Nerves - The Lower Limb Edition

Welcome to part 3 in our nerve series - yes, we’ve made it to the lower body! We know this is the part many of you have been waiting for.

Before you get carried away, please make sure you’ve reviewed ‘Nerve 101’ blog found HERE and the ‘Upper Limb Nerve’ blog found HERE. You’ll need info from there to get the most from this ‘Lower Limb Nerve’ blog.

All caught up? Then scroll down and enjoy!

As we discovered previously, if our nerves are unhappy, we may experience sensation changes, reduced movement, or even loss of strength (neurological weakness). Definitely not things we want at pole or everyday life.

Let’s dive in with the lower body nerve anatomy.

Lower body nerves

Starting with the lower back, we have 5 lumbar nerve roots (L1-5), 5 sacral nerve roots, and the often-forgotten coccygeal nerve.

All of these spinal nerves are part of the Peripheral Nervous System (PNS) which originates from the spinal cord and brain, ie the Central Nervous System (CNS).

Here is an overview of where they are and what they do:

Image 1-3: Lower limb nerves, sensation & motor supply

Key peripheral bundles in the lower limb (LL)

Key nerve bundles we will focus on are the sciatic and femoral. While the sciatic is often over blamed for pain, the femoral is frequently under recognised in polers as a source of mobility restriction. Both key nerve bundles can impact our flexibility for splits and on the pole, even if they aren’t a source of pain during daily activities.

There are many other peripheral nerve divisions in the legs, but we are focusing on the sciatic and femoral bundles today as problems are more commonly seen to reduce mobility in polers and are easier to recognise.

Beliefs about nerve pain

Have you ever had a particular kind of pain and assumed it was a nerve? It might have been shooting, intense, or wouldn’t go away.

Many people assume they have nerve pain because of the qualities of their pain. Health care providers often ask these kinds of questions about their clients’ pain:

• Is it constant or intermittent?

• What kind of pain is it? Eg: sharp, shooting, burning, aching

• Where is the pain?

We see many patients who think they have a nerve pain because of qualities their pain has, but they may have something entirely different going on. In reverse, there are other types and areas of pain that can be caused by unexpected irritation of a nerve. We might mention a couple of specific examples later, but the moral of the story is get checked by someone who knows (aka a qualified healthcare professional). Many general practitioners (doctors, physios etc) may even miss these things, as they can be niche areas and tricky to diagnose. So, it’s important you don’t try to diagnose yourself through Google or even from this blog! Our team of experts have online appointments to help you out, so there’s no need to guess or suffer silently.

LL nerve mobility basics

A quick review:

• Nerves don’t like to stretch; they prefer to slide between structures to allow us full flexibility.

• We can have general nervous system upregulation (think “fight or flight” mode). This can create general nervous system irritability and wind up and requires a whole-body approach.

• There can be more localised nerve mobility issues affecting one or more peripheral or spinal nerves.

Today we are talking nerve mobility issues, not true nerve compression/neuropathy. Anyone with signs of nerve compression, including loss of muscle power, reduced deep tendon reflexes, and constant sensation changes/numbness should immediately speak to their health care provider.

Now that’s out of the way, onto the stuff you can apply to pole! So, what in my pole life might give clues I need to check my nerve mobility?

Depends on which nerve branch! Let’s check the most common two: the sciatic and femoral nerves.

The Sciatic Nerve

This is the major nerve down the back of the leg that many people love to hate.

It is the largest nerve in the human body and contains nerves from spinal nerve roots L4-S3. It runs through the back of the hip, under the glute and piriformis muscles. From there, it continues down the back of the leg, dividing into smaller nerves at the back of the knee, going all the way into the foot.

The sciatic nerve has functions for sensation and muscle power. It is often blamed for pain in the glutes, but true sciatic nerve pain goes below the gluteal fold and is less common than we tend to think.

The Sciatic Nerve in Pole

Knowing the rough pathway of the sciatic nerve (above), what movements do you think might be affected if sciatic mobility is reduced?

Combinations of these movements require good sciatic nerve mobility:

• Spinal flexion (look down, rounded lower back)

• Hip flexion (thigh coming toward the body in front)

• Knee extension (straightening)

• Ankle dorsiflexion (flexed foot)

All of these movements together add up to a rounded backed, flexed foot pike or “hamstring” stretch position!

