Anchor: This 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 your health and wellbeing. We bring you the topics on Neuropsychology, Neuro-behavior, Neuro-muscularskeletal, Neuro-gastro,
Movement is wellbeing, Metabolism and Microbiome, which are also some of the services that we provide. Today’s podcast is the last our Sciatica Series and we’ll be speaking to you about some of the cases that we’ve seen and how we’ve addressed them.
Please bear in mind that all cases are unique, so none of what we discussed constitutes as advice on any Sciatica presentations and if you have any concerns, please contact your health care practitioner. I have Dr Jurmaine Wong, which we’ll be discussing as “Jurmaine’s butt” is the topic and we also have Sarah Swanee. So we’ll start with Sarah Swanee, which is when we say Swanee, it’s talking about this bases which we sort of touched base on in the first podcast. So I’m hoping you guys listened. And this was where there’s a fracture between. Well, there’s a pause day fix what they called, which is where there’s a little fracture between two areas on the spine, on one the particular vertebrae, on each side. So it means that they start slipping, one particular one start slipping off the top of the other one and it ends up taking the whole vertebrae column along with it and whatever is above it ends up taking along with it…
Jurmaine : It’s not a whole but it’s a [inaudible 01:33] the [inaudible: 01:38] above.
Anchor: No, but they talk about the takes…
Anchor : The hole takes the whole spine with it.
Jurmaine: Yes. That’s what I mean.
Anchor: So it tracks it along with it.
Anchor: And, as a result it can end up in Sciatica presentations, just depending on what level of that. So Sarah is our prime example here. Jurmaine’s been
training Sarah primarily, so I think Jurmaine’s got a bit more information on this for you guys. Well Sarah herself does. Anyone at all? Please, feel free.
Sarah: I can’t describe the pain I have.
Sarah: It’s not really pain per say. I typically feel tightness along my right, butt and all the way down to the back of my knee. So for me when I do squats, any two legged things I will always pull up feeling tighter in my right glut and in my right hamstring. And when I’m doing things like good mornings or an hinging type activities again, the right side always feels tight, which now that I think of is actually weird because my right is my kicking side so technically is my more flexible side. And when I actually do the splits. I do it with my right foot forward. So technically…
Jurmaine: Split, as in split job?
Sarah: No, split.
Jurmaine: Split itself?
Jurmaine: All right, wow.
Sarah: On my right leg forward. So.
Jurmaine: Are you flexible enough to do that?
Sarah: Oh, challenge accepted.
Jurmaine: Not yet, not now.
Sarah: One attempt now, but yes. So.
Jurmaine: No, it’s like a bit of trivia about Sarah that I didn’t know.
Jurmaine: So now, the world knows about Sarah being able to do the splits.
Sarah: Only on one side.
Sarah: So, that the patient presentation and we’ll hand over to Jurmaine to talk about.
Jurmaine: So, when Sarah first came in, I thought that she presented with stiffness of instability in her pelvic region of locking – what I will describe as a
immobility or locking up in her hip joint. So it almost looked like she had to compensate high into a higher level in her spine, in her thoracic spine, so that would be her ribcage and her shoulders. So, at this point in time, she was doing cross fit and also on top of cross fit, she was quite
diligent with her weight lifting training and she came to me and she said to me, “Hey, Jurmaine. I’ve got a fusion in my L5 [inaudible 04:26].” And I was like, “All right, that’s quite common. It’s not uncommon.” What it looked like…
Sarah: Make sure we don’t adjust this segment.
Jurmaine: But what it looks like this at the same time it was still quite unstable each week. Not each week. I don’t think I was seeing you each week, I was
seeing you like once in three weeks or something like that, sometimes six weeks even.
So she will get better, but still you see, for every patient who comes in here, every patient or client who comes in here with regardless of whether it’s Jackie who sees them or Sarah who sees them, they are on a timeline. Everyone’s needs to be on a timeline and a progressive timeline. So Sarah timeline was quite – it was intermittently good and also intermittently stalling. It wasn’t regressing but it was stalling. So given what she was doing and given her job and given her lifestyle activities, including training, working and doing a lot of internships, she was not recovering through the rate that I was quite aesthetic about or I was excited about.
When that happened, I was – to be honest I felt a little bit frustrated, I was a bit at a loss of what’s going on. But I chose what they actually to do. I thing I just chose to just monitor her progress or if it’s stalling, it’s not okay, but there will be a movement, that will be something that is going to show and present itself sometime down the road and that requires patience and waiting for that happen. But what happened eventually was a little bit of a, what do we call it? Incidental finding?
In the previous podcast when we were talking about risks and how Sarah generously shared her case study, was how she injured her wrist and during that time we sent her for two MRIs. One is in her wrist and one in her lower back to see what is happening in her lower back from the surgery that she had many, many years ago. What came back really shocked us and when I read it, I was a bit distraught. I think Sarah was too. What happened was that this fusion, what she thought she had was a fusion surgery, was not a fusion surgery, so it was a decompression surgery. And what that means is that she has been training with her very unstable spine. So with that I consulted Sarah and I said, “Look, this is what we’re going to do from here on.”
