Second part of sciatica. Delve a little deeper into sciatica. Ensure that you listen to the first episode to get better understanding of this podcast. Do you assume you have disc injury just because you have back pain? Can higher amount of water cause more likelihood of disc injury? Do you sit on your wallet? Has it caused you any issues? Find out on this episode!
Well, the thing is that most people don’t know that there’s a medical emergency until you get an X ray done so that it’s quite easily missed. You don’t get bone tumor, you’re looking at pneumonia of the bony point tissues itself. You know, the cancer. Yeah. Cancer of the bone tissues. And so these are not cases where a person comes in and it’s really clear. So most of the time your so excited to go can well, it can come from the bone, it can come from the nerve, it can come from movement dysfunction, it can come from muscular dysfunction as a result of movement dysfunction, or vice versa, or it can be just referral happens. What a lot of times is that? If people are given neurogenic nerf, so neurogenic neuron is nerve or brain neurogenic medication. A lot of times it’s not going to be very effective because it’s mostly an anti inflammatory medication.
So as a result of that, we feel like we have got to explain this a little bit better to people. So instead of your bone so those kind of bony changes such as osteo fascial finds also finds out when the bones the vertebrae in your spine degenerates.
You can have weakness in the big toe or ankle. So some of the symptoms that we’re talking about pain patterns, we can have pain and numbness between the big toe and the second toe, depending on what level of the spine that is.
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 016 : Sciatica part 2
Podcast brought to you by Jurmaine Health
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 is the second in our series on sciatica, and it's a direct continuation from our first sciatica podcast. As there we gave you a brief introduction into the common causes of sciatica, and in this podcast we will delve a little deeper to give you a better understanding on some of those causes. If you missed the first podcast, go back and have a listen, as it's definitely an ear opener. And I have Dr. Shermain Wong with me today. So say hello Shermain.
Hello. There are some things about sciatica that we would like you to know and where it can stem from and how it presents.
Of course we said them we said this initially in the first podcast. So as I said, go back and listen to that one. This is a direct continuation to it. We're just delving a little deeper into this one. So I think we should start with what we put as a group as bony issues that can be causes of sciatica. So guys, in this one, when Shermain and I were discussing it, we grouped it as a bony issues as a sort of group because they're all stemming from the bone clearly. So it doesn't necessarily mean it's just one thing there can be multiple different causes, but we just put into the one group and into this group, we had degenerative joint disease, which is usually what people refer to as osteoarthritis of the vertebrae. So usually that one comes with age or wear and tear
we have got things like bone tumor that can happen too
This is where I go back and say medical emergency.
Well, the thing is that most people don't know that there's a medical emergency until you get an X ray done so that it's quite easily missed. You don't get bone tumor, you're looking at pneumonia of the bony point tissues itself. You know, looking at cancer. Yeah. Cancer of the bone tissues. So these are not cases where a person comes in and it's really clear. So most of the time your sciatica can well, it can come from the bone, it can come from the nerve, it can come from movement dysfunction, it can come from muscular dysfunction as a result of movement dysfunction, or vice versa, or it can be just referral patterns. What a lot of times is that? If people are given neurogenic nerve, so neurogenic is nerve or brain neurogenic medication. A lot of times it's not going to be very effective because it's mostly an anti inflammatory medication.
So as a result of that, we feel like we have got to explain this a little bit better to people. So instead of the bone so those kind of bony changes such as osteo phytes when the bones the vertebrae in your spine degenerates.
Just imagine you've got little bony spurs.
Yeah. And displaces you see, they become sharp with dagger like edges, literally, you can see it on the X rays, and that most of the times that one causes the most kind of pain.
Not necessarily just because of the actual bones themselves a lot of the time, but unless they're literally contacting bone on bone, not a problem most of the time. It's the actual structures that they irritate, like Shermain was describing with those little daggers, those little osteophytes that are touching it. So if they're going externally, if they point so if they're pointing outwards, so if they are growing outwards, they can be pretty much irritating your ligaments around the areas they can be irritating your muscles, they can be irritating any nerves that run past,
You can have weakness in the big toe or ankle. So some of the symptoms that we're talking about pain patterns, we can have pain and numbness between the big toe and the second toe, depending on what level of the spine that is
On the degenerations that are happening.
This also continues as to what Shermain was talking about, as they contribute as well. So going back to the little osteophytic, so they can also grow inwards. So instead of them necessarily being bony, like the little sharp daggers, they can just be rounded like bubbles and stuff. So it ends up instead of your spinal column, like your spinal, your vertebrae column where the spinal cord gets to see it, instead of it being nice and wide. It just keeps getting narrower and narrower. So just keeps getting smaller and smaller.
