle
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