Anchor : This is Jermaine health, the center to help you achieve wellness in both your brain and body. We endeavor, to encourage cross communication between health professionals for health and wellbeing. We will bring you topics on Neuro-psychology, Neuro-behavior, Neuro-musculoskeletal, Neuro-gastro,
Movement is wellbeing, 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 podcasts, will delve a little deeper to give you a better understanding on some of those courses. If you miss the first podcast, go back and have a listen as it’s definitely an ear opener. And I have Dr Jurmaine Wang with me today, so say hello Jurmaine.
Jurmaine: Hello! There are some things about sciatica that we would like you to know and where it can stem from and how it presents.
Anchor: Of course we said them, we said these initially in the first podcast. So as I said already, go back and listen to that one. This is a direct continuation to it, so we’re just delving a little deeper into this one. So, I think we should start with what we put it as a group, as bony issues that can be causes of Sciatica. So guys in this one, when Jurmaine and I were discussing it, we grouped it as a bony issue 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 it into one group and we’re 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. That one’s more directive that.
Jurmaine: we have got things like bone tumor that can happen too.
Anchor: This is where I go back and say a medical emergency.
Jurmaine: Well, the thing is that most people don’t know that there’s a medical emergency until you get an Xray done. So that is quite easily missed. You know, don’t get bone tumor you either looking at pneumonia of the bone tissues itself. You are looking at the, yes.
Anchor: [inaudible 02:16] I know that one.
Jurmaine: Stem cells or the bone tissues. So, these are not cases where a person comes in and it’s really clear. So most of the time sciatica 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, neuro is nerve or brain. Neurogenic medication, a lot of times it’s not going to be very effective because it’s mostly an entity inflamed medication.
Anchor : Yes.
Jurmaine: So as a result of that, we feel like we have to explain this a little bit better to people. So instead of your bone, so those kinds of bony changes. So it’s just Osteophytes, Osteophytes is when the bones of the vertebrae in your spine degenerate.
Anchor: Yes. Just imagine you’ve got little bony spurs.
Jurmaine: Yes, and displaces, they become sharp, dagger like edges naturally you can see it on the X-rays.
Jurmaine: And that most of the times that one causes the most kind of pain,
Anchor: Not necessarily just breaking into the actual bones themselves, a lot of the time, but unless they actually contacting bone-on-bone not a problem, I
still thought it’s the actual structures that they irritate like Jurmaine was describing with those little daggers, those little osteophytes that are touching it. So if they’re going externally, if they pointing outwards, so if they 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 it.
Jurmaine: You can have weakness in the big toe or in [inaudible 04:10] 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…
Anchor : Based in degeneration that’s happening.
Jurmaine : That’s right.
Anchor : This also continues on with what Jurmaine’s talking about as like contribute as well. So going back to the little osteophytic so they can also grow inwards. So instead of unnecessarily 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 vertebrae column, when the spinal cord gets to see instead of being nice and wide, it just keeps getting narrower and narrower. So it just keeps getting smaller and smaller…
Jurmaine: As the reflector.
Anchor: Yes. 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 Jurmaine said, different symptoms are more common at different levels.
Jurmaine: So some of them are raising the [inaudible 04:14] usually when that happens, you’re really thinking about fairly severe cases as compared to the less, well it’s not the lesser cases. Sometimes it takes people…
Jurmaine: Away. Like for example, a pain in the butt, like you have a little pain in the butt right? So that.
Anchor: Probably one of the biggest symptoms I should say outside of sciatica.
Anchor: The most prominent one that people talk about.
Jurmaine: Pain in butt, back up to the thigh.
Anchor: Another one.
Jurmaine: Back in outside of the calf and foot and toes. Let’s look at these first three which are on the buttocks, spread on the thigh and lateral side, back and outside of the calf. It could be as simple as having a tight glut. So guys, if you have a tight glut or how I like you…
Anchor: Get a tight butt.
Jurmaine: [laughs] well Jackie goes for the tight butt, I go like, “You are a tight ass right?” So sometimes you know there is that as well, or sometimes people, it’s a really simple case of not sitting on your wallets for men.
Anchor: Yes. That one also comes in later for Sacroiliac joint issues.
Jurmaine: That’s right.
Anchor: Because it also stabilizes the sacrum for that very reason…
Jurmaine: And also maybe not crossing your legs and twining it. You know how some females they’re like, their legs are so flexible and they can just twist it
around and around the sheen and the ankle and the foot. And I can’t do that.
Anchor: So guys are you still listening here as Jurmaine said, that I may or may
not have uncrossed my legs. [Laughs]
Jurmaine: So yeah, she doesn’t have sciatica but you know, get out of it.
Anchor: I think I do have this psycoilliac joint, it’s one of the cult compensation you accuse me off.
Jurmaine: There is that. And sometimes, again if the symptoms are bad, all right. If the symptoms are bad, you have pain when sitting, standing, getting up
and down the stairs, pain aggravated by sneezing or coughing. Those kinds of things you’re talking about is issues.
Anchor: More so, yes.
Jurmaine: Yes, you’re very rarely talking about muscular [inaudible 07:25] issues.
