John Terry Injury
Talking in the Mail Online on 18th November 2010 about the Terry injury he said: ‘I have been struggling with a nerve pain coming from the top of my leg down to my hamstring and to the outside of my calf. It started towards the end of last season but with Chelsea being in the mix until the day of the FA Cup final, I didn’t have the chance to rest or pull out of games. Then I went straight to the World Cup with England.
‘I had three weeks’ rest after that and thought I would come back without it, but since then it has got worse and worse. It has been manageable up until the last two weeks but when we played Fulham I stretched to win the ball against Clint Dempsey and it got a lot worse.
‘It is at a point where I can’t carry on with it. I used to be able to make it through games because the adrenaline gets going and you blank the pain out, but now there really is no decision to make.
‘After games I am in agony and not sleeping at all. I used to play with pain at seven out of 10. Now? It’s 10 out of 10. I need to take a few weeks rest, see a couple of specialists and solve the problem.’
He may fly to Italy later this week to see a specialist team recommended by Ancelotti, and has also been referred to nerve specialists in London.
An epidural treatment given on Friday failed to work.
WARNING – this is a long and necessarily detailed post.
Set aside a good 10 minutes to read it – it will be worth it!
Please “Like” etc if you find it useful – thanks.
What is Sciatica?
Sciatica is one of these terms that people use to describe a wide variety of aches and pains in the leg – most of them incorrect!
Sciatica is defined as leg pain that is localised in the distribution of one or more of the nerve roots (L4-S3), with or without neurological deficit. Neurological deficit means ‘numbness’ or loss of sensation and / or weakness.
The red area in the diagram represents the typical areas of skin supplied by the Sciatic nerve.
As you can clearly see the whole of the back of the leg from the buttock to the hell is supplied by the Sciatic Nerve
(apart from a small area in the inside of the knee and inner calf).
The outer part of the lower thigh and the whole of the front of the lower leg are also supplied by branches from the Sciatic Nerve.
Generally Sciatica is considered as pain down the back of the leg but as you can see it can also affect the front.
Depending on what nerve root is affected it can be back, side or front and more rarely a combination of these.
I mentioned the nerve root in the previous paragraph.
The nerve root is the part of the nerve as it comes off the spinal cord and as it exits from between two vertebra (see below).
There are 31 pairs of nerve roots exiting through holes (vertebral foramen) formed between two vertebrae.
These nerve roots start at the base of the skull and end at the coccyx or tail-bone.
From your chest down each nerve root is labelled with the name of the vertebra that forms the top of the hole that it passes through.
As you can see in the diagram the sciatic nerve is formed from several nerve roots.
There are 5 nerve roots involved in the Sciatic nerve – L4, L5, S1, S2 and S3.
L4 passes out through the vertebral foramen (tunnel) between L4 and L5 vertebrae.
In this diagram I have labelled the L4 and L5 vertebral bodies.
The vertebral foramen (tunnel) is outlined in red.
At the front of the foramen is the inververtbral disc which I have coloured green.
At the back there is a joint between parts of the L4 and L5 vertebrae.
You are now looking down on top of the L5 vertebral body.
The outline of the disc is Green
The lower part of the spinal joints on either side are Blue
The pair of L4 nerve roots are Yellow and lie in the bottom half of the tunnel.
Hopefully now you can visualise what happens if there is a ‘slipped’ disc.
The disc bulges backwards into the tunnel and takes up space.
This is represented in the diagram by the Red Arrow.
This means that there is less room for the nerve and its blood vessels as they pass through.
This impingement of the nerve root leads to pain in the area of skin in the leg supplied by that part of the nerve – Sciatica.
It may also result in weakness in the muscle(s) and loss of sensation in the skin supplied by that nerve root.
Facet Joint Pain
If you look at the diagrams above you can see that the back of the tunnel is formed by a joint between the two vertebrae (coloured Blue).
In this diagram the Blue arrows are showing the facet joints on the left side of the vertebral column for L3/L4, L4/L5 and L5/S1.
These facet joints are exactly the same as any other joint in the body in that –
- both surfaces of the joint are covered in articular cartilage
- there is a joint capsule with a synovial lining
- this synovial lining produces fluid to keep the joint lubricated
If there is a sprain or damage to the joint it behaves exactly the same as your ankle or knee does – it becomes swollen and painful.
If the joint swells or becomes arthritic it can also cut down on the space available for the nerve root in the tunnel and cause leg symptoms.
As described above the Sciatic nerve forms in the pelvis from 4 or 5 nerve roots and from there is passes through the pelvis and exits at the back of the Ilium.
At this point the Sciatic nerve is the largest in the body measuring 2 cm across.
The nerve then passes through a gap between the Piriformis Muscle and the Gemellus Muscle.
The Piriformis Muscle is attached to the front of the Sacrum and to the capsule of Sacroiliac Joint.
Then it runs laterally to be attached to the top of the Femur at the back of the Hip Joint.
It is coloured Red in the diagram for easy identification.
You can see the Sciatic Nerve emerging below the bottom edge of the muscle.
If there is an increase in tension in the Piriformis Muscle this can produce tension on the Sciatic Nerve and produce pain down the leg.
Increased Tension in the Piriformis can be due to a host of factors but the most common in my opinion is spasm because of problems at the Sacroiliac Joint.
Another common cause of spasm in the Piriformis is poor core stability / balance control and lots of running or training.
John Terry Injury / Nerve Tension
Terry Injury – Possible Sites
Tension anywhere along the length of the Sciatic Nerve and its divisions the Tibial Nerve and Common Peroneal Nerve can result in John Terry’s leg pain.
This pain can be widespread or very localised.
Common sites for the John Terry injury and Nerve Tension are :
- the Piriformis Muscle as described above
- midway down the thigh in the Biceps Femoris in the hamstrings
- just above the knee where the Sciatic Nerve splits into the Tibial and Common Peroneal Nerves
- above the knee where the Common Peroneal Nerve passes between Biceps Femoris Tendon and the Lateral Head of Gastrocnemius (calf)
- at the head of the Fibula where the Common Peroneal Nerve splits into superficial and deep
- upper calf where Tibial Nerve passes deep to the Soleus Muscle
- at the front of the ankle where the Deep Peroneal Nerve passes through the extensor retinaculum
- back of the Lateral Malleolus where the Sural Nerve, which is a branch of the Tibial Nerve, enters the foot
- back of the Medial Malleolus where it branches into the Medial and Lateral Plantar Nerves to supply the sole of the foot
- not on the diagram but the Vertebral Foramen where the Nerve Roots exit the spine as described earlier
I obviously have no knowledge as to what or where the John Terry injury is but it has to be one of these sites.
Chances are it’s one of the higher ones but any increase in tension at any of these mechanical interfaces can lead to problems anywhere else in the nerve. It is this that makes it so difficult to find the root of the problem even for someone with the vast resources and medical back up that John Terry and Chelsea have available!
I hope that has helped your understanding of what is going on.
Please leave your comments or questions below.
Please “Like” etc if you found it useful – thanks.
This entry was posted on Friday, November 19th, 2010 at 3:14 pm and is filed under Back Pain Sacroiliac Pain and Sciatica. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.