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015 Sciatica part 1

015 Sciatica part 1

By Jurmaine Health

What is sciatica? Are all back problems related to the sciatic nerve? Find out what other back conditions there are on this podcast!

SHERMAIN [09:54]
Yeah, abnormal spinal movement. Those can also result in sciatic nerve following from bottom up, we have got your knee usually it’s the knee, very rarely it’s the foot itself, but usually it’s the knee and knee and traveling upwards with sciatic pain.
The dysfunction in the knee can cause a tension or in the sciatic nerve or in the hip joint and therefore resulting in an overuse and elongation tension, neural tension in the sciatic nerve.

SHERMAIN [01:35]
So what usually people need to know first is that how this sciatic nerve is formed. So the sciatic nerve comes from L4, L4 nerve, L5 nerve, S1, S2.

SHERMAIN [01:50]
Yeah, and occasionally S3. So you’ve got like four nerves, that forms the really big nerve called the sciatic nerve. And this nerve extends from that space in your spine, all the way down into your feet or foot.

SHERMAIN [02:13]
Yeah, both feet. So your both legs have sciatic nerve. As a result of that, if a person is compromised in any form, way or shape up or down the structure, we can start getting sciatic nerve like symptoms.​​

Dr Shermain Wong is a seasoned chiropractor with particular expertise in Sports Medicine and a passion for the benefits of in ‘Active Release Technique™ (an advanced Soft Tissue Technique developed by Chiropractors). She is professionally trained in ART and has a Masters in Clinical Chiropractic from RMIT University. Dr Wong has provided chiropractic and movement rehabilitation services at international sporting competitions, and provided rehabilitation and training for professional dancers, professional football players and professional athletes.

She can be found at https://www.jurmainehealth.com.au/dr-shermain-wong/

Episode 015 : Sciatica part 1

Podcast brought to you by Jurmaine Health

JACKIE [00:00]

This is Jurmaine Health, the center to help you achieve wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We bring you topics on neuro psychology, neuro behavior, neuro musculoskeletal, neuro gastro, movement is well being, metabolism and microbiome, which are also some of the services that we provide. And today's podcast marks the beginning of our series on sciatica will be a three part series and today's podcast is part one in the series. Today we'll give you a brief explanation of what the term sciatica actually means. A short anatomical lesson about the sciatic nerve, as well as a brief introduction into the common causes of sciatica And today, I have Dr. Shermain Wong with me. So say hello, Shermain.

SHERMAIN [00:50]

Hello.

JACKIE [00:51]

So guys. We'll get started with a brief explanation of what the actual word sciatica means, what it's often confused with or how it's misunderstood, I guess, or how it's interpreted, I guess from people to people. Would you like to get the ball rolling Shermain, I can see you holding some bits and pieces there.

SHERMAIN [01:10]

Bits and pieces has taught us a lot about nothing.

JACKIE [01:14]

Yes. So it's told us a lot of the reason why we actually doing the podcast to help explain some of the miscommunication that some, about some of the info that's actually out there for you guys. So hopefully you find this podcast helpful. And with that, we will try and give you an explanation of the term sciatica.

SHERMAIN [01:35]

So what usually people need to know first is that how this sciatic nerve is formed. So the sciatic nerve comes from L4, L4 nerve, L5 nerve, S1, S2.

JACKIE [01:49]

And occasionally S3.

SHERMAIN [01:50]

Yeah, and occasionally S3. So you've got like four nerves, that forms the really big nerve called the sciatic nerve. And this nerve extends from that space in your spine, all the way down into your feet or foot.

JACKIE [02:12]

All the way down into both feet.

SHERMAIN [02:13]

Yeah, both feet. So your both legs have sciatic nerve. As a result of that, if a person is compromised in any form, way or shape up or down the structure, we can start getting sciatic nerve like symptoms. It might not and most of the time is not the sciatic nerve that's the issue in and of itself.

