You may have seen in the media yesterday that John Terry, former England captain has pulled out of the England squad for tonight’s game with France due to nerve pain in his right leg.
So, what can cause this kind of injury?
There a number of causes that include:
* Lumbar disc bulge
* Piriformis syndrome
* Weak Gluteal muscles
* Spondylolysthesis
* Spinal Stenosis
* Scar tissue
The common theme with this kind of injury is that one of the nerves that supplies the leg, the sciatic nerve, is usually being irritated, causing the pain.
A disc bulge at the lower part of the lumbar spine (L5/S1 or L4/5) can occur (and is common) after a prolonged period of time with a flat back posture. A flat back posture is when the natural curvature of the lumbar spine is lost and has less than a 30-degree curve.
A flat back puts pressure on the front of the lumbar discs and pushes them backwards towards the spinal cord. If there is enough pressure on the disc, it can bulge and rub or even herniate against and entrap the nerve, irritating it. This can cause the pain to travel down the leg along the nerve.
A tight Piriformis muscle, which is in the same region as the gluteal muscles can also entrap the sciatic nerve, causing pain along the sciatic nerve.
Weak gluteal muscles (hip abductors) will cause the spine to excessively side-flex when walking, jogging and sprinting. Excessive side flexion is caused by the inability of the gluteal muscles working (as a force couple) with the adductor muscles and quadratus lumborum muscles to stabilize the pelvis from side to side (frontal plane). This is known as a Trendelenburg Sign. The side to side motion of the lumbar spine creates excessive pressures on the edge of the discs, pushing them outwards to the opposite side. This lateral bulging of the disc can also irritate the nerves.
Spondylolysthesis, which is a break of part of one of the vertebra (pars articularis) and causes a forward slippage of the affected vertebra, which can also entrap the nerve supply.
A spinal stenosis, which is a blockage of the spinal canal whether it’s due to boney growths, congential issue, scar tissue (often from surgery) or a spondylolysthesis, can also cause irritation to the nerves.
If I had to guess (I never guess when working with clients), I would guess that John Terry has a flat lumbar spine pushing his lumbar discs towards his spinal cord and may have weak gluteals muscles too further adding to the problem.
However, what needs to happen is a full assessment of his posture, measurement of his spinal curvatures, assessment of his abdominal function, nutritional status and movement pattern analysis to find out the causes of his symptoms and address the causes.
I have had a number of clients with Sciatic symptoms and it is normally very easy to correct with a corrective exercise programme, nutrition plan and manual therapy (to release any trigger points in the muscles and fascia and to release any nerve adhesions).
These conditions however, do tend to become more challenging to resolve once surgery to that area is introduced due to the build up of scar tissue, so surgery should always be a last resort. John Terry is at one of the biggest teams in Europe and I have no doubt the medical team will have him back playing within four weeks, no problem.