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In today’s podcast marks the beginning of our series on Sciatica. We had 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 listen about the Sciatic Nerve as well as a brief introduction into the common causes of Sciatica. And today I have Dr Jurmaine Wang with me, so say Hello Jurmaine.
Anchor: So guys, we’ll get started with some brief explanation of what the actual wood Sciatica means, what is often confused with or how it’s misunderstood I guess, or how it’s interpreted, I guess from people through people. Would you like to get the ball rolling Jurmaine I can see holding some bits and pieces there?
Jurmaine: Well, our bits and pieces has told us a lot about nothing.
Anchor: Yes. [Laughs] it’s told us a lot of the reason why we actually doing the podcast to help explain some of the mis-communication 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.
Jurmaine: So, what people need to know is that how this Sciatic nerve is formed. So the Sciatic nerve in terms of L4…
Anchor: L4 nerve, L5 nerve, S1, S2 and occasionally S3.
Jurmaine: Yes, and occasionally S3. So you’ve got like four nerves at least that forms the really big nerve called the Sciatic Nerve because it exit the sciatic notch. And this nerve extends from that space in your spine all the way down into your feet or foot.
Anchor: Yes. All the way down into both feet.
Jurmaine: Yes, both feet. So your both legs have got sciatic nerve.
Jurmaine: 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 itself.
Anchor: It can’t be the sciatic nerve but it’s more of a case of it’s not the cause of it is not what most people assume it to be,
Jurmaine: That’s right.
Anchor: Which is what…?
Jurmaine: So, the nerve itself is not the one that’s…
Anchor: Yes, pretty much.
Jurmaine: So, as a result of that. So some of the causes include herniated disc.
Anchor: Yes, 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 prolapsed or anything of the disc, also goes the other way around. As soon as somebody says that they’ve got a herniated disc, they just associated it with that they’re going to have sciatica.
Jurmaine: Which is not true.
Jurmaine: Yes. About a good 60% or more actually people who has got disc herniations and they don’t really have symptoms and signs of sciatic nerve.
Anchor: There’s been massive studies done observing people that asymptomatic, which means no pain like Jurmaine just said, and where they’ve just MRI there lumber in a sense to study where the foot disc herniation or prolapses or just a [inaudible 04:02.] With what Jurmaine just said, I believe it was somewhere around the 40% to 60% mark actually came back with a disc herniation or protrusion, prolapsed, anything of a 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.
Jurmaine: To drive home the case in point, a number of weight lifting have herniated disc and impingements. In fact, but they don’t suffer at all from sciatica. So the understanding of that sciatica and sciatic nerve and its pain related functions are not quite correlated.
Anchor: Other structural courses can be bony growths, Piriformis Syndrome, lumbar spinal canal stenosis,
Anchor: Which can also be through bony growths.
Jurmaine: That’s right. And spinal listhesis.
Anchor: Spinal Listhesis is where the spine itself, one vertebrate starts slipping on top of another one duo to a stress fracture that’s gone through. Usually it’s because through a stress fracture that’s gone through all three degenerative change through the little pause, what we call it, and 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…
Anchor: Compromised yes,
Jurmaine: But by that time, I don’t think sciatica is the worrying problem. By the time we will be worrying about something else all together and that’s a huge case in itself actually.
Anchor: And just because 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 that you need to be aware of that on as soon as I can find my specific ones. Where you definitely need to stop searching out – is where it becomes a medical emergency is what Jurmaine was referring to.
Jurmaine: Are you referring to. [Inaudible 06:20?]
Anchor: I am.
Anchor: In this case. The bowel and bladder pretty much lack of control where you start losing control of the bowel and bladder.
Jurmaine: You are not talking about little drips, right?
Jurmaine: You’re not talking about little drips or urinary frequency?
Jurmaine: You are talking about absolute loss of control, yes.
Anchor: Yes. And the same with the bowels, so when you truly cannot hold and you…
Jurmaine: You are just going.
Anchor: Yes, pretty much. The same goes if you’ve suddenly gone lost sensation in your legs? Again, this becomes a medical emergency. This is where respond low has pretty much slipped entirely
and that’s compromised the spinal cord itself. This is a medical emergency, so the only reason why I’m mentioning this one in a little bit more detail than I would have with the others or we’re touching over is just to be very aware of those wants to look out for them.
Jurmaine: It rarely happens.
Anchor: Yes, it’s It not something to be that much alarmed for but it’s just…
Jurmaine: You just repeat a mobile emergency three times.
Anchor: I know, I’m just putting it out there.