JACKIE [02:41]

Can be the sciatic nerve. It's more of a case of it's not the cause of it, is not what most people assume it to be.

SHERMAIN [02:53]

So the nerve itself is not the one that's �

JACKIE [02:56]

Yeah, pretty much.

SHERMAIN [02:58]

So as a result of that, so some of the causes include herniated disc.

JACKIE [03:03]

Yep. And that's the one that most people actually assume as soon as they hear the word sciatica predominantly, that's the diagnosis that they automatically assume that they've either got a herniated disc disc bulge or prolapse anything of the disc also goes the other way around. As soon as somebody says that they've got a herniated disc, they just associate it with that they're going to have sciatica.

SHERMAIN [03:31]

Which is not true.

JACKIE [03:32]

No.

SHERMAIN [03:33]

Yeah, about a good 60% or so or more actually, people who has got disc herniations and they don't really have symptoms and signs of sciatic nerve.

JACKIE [03:42]

There've been massive studies done observing people that are asymptomatic, which means no pain, like Shermain just said, and where they've just MRI their lower back in the sense to study what have happened, what Shermain just said. I believe it was somewhere around the 40 to 60% mark actually came back with a disc herniation or protrusion prolapse anything of the sort. But as I said they were asymptomatic. So it was more of an incidental finding of what we call incidental means that it was just found, as I said, just because they did the MRI versus there was actually something pushing that person to go and have the MRI to start to begin with.

SHERMAIN [04:31]

To drive home the case in point the number of our weightlifters, have herniated disc and impingements in fact, but they don't suffer at all from sciatica. So that's, so the understanding of that, that sciatica and sciatic nerve, and its pain related functions are not quite correlated.

JACKIE [04:57]

Other structural causes can be bony growths, piriformis syndrome, lumbar spinal canal stenosis.

SHERMAIN [05:06]

Which can also be through bony growth.

JACKIE [05:08]

That's right.

SHERMAIN [05:09]

And spondylolisthesis.

JACKIE [05:12]

Spondylolisthesis is where the spine itself, one vertebra starts slipping on top of another one due to a stress fracture that's gone through, usually it's because through a stress fracture that's gone through or through degenerative change through a little, pause what we call it, it starts as a result when one slips, it takes the whole all the rest of the spinal column that's above it, it takes it along with it so it can end up having the spinal cord and the spinal column.

SHERMAIN [05:41]

Compromised.

JACKIE [05:43]

Compromised.

SHERMAIN [05:44]

By that time, I don't think sciatica is a worry or a problem, by that time we will be worrying about something else. All together and that will be a that's a huge �

JACKIE [05:55]

And that since just because it's gone, we're on this one briefly. I'm going to just put the signs and symptoms to be very aware of in that case if it gets to that point where you need to be aware of that one as soon as I can find my specific one. We definitely need to start searching out where it becomes a medical emergency which was what Shermain was referring to?

SHERMAIN [06:18]

Are you referring to quote unquote?

JACKIE [06:19]

Oh yeah okay in this case, the bowel and bladder, pretty much lack of control where you start losing control of your bowel and bladder.

SHERMAIN [06:27]

It's not you're not talking about little drips right? It's not you're not talking about little drips or urinary frequency.

JACKIE [06:33]

No.

SHERMAIN [06:34]

You're talking about absolutely loss of control here.

JACKIE [06:39]

And the same with the bowel, so when you truly cannot hold and you're.

SHERMAIN [06:46]

You're just going.

JACKIE [06:47]

Yeah pretty much the same goes, if you suddenly got loss of sensation in your legs, again, this is a this becomes a medical emergency. This is where spondy has pretty much slipped entirely and that's compromised the spinal cord itself, this is a medical emergency. So this is the only reason I'm mentioning this one in a little bit more detail than I would have with the others, or we are touching over, just to be very aware of those ones to look out for them.

SHERMAIN [07:16]

It rarely happens.

JACKIE [07:16]

It doesn't. It's not something to be that much alarmed for but it's just.