Anchor: It’s a good indicator. So we get a lot of people when they 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 of, “Oh crap, I’ve blown a disc.” “I’ve got a disc herniation.” “I’ve got a disc [inaudible 07:48]” That’s the first unusual final thought, nobody assumes that can be a different cause.
So a good indicator for us as well as for the patients or if there is so that you guys don’t get worried so much sometimes, is like Jurmaine just said, if you ever 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 that is telling you that it might actually be more of a disc issue because it moves with it. As opposed to and 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.
Jurmaine : There are many people walking around with herniated disc and having nosymptoms, signs and symptoms.
Anchor: Believe it or not most people again assume disc injuries happen late into your lives, so 40+, 50+.
Anchor: You know, it’s like when you’re thinking about it for disc injuries.
Anchor: Most commonly, the injuries actually occur at around anywhere between around age 20 to 40 because that’s when your disc carries 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 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 Jurmaine was talking about just before the different symptom do arise depending on what level you’ve got a disc herniation or a disc bulge that may be compressing onto a spinal nerves. So say it’s happening at L4, L5, the presentation’s going to be slightly different than if it’s happening at S1, S2.
So, S1, S2 would be more, you’re looking at your calf and your toes. L4, L5 would be looking at more up into your thighs gluts sort of area, so little bit different presentations, so sometimes gives us an indicator as well 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 yet, go see the chiropractor because they’ve got sciatica and swear by it and then you’ve got others that have a sciatica issues and are more than happy to go see a Physio, Massage Therapists, Remedial Therapist, Exercise Physiologist, everyone and then go, “No, surgeries is an option,” and then opt out from seeing a Chiropractor for this sort of reason. Not that might Chiropractor, I don’t think so, the bypass them unless new surgery.
Jurmaine: But the thing is this, you see if all you’re doing for sciatica nerve pain is assuming that it’s all just Piriformis Syndrome, which they would then you know in their really sharp elbows in the upperparts. Then of course they’re not going to address the whole…
Anchor: Dysfunction results.
Jurmaine : Yes, and they are not going to get complete results. Because what happens is that if you have got severe body changes, then depends on the severity.
Then maybe surgery might be a better option.
Anchor: I agree.
Jurmaine: Because with that kind of pain levels we will say to our patients that, look, you can – we have this there, it’s not going to make a huge change
because there’s a structural change in and of itself.
Jurmaine: So even if you go for things like cortisone injections, which is anti inflame, it’s going to be very, very temporary.
Jurmaine: It is so temporary that my 12th symptoms [inaudible 11:48] at the time and seek an opinion. Speaking of seeking an opinion, we would encourage people to not only go Ortho, that’s all 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 can get totally confused or they would have a better opinion. What we normally do here is that we try to triage that for them, for people with cases like that. Otherwise, if it’s mostly not disc, not spinal cord injury, which is comes from a spinal stenosis or a disc herniation. We’re talking about a normal spinal movement and we are talking about a [inaudible 12:55] joint dysfunction…
Jurmaine: Guys who 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 the new year I think, we’re going to speak about Pelvis Dysfunction.
Anchor : I have one more, that’s a very, 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 stepped up onto each other with or without a pillow between
Jurmaine: Oh yes.
Anchor: It’s the one where you’ve got your groin kicked over. So one leg’s straight, the bottom leg’s straight but the top leg pretty much like a 45° as if you’re trying to make like a four sign with your legs. That is a very common…
Jurmaine: That’s a pattern.
Anchor: Yes, 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. They can’t and then you think of – and then you just ask questions going, “Okay, if I’ve wrote this, you don’t do this, you don’t do that, you don’t do that?” It’s probably one of the final questions they usually ask. If
they honestly can’t come up with anything. It’s okay, let’s just try and say, “How do you sleep?” And then you find the culprit, whereas in a sustained stretch position, so it gets tight as a result.
Jurmaine : Most patients don’t know what they have done, all cannot recall what they have done or conveniently forget and eliminate the information.
Jurmaine: 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 it would go like, well, if you do nothing to cause pain, you wouldn’t get pain and we wouldn’t be in existence in business, really.
Anchor: Granted in this case we probably would be because one of the actual causes can just be sitting down all day.
Jurmaine : That’s true.
Anchor : [laughs] that’s the only time we still sort [inaudible 15:11]
Jurmaine : That’s true. But so what we have done is we usually, if that’s the case, if your 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 the body is a whistleblower, you know that code? Yes. 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 alignment. We don’t just look for spinal alignment, we look for your story and your body…
Anchor: We are the police of the body
Jurmaine: Body alignment, yes… So that’s what we look for. And let’s say for example, we are talking about Piriformis Syndrome, a 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, big topic.
So what can cause Piriformis Syndrome? There are a lot of things in there. You have the bladder, the uterus, you have all the female organs, and you have the prostate for the men. You have got the imbalance between your adapters and your lateral rotators, rotatory or rotators, which is like the one set to the little muscles that turn your hip joint outwards. So if you have that kind of imbalances and we are going to start having problems with not just Piriformis Syndrome and just decided to go. We can also have a real – we can in prolonged 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 of pain, you get knee pain, 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 some 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 for the…
Anchor: Yes, 100%. But you did say, right, if you remember we established this in the first and sciatica is just a term. So you didn’t have to clarify. Just
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.