It gets flatter and flatter.
Yeah, so the spinal cord can end up getting compressed as well. So again, same sort of thing depending on which level this starts happening at, the same sort of thing is what Shermain said. Different symptoms are more common, at different levels.
So some of them are raising the heels off the ground. Usually when that happens, you're really thinking about fairly severe cases as compared to the well, it's not the lesser cases. Like for example, a pain in the butt like you have, literal pain the butt right?
Probably one of the biggest symptoms I should say of sciatica, the most prominent one that people talk about
Pain in the butt, back of the thigh
back end outside of the calf, and foot and toes let's look at the first three, which are on the buttocks back of the thigh, lateral side, back and outside of the calf, it could be as simple as having a tight glute. So guys, if you have a tight glute
a tight butt
Well, Jackie goes for the tight butt I go like you�re a tight ass right?
So sometimes you know, there is that as well. Or, sometimes it's a really simple case of not sitting on your wallets for men.
Yes, that one also comes in later for sacroiliac joint issues.
because it also destabilizes the sacrum for that very reason.
And also, maybe not crossing your legs and twining it. You know how some females, they are like, their legs are so flexible and they can just twist it around and around the shin and ankle and the foot and I can't do that.
So guys, what you're listening here, as Shermain said that I may or may not have uncrossed my legs.
So yeah, so she doesn't have sciatica but you know, you get the idea.
But I think I do have the sacroilic joint. It's one of the culprits they accuse me of.
There is that and sometimes it's, if the symptoms are bad you have pain when sitting, standing, getting up and down the stairs pain aggravated by sneezing or coughing, those kind of things you're talking about disc issues.
More so. Yeah,
You're not talking, you're very rarely talking about musculoskeletal issues.
It's a good indicator. So we get a lot of people in, that have sciatic presentation where it is yes, it's more of a muscular issue. And this is the best way that we actually do describe it because as we discussed in the first podcast, most people when they hear sciatica automatic assumption, oh crap, I've blown a disc I've got a disc herniation I've got a disc bulge. That's the first and final thought nobody assumes there can be a different cause. So a good indicator for us as well as for the patients, so that you guys don't get worried so much sometimes is like Shermain just said, if you get pain suddenly that's aggravated when you're coughing and sneezing, good indicator pretty much that you may actually, that's more of an indicator. Let me try it again that it might actually be more of a disc issue, because it moves with it, as opposed to and the pressure, because of the pressure changes in the body versus if it's just a purely muscular issue that's causing it. So we do use that for patients as well for their peace of mind. So they're not worrying too much about it, as we discussed in the last podcast as well. A lot of these issues can be asymptomatic. So don't automatically assume because you've got back pain, it's got to be a disc.
There are many people who are walking around with you know, herniated disc, and having no symptoms signs and symptoms.
A hundred percent. Believe it or not, most people again, assume disc injuries happen late into your life. So 40 plus 50 plus,
you know, but that's it's like when you're thinking about for disc injuries, most commonly the injuries actually occur at around anywhere between around age 20 to 40. Because that's when your disc has the most water, it's the most hydrated, it's a lot more prone to actual damage than it is later on in life. It usually presents itself believe it or not, later on in life, that's when you once you start, once it starts decreasing in water, that's when people start having sometimes a bit more symptoms, just because it starts getting flatter and flatter, as opposed to the actual bulge itself, compressing anything, but again, as we discussed just before with the bony part, it is also different presentations, like Shermain was talking about just before the different symptoms do arise depending on what level you've got a disc herniation or a disc bulge that may be compressing onto a spinal nerve so say it's happening at L4 L5 the presentation is going to be slightly different than if it's happening at S1 S2. So S1 S2 will be more you're looking at your calf and your toes L4 L5 we'll be looking at more up into your thigh, glutes sort of area. So a little bit different presentations. So sometimes gives us an indicator as well of where how high that we need to be aware of or what we need to be looking for as well. So yes, you do hear a lot of people that know, right cool go see their chiropractor because they've got sciatica and swear by it, and then you've got others that have sciatica issues and they're more than happy to go see a physio, massage therapists, remedial therapists, exercise physiologist, everyone and then go nah, surgeries are an option and opt out of seeing a chiro for the sole reason, �no don�t like chiros, don't think so�. Let�s bypass them and let�s do surgery.