SHERMAIN [07:21]

Just a repeat, emergency times.

JACKIE [07:23]

I know. That's why I'm just putting it out there.

SHERMAIN [07:26]

Of course, yes.

JACKIE [07:28]

Erring on the side of caution in this case.

SHERMAIN [07:31]

Caution, not paranoia.

JACKIE [07:32]

I didn't say that. I said, I automatically just put it out there saying it's not something to be alarmed about because it really happens.

SHERMAIN [07:38]

Okay. All right.

JACKIE [07:40]

I added that. Other things, of course, that can cause impingements through that, where we're talking about onto the nerves of the spinal cord are of course, like your little tumours, whether they're benign or malignant is a different story. But again, there's something that can be present. Trauma as well from car accidents is another one, issues with your sacroiliac joint so what some patients or some clinicians refer to as your SI joint, and what else did you say? You already said piriformis syndrome?

SHERMAIN [08:15]

Yes, to add on to the to the musculoskeletal, cohort or group will be sprains and strains of the hamstring. Yep. sprains and strains of the hamstring is one that we'll be speaking about a bit later in the next podcast, I think. Okay.

JACKIE [08:40]

Same as the piriformis syndrome, piriformis. And the sprain of the sacral ligaments as well.

SHERMAIN [08:47]

Of the sacral ligaments, which includes your sacroiliac joint, as the coccyx or the sacrum that can have an impact on the tissues that surround the sciatic nerve.

Alright, very tight glutes can provide referral symptoms to having sciatic nerve issues very tight QLs can do that to people who have had difficult pregnancies, difficult pregnancy, meshes and bladder dysfunctions, those kinds of situations we will have, we are likely to see sciatic nerve related issues.

And people who have got pelvis, it's as simple as � We are now reverting back to simpler things like pelvis and hip joint dysfunction and imbalances. Those things can result in.

JACKIE [09:52]

As well as abnormal spinal movement. Yeah.

SHERMAIN [09:54]

And yeah, abnormal spinal movement. Those can also result in sciatic nerve following from bottom up, we have got your knee usually it's the knee, very rarely it's the foot itself, but usually it's the knee and knee and traveling upwards with sciatic pain.

The dysfunction in the knee can cause a tension or in the sciatic nerve or in the hip joint and therefore resulting in an overuse and elongation tension, neural tension in the sciatic nerve, which we all will deep dive into it the next time around when we come when we are talking about it in part 2.

JACKIE [10:38]

With what we were talking about with the term sciatica, we sort of touch briefly we did touch briefly on the anatomy so we did explain on to that one. What they call sciatica, or what everyone refers to sciatica is the actual symptoms predominantly. So again, you just heard that there's a whole list of actual common causes for sciatica itself. Rather than what's in.

SHERMAIN [11:01]

Common presentations, not usually causes.

SHERMAIN [11:13]

Yeah. Well, that everyone call it causes. We call it a presentation.

JACKIE [11:17]

That's fine. That's us.

SHERMAIN [11:18]

Yes. Because I think there's a fundamental difference. Because for us, when we call it presentations, it usually means that we are still investigating, there's a sense of further investigation. If we say, hey, that's a cause. This is a cause, we are going to be like, that's the ultimate diagnosis, you're going to be locked down into that diagnosis, and therefore you'll be treated in a formulated manner.

JACKIE [11:43]

Which is what people are at the moment being done. So that's why I said, this is why we're doing this whole introduction just so that people get the explanation is that a lot of people are being treated for sciatica just with that one cause, they are being locked down into one diagnosis that it is in some way shape or form a disc issue.

SHERMAIN [12:02]

Of course.