Jurmaine: Of course, yes.
Anchor: Erring on the side of caution in these cases.
Jurmaine: Caution, not paranoia.
Anchor: I didn’t say that, I said I wouldn’t if we just put it out there saying it’s not something to be alarmed about because it rarely happens. [Laughs]
Jurmaine: Okay, all right.
Anchor: I added that.
Jurmaine: [inaudible 07:42]
Anchor: Other things of course that can cause impingement through that. Where were we talking about? Onto the nerves or the spinal cord are of course like your little tumors, 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 USI joint. What else did you say is
your Piriformis Syndrome.
Jurmaine’: Yes. But to add onto the, to the musculoskeletal cohort or group will be sprains and strains of the hamstring.
Jurmaine: Sprains and strains of hamstring is one that we will be speaking about a bit later. And the next podcast I think we will
speak about that right?
Anchor: Yes, we’ll do it.
Anchor: Yes. Same as a performance.
Jurmaine: Same as the performance.
Anchor: And the sprain of the sacral ligaments as well.
Jurmaine: Sprain of the sacral ligaments which includes your
sacral iliac joint.
Jurmaine: As the [inaudible 08:55] or the sacrum that can have an impact on the tissues that surrounds these sciatic nerve.
Jurmaine: All right, very tight gluts can provide referrals symptoms to having sciatic nerve tissues very tight. Who else can do
that to? People who have had difficult pregnancies.
Anchor: Yes, difficult pregnancies is listed here as well.
Jurmaine: Yes, difficult pregnancy meshes and bladder dysfunctions, those kinds of situations we are unlikely to see sighting of related issues. And people who have got pelvis, we’re not reverting back to simpler things like pelvis and hip joint dysfunction and imbalances, those things can result in…
Anchor: As well as abnormal spinal movements, yes.
Jurmaine: Yes. Abnormal spinal movements, those can also result in what’s it called, 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 in the hip joint and therefore resulting in an overuse and neuro tension in these sides. Which we will all dive deep into it the next time around when we come, when we recording in part two.
Anchor: We will. With what we were about, with term Sciatica. We sort of touched briefly, we did touch briefly on the anatomy, so we did explain onto that one. What they call Sciatica or what one 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 common…
Jurmaine: Common presentations, not usually causes.
Anchor: Not usually causes.
Jurmaine: I will call it presentations.
Anchor: But most of them – everyone else always calls it that’s why I’m using the term the people calls it in that case.
Jurmaine: All right.
Jurmaine: Well, let everyone call it, we call it
Anchor: That’s fine.
Anchor: [inaudible 11:20]
Jurmaine: There’s a fundamental difference.
Anchor: It is.
Jurmaine: Because for us, when we call the presentations, it usually means that we are still investigating. There is as a sense offurther investigation. If we said that, “Hey, there’s a cause. This is the cause.”
Jurmaine: We are going to be…
Anchor: The ultimate diagnosis.
Jurmaine: The ultimate diagnosis, you’re going to be locked down and do that diagnosis and therefore you’ll be treated in a formulated manner.
Anchor: Which is where 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.
Jurmaine: Of course.
Anchor: Is that a lot of people are 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.
Jurmaine: Of course.
Anchor: More often than not, everything else that we’ve just discussed as the possible as I’ve been using the word covers to say, as possible presentation. Pretty much most of the time it gets ignored. Everyone more or less gets looked down into the, “Okay, they’ve got a disc herniation, we’re treating it as a disk, this is
what it is, this is how we treat it, that’s it. Off you go.”
Anchor: You 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 it is a disc issue. That’s if they don’t know the risk, which is why we’re doing this whole explanation for them.
Going back again for 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.” 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 actually telling
Jurmaine: Anything, really.
Anchor: What can be possibly causing it? Where it’s actually stemming from? Anything of the sort. All you’re actually saying is “I have pain down my sciatic nerve.” The sciatic nerve as Jermaine said goes all the way down to your foot, of course it’s called – later on it gets divided into your tibia nerve, common perinea nerve et cetera.
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 anyway that course. So with that, the common presentations that people actually rock up with, or the common symptoms that they actually show are, in this case, you’re looking at a sharp shooting or searing pain, so what we normally call or what we normally see with nerve pain in any nerves that in itself can be [inaudible 13:58] can be immediate, 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 that, in your whole lower limb. So anywhere in your thigh, anywhere down your leg. Your leg, saying beyond your knees, anywhere into the four, anywhere along that whole track. The same with any weakness in moving your leg or your foot. If you’re starting to feel “All right, 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 are calling sciatica in these case. An entrapment somewhere in that sciatic nerve where it’s being compressed, where it’s been anything, is it.
