14/08/2025
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The image is a diagram of a neurological examination of the lower extremities that shows the relationship between spinal nerve roots (L1 to S5) and motor, reflex, and sensory functions in the legs. This is important in diagnosing pinched nerves, disc herniation, or other neurological disorders.
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🧠 Right Side of the Image: Spinal Nerves L1 - L5 and S1 - S5 are the nerve roots from the lumbar and sacral spine. These nerves innervate the muscles and skin of the legs. The yellow color indicates the pathway of the nerves from the spine to the lower limbs. ---
👣 Left Side of the Image: Neurological Examination is divided into 3 columns: Motor, Reflex, and Sensation.
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1. 💪 Motor (Muscle Movement) Nerve Muscle Examined Movement Function L4 Tibialis anterior Dorsiflexion (lifting the foot up) L5 Extensor digitorum longus Extending the toes S1 Peroneus longus & brevis Plantar flexion and foot eversion S2–S5 Small foot muscles Clawing of toes (flexing the toes) --- 2.
🔁 Reflex Tested Reflex Nerve L4 Patellar tendon reflex (knee) L5 No typical reflex S1 Achilles tendon reflex (ankle) S2–S5 A**l reflex (a**l wink) --- 3. 👆 Sensation (Numb or Tingling Areas) Nerve Affected Area L4 Inner thigh to the inside of the foot L5 Dorsum of the foot and middle toe S1 Outer side of the foot and heel S2–S5 Area around the a**s
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🔍 Clinical Conclusion: Pain, numbness, or weakness in specific areas may indicate which nerve is pinched or damaged.
For example: Numbness in the 1st and 2nd toes → likely L5. Weakness in lifting the foot (drop foot) → likely L4 or L5. Pain radiating from the buttock to the calf → often S1. 🔴 Therapy Points Based on Nerve Location
✅ L4 (Lumbar Spine 4) Common complaints: Pain in the front thigh, weak knee, tingling on the inner side of the leg. Therapy points: Acupuncture: BL24 (Qihaishu): Near the lower back. ST36 (Zusanli): Below the knee, good for strengthening leg muscles. Massage/Trigger Point: Middle front thigh (quadriceps). Inner side of the lower leg. ---
✅ L5 Common complaints: Pain from the buttock to the outer thigh, to the calf and top of the foot. Weakness in toe lifting. Therapy points: Acupuncture: BL25 (Dachangshu): Next to the L4–L5 vertebrae. GB30 (Huantiao): In the buttock, very effective for pain radiating to the leg. GB34 (Yanglingquan): On the outer side of the knee. Massage/Trigger Point: Lower back muscles (lumbar erector spinae). Outer calf (peroneus). Dorsum of the foot. ---
✅ S1 Common complaints: Pain from the buttock to the back side of the leg and to the heel/lower knee. Weakness in dorsiflexion of the foot (pressing the pedal).
Therapy points: Acupuncture: BL26 (Guanyuanshu): Above the sacrum. BL57 (Chengshan): In the middle of the calf, a strong point for sciatic pain. KI3 (Taixi): Behind the inner ankle.
Massage/Trigger Point: Buttock muscles (gluteus maximus & piriformis). Back of the calf (gastrocnemius). Heel and sole of the foot. --- ✅ S2–S5 Common complaints: Bladder control disorders, tingling/numbness in the genital/a**s area (saddle anesthesia).
Therapy points:
Acupuncture: BL32 (Ciliao): In the sacral hole, important for pelvic disorders. BL33 & BL34: For dysfunction of internal organs and cauda equina nerves.
Massage/Trigger Point:
Around the sacrum. Inner buttock. --- 🌿 Additional Therapies That Can Support: Wet cupping: In the L4–S1 area to improve blood flow and reduce inflammation.
Dry needling/muscle acupuncture: Focus on spasmed muscles or trigger points like the piriformis. Nerve flossing: Very effective for L5/S1 in reducing nerve compression. Light yoga: Stretching the sciatic nerve, such as pigeon pose or child’s pose