JACKIE [12:03]

More often than not everything else that we've just discussed as the possible as I've been using the word causes as the possible presentation, pretty much most of the time gets ignored. Everyone more or less gets locked down into the okay, they've got a disc herniation we're treating it as a disc. This is what it is. This is how we treat it. That's it off you go. Yes, can't do X Y Z, and that's it. And a lot of people, that's all they know of sciatica. They think of it that is a disc issue. That's it. They don't know the rest, which is why we're doing this whole explanation for them going back again for the term sciatica. So sciatica in itself is actually more to describe the symptomology versus an actual diagnosis. If you came in and said, I've got sciatica. Mate again as I said, all you're doing is telling us that you've got something going on. Literally the word sciatica means there's something going on with the sciatic nerve, not saying anything else. Not saying, not actually telling us anything.

SHERMAIN [13:05]

Oh really.

JACKIE [13:05]

What can be possibly causing it where it's actually stemming from anything of the sort you're, or you're actually saying is, I have pain down my sciatic nerve. The sciatic nerve, as Shermain said goes all the way down to your foot, of course, it's called later on, it gets divided as it enters your tibial nerve, common peroneal nerve, etc. So it gets divided into smaller branches. But ultimately, it is literally a nerve that supplies your whole leg from thigh all the way down to foot. And the word sciatica itself actually just means pain down anywhere that cause so with that, the common presentations that people actually rock up with all the common symptoms that they actually show are in this case, you're looking at your sharp shooting or searing pain. So what we normally call or what we normally see with nerve pain in any nerve that in itself can be femoral can be median can be any. So these are the normal presentations of a nerve pain sensation in itself potential numbness or pins and needles again, anywhere in your whole lower limb. So anywhere in your thigh, anywhere down your leg, beyond your knee anywhere into the foot, anywhere along that whole track. The same with any weakness in moving your leg or your foot. If you're starting to feel alright sweet I was a lot stronger than this but you're suddenly starting to feel that you're losing strength in it can be a form of what we call sciatica in this case, an entrapment somewhere in that sciatic nerve where it's being compressed where it's being anything, electric shock sensations again in the back pain, or legs, so again, a normal presentation of nerve pain again, this would be the same for nerve pain anywhere else this the electric type of sensation.

SHERMAIN[14:54]

All these symptoms are the same for any.

JACKIE [14:57]

Nerve pain. Yeah, really.

And that's it. That's but that's the whole thing.

Every sciatica is a nerve pain. Exactly. So.

JACKIE [15:05]

Unfortunately Yes, I am going to be repeating this every time we have a nerve pain podcast, but it's so that you guys know that what nerve pain at, one what nerve pain actually feels like and in this case, you get an understanding of sciatica actually just means nerve pain, of the sciatic nerve.

SHERMAIN [15:23]

Yes.

JACKIE [15:24]

So the other pretty much the other couple of ones that you're looking at is, again, burning or prickling sensations and what Shermain just said, this is another another form of nerve pain itself, like presentations, you're looking at, in this case, inability to bring the foot upwards. So you may struggle to walk on your heels, you may struggle to lift your big toe up, or your ankle up. That's another big sign that we're looking in this case we're looking more at the lower segments that may be impinged ones that are already going down into the foot. You may have pain or numbness on the top of your foot. Usually between your big toe and the second toe, you may have some pain or numbness anywhere on that outside of your foot. And that can actually go anywhere, the whole length of the leg as well. And then you may, like I said, also have difficulty raising your heels off the ground. These are the usually the most common sort of presentations that we see. But again, just because you are coming in with any of these does not mean we have any idea as to what your ultimate issue is where that culprit is that's catching that sciatica.

SHERMAIN [16:33]

And what we are going to do about it?

[16:34]

Yeah, we're not automatically going to lump you into the group of yep, you've got a disc issue and that's it. Let's treat it as a disc.

SHERMAIN [16:41]

For that you've got piriformis syndrome as a result and just, you know.

That's Jackie, just, you know, showing the elbow rub into the buttocks. Like really excitedly and enthusiastically, but you really don't want that to happen. Because what that does is irritate a lot of the tissues around the sciatic nerve.

JACKIE [17:07]

Makes it even worse.

