Question
QUESTION: I have been suffering for several years with what I thought to be calf strains. Recently however I have had another assessment where I was told that my problems may be due to having a tilted pelvis which has put pressure on the nerve in my lower back which in turn gives me the pain in my calf[similar to a cramp]. Can you tell me any more please?

ANSWER: Dear Guy,

What you have been told relates to the biomechanics of the pelvis and associated anatomical structures.  Descriptions such as this used to be common place in chiropractic, but with newer research and science, explanations such as this seem to be rendered only with older doctors, or those who practice techniques that were developed years ago, and have not progressed as much as the rest of the profession.

Current thought on biomechanical considerations such as what you have described tend to lean more toward myofascial involvement due to the fact that the muscular and fascial system is intertwined from head to toe.  In fact the fascial system which covers all of the muscles is thought to be a continuous fibrous band of tissue.  therefore, I would disagree with the assessment given, but only for the reason that I do not believe that the nerves are the source of the problem, but rather a tightening of the fascial system which in turn can limit the freedom of motion in the muscles or muscle connections contained within.

If the pelvis is tilted, then the doctor/therapist or whoever gave you this opinion, should be able to quantify (measure) the tilt and show you what the measurement is in relation to the published normative values.  If the clinician cannot quantify this measurement, and show you the normal measurements published in the scientific literature, then ask them why they cannot.  Ask for a rational scientific explanation of what the problem is specifically, and where you can reference information about it.

The nerves in question are branches off of the sciatic nerve.  The problem with this idea is that if there was pressure on these nerves is should result in characteristic pain patterns, numbness and possibly tingling along the back of the thigh and below the knee. Commonly referred to as sciatica...this is usually caused from degeneration in the low back, nerve root encroachment in the low back, or a muscular encroachment in the buttock sometimes referred to as Piriformis syndrome.

I would suggest that you first ask the clinician you are seeing to explain their diagnosis in a better manner with the scientific evidence to back up their opinion.  If they can't or won't, then get another opinion, and make sure that you get a functional examination of the low back and the legs to include orthopedic testing.  

Good luck Guy.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

---------- FOLLOW-UP ----------

QUESTION: Many thanks for your reply.
I do sometimes experience pain in my buttock which radiates down into my hamstring but not lower than this.The pain is sometimes aggravated if I use the Concept rower for long periods. I've always considered this to be sciatica. When I've had my calf problems, which I've always thought to be tears,they have happened when running.If it is possible that this acute pain is not in fact a tear of the muscle but a result of the tightness in my fascial system why does it come on so suddenly? Do you have any suggestions as to what, if anything, I can do to help the situation.

Answer
Dear Guy,

The pain you have experienced from the rowing machine could be from the sciatic nerve, or could easily be from the sacroiliac joints in the pelvis.  The pain patterns are very similar and overlap, and a functional examination is the only true way to try an differentiate the two sources of pain.

The muscle cramping/pain is probably not from a true tear, as this is very excruciating at the onset, and is usually felt immediately.  A true tear will stop you in your tracks at the time of injury.  Now with fascial tightness or muscle spasm and trigger points, the pain can be intense, and diffuse, but will not normally stop you in your tracks, unless there is a severe cramp.  But, a cramp can be worked out fairly easily and does not usually cause continual problems.

Clear as mud right?  My advise, unless you are going to have the muscle examined directly with palpation and orthopedic tests, don't worry so much about the diagnosis at this point, but rather at what you can immediately due to remedy the situation.

Some ideas:  
Water intake and electrolyte imbalances...make sure that you are getting enough water to stay fully hydrated.  Half your body weight in ounces is a good measure for normal activity.  So if you weight 200 lbs, then you should be drinking 100 ounces a day of water.  Now for every hour of exercise you should drink an additional 32 ounces, after the initial hour, then a sports drink is appropriate for further hydration and electrolytes.

Stretching:  pre and post workouts!  This should include your entire torso and lower body, with a special emphasis on your hamstrings and calf musculature.  Additionally realize that if your low back is tight it will pull on the pelvis and then tighten the hamstring musculature.  this is why torso stretching is just as important as the lower legs concerning running athletes.

Massage:  I recommend that you partake in some sports massage to include deep tissue work in all of the musculature of the legs.  The therapist should incorporate resisted stretches into the massage, and will likely find very tender points on the front of the legs, as the anterior tibialis, and peroneus muscle are often problematic in runners, and can cause increased calf muscle (gastroc and soleus) tightness and pain.

Lastly, check your shoes...make sure that they give you enough support, and think about having your gait cycle (the way you walk and run) analyzed by an certified athletic trainer that is trained to do so, or by a sports trained chiropractor to look at foot and lower leg mechanics.  If the foot is not working properly, the problem could be there and creating symptoms upward, rather than a back problems creating symptoms downward.

Give that a shot and monitor your results.  Furthermore, the post-run stretch can be followed by ice (10-20 minutes)to limit inflammation and soreness, and will help to retain the lengthened position of the muscle fibers.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net