Jurmaine : That’s true. But Jackie, you do have a really good description of what sciatica is.
Anchor : Oh, I am very proud of this one. [Laughs]
Jurmaine : Yes.
Anchor: [laughs] but it also means you meeting the other condition though too.
Jurmaine: So why don’t you share with them our eager listeners?
Anchor: So I think probably a couple of weeks ago when we knew we were going to be discussing sciatica, Jurmaine may or may not have received a message
from me at night at 11 pm also.
Jurmaine: About 10.
Anchor: It would be late at 10 you have gone to bed and I’m not that bad. 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 [laughs]
Jurmaine: No, no encouragement past 9 pm.
Anchor: I was very proud because I came up with the sciatic pretty much the condition that we’re talking about is what we call the Carpal Tunnel Syndrome of the lower limbs. So, the lower limb means your leg downwards, so your thigh downwards, all the way to 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 wrist series, is a median nerve
Jurmaine: Can be.
Anchor: It is. Carpal tunnel syndrome is compression of the median nerve, but he’s only one of the causes of it, yea.
Jurmaine: That’s right.
Anchor: And that’s exactly the same and that’s why I described it as the carpal tunnel syndrome of the lower limb because with carpal tunnel syndrome or with median nerve compression, everyone assumes it’s the carpal tunnel, so everyone automatically assume, alright, we need to split the wrist, do surgery with the wrist and everything will be fine. Symptoms go away,
Jurmaine : Like literally, it’s not a…
Anchor: No no, it’s not me telling you to cut yourself, which actually that’s the surgery.
Jurmaine : That’s true, yes.
Anchor: That’s the best way that I can describe the surgery. Basically, there’s a little shape 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 the compression of the median nerve. So that’s one side where the median nerve compresses. But it has multiple other sides along the chain upwards all the way up into the next, all the way up your hand, 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 or hear the words sciatica, they automatically jump, “So, it’s a disc issue?” That was why I described it – but again, we just described multiple other areas and multiple other causes that can be causing sciatica in itself rather than it just being a disc issue.
And again, this is when we’re starting with everyone jumps to one onclusion, whereas they can be another pain that can be doing it. And the same goes for the Carpal Tunnel Syndrome, everyone jumps to one conclusion, when there could be another pain that can be causing it. So I was very proud of my little description of it, despite the fact that it took Jurmaine a whole probably nine hours or so, 10 hours to respond to me with yes, so that was actually pretty good. [Laughs]
Jurmaine: Yes, that’s good. I liked it.
Anchor: I was proud of it.
Jurmaine: I’m usually lagging on social media.
Anchor: Not on social media as I sent it by SMS.
Jurmaine: That’s very good, I usually lagging on time.
Jurmaine: One wonders how I make decisions really, really slowly.
Anchor: Like time.
Jurmaine: I am sorry.
Anchor: Think process and then hit submit button.
Jurmaine: Well, you see, I’m very kinesthetic, my nature, so I think kinesthetically, which means I get think very slowly with movements. So if I’m moving slowly, there’s no thinking at all happening. Okay, so was there anything else that you want to speak on?
Anchor: Are there any other one that we know, guys that you should be aware of? Well, not guys. Well 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 that if they’ve had a pregnancy. A lot of the time, yes, the pregnancy weighs upon the muscles and it can pinch and pull and drag the sciatic nerve along. So a lot of sciatic nerve symptoms do present themselves with 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, Jurmaine yes no? in green for that one, or do you seem earlier?
Jurmaine : It happens in pregnancy, well, it doesn’t have to happen in the third trimester. It can start happening in the second. And what can happen for
females is that, the body naturally becomes very loose. So the Ligaments become very – what we describe as laxity has a lot of [inaudible 23:04.]
Anchor : Yes.
Jurmaine : This is to facilitate giving birth, that’s what it’s used for. However, sometimes when that happens and the body has got too much intro-pelvic
pressure for one reason or another, it could be many, many reasons and we don’t know why. What can happen is that the way that babysits in the pelvis and the weight of that can compress on the [inaudible 23:37] nerve, the genital femoral nerve and then that goes to, all those nerves go to the front and the side of the
However, those nerves join to exit together and join and form the sciatic nerve. So, 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 would have growing pain, you might have sciatic pain, you may 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 it? We will probably speak to you then and in the next teaching.
Anchor : So guys, make sure you listen out into our final piece on Sciatica. As our third and final podcast on the topic. We’ll go through a few cases that we’ve seen in practice and how we addressed them. Guys, if you like what we’re presenting, please give us a thumbs up, or like or share it with one other person whom you think we may be of help. For those who are coaches, dancers or athletes may find this 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 or please do socialize with us on our Facebook which is also “Jurmaine Health” and now Instagram, whichis “Jurmaine Health Body.” And last but not least, since this podcast is made for you, our clients, patients and fans. Do let us know what else youmight like to hear about. And guys that’s us for today. So have a good week