Electric shock sensations again in the back pain or legs, so again a normal presentation of nerve pain. Again, this should be the same for nerve pain anywhere else, the electric type of sensation.
Jurmaine: All of these symptoms are the same for any nerve pain, really.
Anchor: Yes. But that’s the whole thing. Every sciatica is a nerve pain.
Jurmaine: That’s exactly is.
Anchor: So unfortunately, yes, I am going to be repeating this every time we have a nerve pain podcasts, but it’s so that you guys know that what nerve pain at one, what no pain actually feels like and in these cases that you get an understanding of Sciatica actually just means, “Nerve pain of the sciatic nerve.”
Anchor: So the pretty much the other couple of ones that you’re looking at is again burning or prickling sensations and what Jurmaine just said, this is another form of nerve pain itself. Like presentations, you’re looking at, in this case inability to bring 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’s we’re looking. In this case, we’re looking more at the lower segments that may be impinged, the 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 up your heels up off the ground. These are the usually the most common sort of presentations that we see.
But again, just because you’re coming in with any of these does not mean we have any idea as to what your ultimate issue is. Where that problem is that’s catching that sciatica and what’s causing it.
Jurmaine: Yes, and what we are going to do about it.
Anchor: Yes. We’re not automatically going to lump you into the group of, “Yes, what, you’ve got a disc issue and that’s it. Let’s treat it as a disc.”
Jurmaine: Or that you’ve got performance syndrome as a result and just, you know, elbow. [Laughs] and that’s Jackie. Just, you know, showing the elbow rub into the buttocks like really, really excitedly and enthusiastically. You really don’t want that to happen because what does irritate a lot of the tissues around sciatic nerve…
Anchor: It makes it even worse.
Jurmaine: Yes. A lot of people do that and sometimes they feel better for a short while and then their symptoms start to become
Anchor: Very true.
Anchor: So, like what we talked about predominantly how it present, so the locations for it mainly that you guys would usually feel. It 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 your calf. As well as your foot and toes. As I was mentioning, struggling to bring yourself up on to your heels or as I said, you may have the pins and needles into the foot, etc. These are the little things thatwe’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 that…
Jurmaine: It’s not [inaudible 18:00]
Anchor: It’s not certain [inaudible 18:01] no way. So, again, don’t just automatically assume in any of these sorts of issues unnecessarily the cause…
Jurmaine: Over here on this particular piece of paper, this bit that Jackie has printed out, it says “Pain is operated by sneezing and coughing.” That’s not quite true.
Anchor: No, that’s…
Jurmaine: I think that’s a bit of a mi – I don’t know, misguided.
Anchor: They usually use that one again when they are looking at a disc issue.
Jurmaine: Yes, that’s right.
Anchor: That’s predominantly again, used as a disc issue, so don’t be surprised that yes 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 us asking random questions.
Jurmaine: Yes, it may not be anything.
Anchor: It may… Yes.
Jurmaine: Yes, because anyone can have pain, deep disc like pain issues even when they are coughing, even when they have a external or internal… or TA Transverse Abdominis issue.
Anchor: Right, yes.
Anchor: So I can still have rib issues and still have pain.
Jurmaine: That’s correct. So there are a lot of other structures to think about when it is mentioned in this manner.
Jurmaine: But there’s also the big cause – the brain itself, it’s difficult for consumers I think to really understand that hey, this symptom, but there’s a list of things that can happen. The variables are so wide along 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 able, consumers will be able to understand and kind of comprehend say, “Hey, this sounds a little bit like me.”
Anchor: Unfortunately, most of them are actually written to, again they always tend to go back to the disc issue, whether it’s a disc, whether it’s degeneration of the spine, it usually just tends to go back to that. More often than not even the brief ones or it’s just skin over all your other presentations or your potential
contributing issues that could be the – it 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 work on our brain side and everything.
Again, it’s a common misconception that sciatica is automatically a disc issue or lower 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 and [inaudible 20:48] that can be pretty much be even causing the exact symptom just because of that very reason.
Jurmaine: Yes. It’s literally nerve pain.
Anchor: Okay, so this is the end of part one, I believe. And guys as we progress through our series, we’ll talk more in depth about the causes of sciatica. So as we touched briefly on, some of them will go and 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 this common condition in little inverted commas.
Jurmaine: She’s driving home a point again.
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Jurmaine: Thank you. Bye bye.
Anchor: See you.