Photo used with permission from from Mark at EVN Creative @evncreative

Here are some common problems we see at pole if the sciatic nerve is not sliding well:

• “Tight hamstrings” that don’t get better or may get worse with stretching. Often feels like a thin line of pull down the back of the leg.

• Adding a flexed foot to a pike or hamstring stretch increases the stretch or gives pain.

• Head pops up (neck extension) in a hamstring stretch.

• Knee won’t straighten in a hamstring stretch/pike, even though the knee joint has full range of motion.

• Pins and needles in the back of the leg or bottom of the foot when stretching, especially with a flexed foot.

There can be lots of subtle differences in exactly the symptoms or positions that bring them on, depending on the person.

If you think your sciatic nerve mobility might be limiting your mobility on or off the pole, check out this video on how to self-test it.

The Femoral Nerve

The femoral nerve is the major nerve situated in the front compartment of the thigh. It is made up of parts of the L2-4 nerve roots and runs down the front of the leg before turning into the saphenous nerve and travelling down the inside part of the knee/shin. The femoral nerve provides sensory information about the front of the thigh and part of the shin area (medial). It also provides muscle power to the key muscles at the front of the thigh, including those that flex the hip and extend (straighten) the knee.

Femoral Nerve in Pole

The femoral nerve has a slightly more unique journey, crossing from the back of the body (spine) to the front of the hip. This means it can be a little more confusing to work out what tensions it than the sciatic nerve, which instead runs straight down the leg.

The combination of movements that tension the femoral nerve are:

• Spinal flexion (head down, back rounded)

• Hip extension (as in the back leg of a front split or lunge)

• Knee flexion (bend)

This means if the femoral nerve is restricted, we might find:

• Limited hip extension with a thin line of tension down the front of the thigh. Doesn’t seem to improve over time with stretching. (Caution: there are multiple things that can cause this and they have VERY different treatments.)

• Looking down in a hip flexor stretch makes the stretch more intense.

• Bending the back knee in a hip flexor stretch makes it more intense (note, this can also be quad tightness), and doesn’t seem to get better with stretching.

• Side bending away from the nerve makes the stretch more intense

photo used with permission @hannahkate

If you think your femoral nerve mobility might be limiting your mobility on or off the pole, check out this video on how to self-test it.

Don’t forget

Working out which nerve might be limiting you, and even doing some slider exercises, is only part of the solution. It’s important to work out why the nerve mobility was limited to begin with. Was it a result of an old injury, a habitual/repetitive movement pattern, or something else that created restrictions along the nerve pathway?

This is best worked on with your health care provider, but it’s a good idea to start thinking about if you’d like to improve your lower limb flexibility or get on top of that niggly pain.

Bonus!

We will leave you today with a couple of little “did you knows?” for your next trivia night ;)

Besides being examples that nerves can do some weird and wonderful things, this is your reminder that persistent symptoms really do need proper assessment by a physio, chiro or osteo who knows.

1. Localised pain at the front of the knee

There is a tiny branch of the saphenous nerve (which comes from the femoral nerve) called the infrapatellar branch, pictured. Occasionally, this nerve can become annoyed and present as musculoskeletal knee pain. It is commonly misdiagnosed as patellofemoral pain, but rehab can be quite different.

2. Have you heard of the pudendal nerve?

It’s a major nerve in the pelvic region. It is involved in pelvic floor function, including continence, as well as sexual function, and sensation in the pelvic region. We all know how important our pelvic floor is for pole (right?!), and we have the pudendal nerve to thank for the hard work those muscles do! It can become dysfunctional or irritated, like any other nerve, and is best assessed by a pelvic health physio or doctor.

We hope you’ve enjoyed diving into some more functional nerve anatomy with us! This is the absolute tip of the iceberg. Nerves are incredibly fascinating and complex things.

Keep an eye out for an upcoming workshop in 2023 where we will break down the complexity of the nervous system in great detail and help you overcome any mobility restrictions you have been facing.

Are you working on a pole trick and not making improvements in your flexibility? Book an appointment with a member of the Pole Physio team here to determine the root cause and to have a mobility program tailored to you.

Online telehealth appointments can be booked with the Pole Physio via our ‘Book Online’ page that can be found here. Assessment and tailored rehabilitation are provided in accordance with best practice and evidence-based treatment to help you unleash your 'poletential'.

Until next time, train safe.

The Pole Physio

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