SHERMAIN [17:09]

Yes, but a lot of people do that and sometimes they feel better for a short while, and then the symptoms start to become worse.

JACKIE [17:18]

Very true.

SHERMAIN [17:19]

Yeah.

JACKIE [17:19]

So where like we talked about predominantly how it presents, so the locations for it mainly that you guys will usually feel can be pain anywhere in your buttocks area can be pain in the back of the thigh, can be pain on the back or the outside of your calf, as well as your foot and toes. As I was mentioning, struggling to bring yourself up onto your heels or as I said, you may have the pins and needles into the foot, etc. These are little things that we're looking for as well. And usually they are more common to be on one side as opposed to on both sides. But that's again, not saying.

SHERMAIN [17:58]

That's not set and stone.

JACKIE [17:59]

It's not set and stone no way. So again, don't just automatically assume in any of these sorts of issues unnecessarily the cause.

SHERMAIN [18:10]

Over here, on this particular piece of paper, this bit that Jackie has printed out, it says pain exacerbated by sneezing and coughing. That's not quite true.

SHERMAIN[18:23]

No. I think that's a bit misguided.

JACKIE [18:30]

They usually use that one. Again, when they're looking at a disc issue. That's predominantly again used as a disc issue. So don't be surprised that yes, if we do ask you do you have issues coughing, sneezing, etc. When you're saying yes, I've got pain down my leg it�s not that I am asking random questions.

SHERMAIN [18:48]

Yeah it may not mean anything.

JACKIE [18:49]

It may Yeah.

SHERMAIN [18:50]

Because anyone can have pain, disc-like pain issues, even when they're coughing even when they have had external or internal oblique or TA transverse abdominus issue, strain. Yep. That's right.

JACKIE [19:06]

They can have issues and still have pain.

SHERMAIN [19:09]

That's correct. So there are a lot of other structures to think about when it is mentioned in this unit. But because the brain itself, it's difficult for consumers, I think, to really understand that, hey, there's this symptom. But there's a list of things that can happen. The variables are so wide and long, that it's difficult for people to understand in smaller concepts, I think what a lot of articles are written about in smaller concepts just so that people will be about the consumers will be able to understand and kind of comprehend hey, this sounds a little bit like me.

JACKIE [19:50]

Unfortunately, most of them are actually written to again, they always tend to go back to the disc issue, whether it's a disk or whether it's degeneration the spine, it usually just tends to go back to that more often than not even the brief ones always just skim over all your other presentations or all your potential contributing issues that could be affecting the sciatic nerve any way down that track that it actually runs. So it's often overlooked, which is why a lot of as I said, people tend to automatically just assume, and that's including people that we've got close here, whether it's colleagues that are now that work on our Brain side and everything. Again, the common misconception that sciatica is automatically a disc issue or a back issue, when it doesn't have to be, as we mentioned, the whole pretty much the whole podcast, it can be anywhere along that track of where the sciatic nerve actually runs, where it can be caught impinged that can be pretty much mimicking causing the exact same symptom just because of that very reason. Yes, it's a sciatic. It's literally nerve pain. Okay, so this is end of part one I believe and guys as we progress through our series we will talk more in depth about the causes of sciatica. So as we touched briefly on some of them, we will go in a lot more in depth for you guys. And we'll also discuss some case studies with you. So keep listening to find out more on these common condition in little inverted commas.

[21:21]

So guys, If you like what we're presenting, please give us a thumbs up a like or share it with one other person who you think we may be a help. For those of you who are coaches, dancers or athletes, and may find difficulty with expressing or executing movement patterns. Please do connect with us on our website, www.jurmainehealth.com.au and Jurmaine Health is spelled j u r m a i n e h e a l t h. Or please socialize with us on Facebook, which is Jurmaine Health or Instagram which is Jurmaine Health body. And last but not least, since this podcast is made for you, our clients, patients and fans, please do let us know what else you might like to hear about. So guys, that's us for today. Have a good week. Thank you. Bye bye, see you.

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