But the thing is this if all they're doing for sciatic nerve pain, is assuming that it's all just piriformis syndrome, which then, you know, aim their really sharp elbows into your buttocks, then of course, they're not going to address the whole, you know,
Yeah, they are not going to get complete results, because what happens is that if you have got severe bony changes, then depends on severity, then maybe surgery might be a better option.
Because with that kind of pain levels, we will say to our patients that look you can rehab his to death, it's not going to make a huge change because there's a structural change in and of itself.
So even if you go for things like cortisone injections, which is anti inflammatory, it's going to be very temporary. Yeah, it is so temporary that might as well save that money at the time and seek an opinion. Speaking of seeking out opinion, we would encourage people to not only go to orthopod that's our short for orthopedic surgeons, we also ask them to seek a neurosurgeon for the effect because neurosurgeons and orthopedic surgeons are like what sport medicine doctors and musculoskeletal medicine doctors are to each other, they would find themselves probably debating sometimes about what is useful and what is not. And as a result of that, a person might get one, either totally confused or totally, or they would have a better opinion. What we normally do here is that we try to triage that for them for people with some cases like that. Otherwise, if it's mostly not disc, not a spinal cord injury which comes from spinal stenosis or a disc herniation. We are talking about a normal spinal movement we are talking about synchronous joint dysfunction, syndrome
guys just sit on their wallets a lot�
People who are squatting too much, and squatting a lot, people who are cycling a lot. So, a lot of these cases which we are going to speak about in probably in a new year, I think we're going to speak about is pelvis dysfunction.
I have one more. That's a very common one. It's a sleeping position. It's one of the most common sleeping positions that most people like so instead of being completely on the side, it's the one way where your legs are stacked up onto each other, with or without a pillow between them. It's the one where you've got your leg kicked over. So one leg straight, the bottom leg straight, but the top leg's pretty much like a 45 degree angle like as if you're trying to make like a four sign with your legs.
That is a very common pattern.
Yeah, that's a very common cause of piriformis syndrome as well. Most people pretty much don't realize what they're doing and most people again can't put a cause down can't think of what could potentially have triggered off their pain in the butt at the time and then you think of and then you just ask questions going okay if I've ruled this out you don't do this you don't do that. It's probably one of the final questions that I usually ask if I'm honestly, if they honestly can't come up with anything, it's okay let's just try and see how do you sleep and then you find the culprit whereas in a sustained stretch position, so it gets tight as a result.
Most patients don't know what they have done or cannot recall what they have done or conveniently forget and eliminate, omit the information or eliminate really from their brains. Information to you know, tell us that they are fantastic and they don't do nothing to cause pain. Then we go like well, if you do nothing to cause pain, you won�t get pain and we won't be in existence in business. Really?
Granted in this case, we probably would be because one of the actual causes can be just sitting down all day
The only time this doesn't apply.
That's true. But so what we have done, so we usually, if that's the case, if you're movement patterns are not showing us what you're saying, which means your body is a telltale I'm sure you guys have looked at our really curated Instagram, that is, that the body is a whistleblower. Do you know that code?
So it is true. We are not lying about this. And we can tell when it's not your story and your body story is not in an alignment. We don't just look for spinal alignment. We look for your story and your body
We are the police of the body.
Body, you know alignment. Yeah. So That's what we look for. And let's say for example, we are talking about piriformis syndrome, spinal syndrome and pelvic we will deep dive into pelvis next year, not now because the year is coming to an end. And that's also a big topic. So what can cause piriformis syndrome there's a lot of things in there you can you have the bladder, you have the uterus, you have the you have all the female organs, you have the prostate for men, you have got the imbalance between your adductors and your lateral rotators, rotatories, which is like the ones that, the little muscles that turn your hip joint outwards. So if you have that kind of imbalance, then we are going to start having problems with not just piriformis syndrome. In prolong situations, we create a dysfunction up and down the kinetic chain meaning up and down the spine. And when that happens, you get back pain you get all sorts pain, you get knee pain, you get, you know, toe pain, any kind of pain that in and of itself is an imbalance. We're talking about, we are most likely looking at two things, a movement dysfunction and an abnormal spinal movement. But wait, there's more we can add on, tissues, which we mentioned about earlier on. And those are many variables that we are looking at that can cause sciatica or that can result in the pain patterns of sciatica. So that will be a bit more precise.
Yeah 100%. But you did say it right initially, remember, we established this in the first and sciatica is just a term so you didn't have to clarify this. Remember, we told them to listen to the first one first. So they should have known this by now. Sciatica is just a pain pattern.
Jackie, you do have a really good description of what sciatica is/
I was very proud of this one.
But it also means you need to know the other condition.
So what is it share with them our eager listeners.
So I think, probably a couple of weeks ago when we knew you were going to be discussing sciatica Shermain may or may not have received a message from me at night. Let's call this about 11pm or so. It will be late because then you're going to bed and I guess if you don't know that bed I was very proud of this one. Although she didn't reply to me until the next day, so it didn't really give me any encouragement.
No encouragement past 9pm.
I was very proud because I came up with the sciatica pretty much the condition that we're talking about is what we call the carpal tunnel syndrome of the lower limbs so of the lower limb means your leg downwards, your thigh downwards, all the way your foot. Now I described it as the carpal tunnel syndrome of the lower leg or the lower limb carpal tunnel syndrome. As we discussed in the elbow series, elbow, wrist hand series, is a median nerve compression can be, it is carpal tunnel syndrome, is a compression of the median nerve, but it's only one of the causes of it? Yes
And that's exactly why I described it as the carpal tunnel syndrome of the lower limb because with carpal tunnel syndrome with median nerve compression, everyone assumes it's the carpal tunnel, so everyone automatically assume all right, we need to split the wrists do surgeries with the wrist and everything we find the symptoms go away.
Like literally it's not a, you know �
No, it's not me telling you to cut yourself literally that's a surgery. That's the best way that I can describe the surgery. Basically there's a little shape that that wraps around your muscles that they sort of cut through. And that's it. It's literally a slice through around the wrist area. But it's a compression of the median nerve. So that's one site where the median nerve compresses, but it has multiple other sites along the chain upwards all the way up into the neck. So all the way up your wrist, up your elbow up your arm, all the way up into the neck. Same goes for what we were discussing with sciatica, which is why I said it's the same as sciatica. Because sciatica when most people assumed, hear the word sciatica, they automatically jump to it's a disc issue. That was why I described it, but again, we just described multiple other areas or multiple other causes that can be causing sciatica and itself rather than it just being a disc issue. And again, this is where we're starting as you go. So everyone jumps to one conclusion, whereas there can be another 10 that can be doing it. And the same goes for the carpal tunnel syndrome, everyone jumps to one conclusion, where then can be another 10 that can be causing it. So I was very proud of my little description of it, despite the fact that it took Shermain a whole probably nine hours or so. 10 hours to respond to me with Yes, that was actually pretty good. In my defense.
Well you see I'm very kinesthetic by nature. So I think kinesthetically, which means I think very slowly with movements. So if I'm moving slowly, there's no thinking at all happening. Okay, so um, was there anything else that you want to speak about?
The other one that we know guys that you should be aware of well, not guys some. No let's say this again, guys and girls should be aware of it females will know because a lot of females will have experienced it if they've had a pregnancy. A lot of the time yes, the pregnancy weighs upon the muscles and it will pinch and it can pinch and pull and drag the sciatic nerve along. So a lot of us a lot of issues do a lot of sciatic nerve symptoms do present themselves. Without pregnancy, especially the further you get along probably I think most of the symptoms arise around the third trimester, I'd be inclined to say Shermain, yes no, are you agreeing for that one?
It happens in pregnancy. It doesn't have to happen in a certain trimester. It can start happening in the second. What can happen for females is that the body naturally becomes very loose. That and so the ligaments become, very what we describe as laxity has a lot of give. This is to facilitate giving birth. That's what it is for. However, sometimes when that happens, but then sometimes when that happens and the body has got too much intra pelvic pressure for one reason or another, it could be many reasons and we don't know why what can happen is that the way the baby sits in the pelvis, and the weight of that can compress on the nerve, the genital femoral nerve, and then that goes all those nerves go to the front and the side of the legs. However, those nerves also joined, exit together and join and form the sciatic nerve so in front both in front and behind those pain patterns for the lower limb, meaning that the side of the hip joints. All the way down to the legs, those things can be compromised quite easily. So you have groin pain, you might have sciatic pain, you might just be painful everywhere. And that is quite common for a lot of females. So when that happens, and then that's not a very good sign really, and how we will address that we will probably speak to you then in the next session.
So guys, make sure you listen out our final piece on sciatica. As in our third and final podcast on the topic. We'll go through a few cases that we've seen in practice and how we address them. 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 And guys, that's us for today. So have a good week.
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