And when a patient goes through that, it can be quite levitating on several levels, including their mental health, their quality of life, identity that comes with the – well, Sarah is a Physio and she’s a Coach and she’s a Weightlifting Coach now, so she got a lot of physicality behind her. At the same time, this wonder woman in my mind, I was like, “Oh my God, this is terrible but why is she not feeling these serious sensations of the instability that’s coming from…?”
Sarah : I have no back pain people.
Jurmaine: Yes. She has no back pain.
Jurmaine: She has no back pain…
Anchor: It doesn’t have to be present in the back, remember we explain this, symptoms can lower down.
Jurmaine: Yes. Her sciatic symptoms down her leg was marginal at best. It’s not even consistent, she can squat, she was squatting, she was you know
cleaning, she was doing. What is that cross fit workout that you do a lot of cleaning in a very short time, I don’t know?
Jurmaine: Grace. Yes, she was doing many cleans in a very short period of time. She was doing jokes on my head and butt.
Sarah: I coms.
Jurmaine : You know, and she did competitions. And the seriousness of her issue is quite alarming at best.
Anchor: It’s a severe one.
Anchor: It’s one of those ones where as Jurmaine has been currently pointing out that I use this too often. If this would be more of a case where it could
be a medical emergency. If you played a contact sport her body is classified as a grade 11, which means it’s highly unstable. So, she’d be one of those that if she wanted to play a contact sport, she would be ruled out. If she wants to play professionally, they would not allow her to play for the sole reason of if she caught the heat in the bath, it could end up paralyzing her. It’s at that level where it’s a potential threat in this case.
Jurmaine: So as a result we discussed that and I asked Sarah to investigate what is happening within her you know, physiology. Usually when this happens, there are some other things that we need to think about. One is that it’s Endocrine. A Neuro-endocrine means hormones, hormone levels, nutrition – not so much of nutrition levels, but it’s quite specifically hormonal levels that we’re talking about and also if the gut health is good or not. So what we want to do is to reduce a lot of inflammation and also build up the resilience within the body as well as the immune system that we’re talking about. Build up the hormonal levels that we’re talking about and also built up the recovery of the bony tissues and how the body tissues are laid. So what happens is that for some people, well no, for a lot of people, if the hormone levels are all over the place, the bony tissue cannot repair itself quite as well as it should.
Sarah: So we’re in the stages of balancing out my hormones so that it’s going to take time with this kind of thing. So I am just being patient with that and
I am shopping around for a surgeon [Laughs]. So if anyone has any suggestions, feel free to send them through. So, right now no lifting for me for now. I really would like to contact sport, Netball. I did playsocial netball though. [Laughs]
Anchor: You don’t do that.
Anchor: That’s a bit rough, you don’t do that.
Sarah: Ran plenty, oh my God, yes. I don’t know how I’m still standing here.
Jurmaine: Standing here.
Jurmaine: Yes, we don’t know as well. So we are like, ” [inaudible 12:02]” [laughs]
Sarah: Now I am so mindful like when I’m bending down or it’s teaching me to move differently.
Jurmaine: So it’s been a big, big year for Sarah.
Jurmaine: It’s a big 2018 for Sarah, yes. So, we are crossing our fingers certainly and we are looking to get her back on track as quickly as possible. And she
is a force something and she is on her way on other things and so we are looking forward to 2019 being a better year for her. There is another case that you know about this sciatic like symptoms?
Sarah : So, we have this patient, she came in presenting with foot pain. And foot pain, she can’t walk for longer than 15 minutes at a time, which you can imagine it’s quite debilitating and the soreness takes probably about a day or two to subside. She’s quite an active individual.
Jurmaine: She’s an Akita.
Jurmaine: Akita Martial Arts…
Sarah: Instructor. So, again, being able to be physical is important to her. So, yes so.
Jurmaine: You know what, how did she present when she first came?
Sarah: That she’s tight everywhere, right? Yes. She was tight but her main presenting complaint is this pain in her foot. Jurmaine started working around, keep working upwards and upwards and upwards and then realize is actually a – almost like a [inaudible 13:42] and glut cut type issue which we’ve been doing. So we’ve not actually worked on a distal point which is her foot much, we spend majority of the time working more centrally closer to the spine and the back. And that’s actually been effective and spot on. Her pain has now gone upwards. So it went from her foot, I think it traveled up to her knee for a while and then now it’s just more localized to where the initial issue was, which is always a good sign when pain moves from distal to more central. So that’s another example.
Jurmaine : So when you first saw her, what would you have thought it would be?
Sarah : I was thinking more of maybe common perennial nerve kind of issue, like just thinking more locally. I would have attempted treating the area first
and if it was a working and maybe explore further up.
Jurmaine : So, when I decided to go straight through the more central location. What were your thoughts around that?
Sarah : I think you got it even just from a subjective, like just, yes just from talking.
Jurmaine: I can even remember.
Sarah: I remember because I was like scratching my head, “How did she end up there?” Yes, so just through the subjective interview you sort of already knew it was going to be in the good and the bad to treat. She’s strong, hersquat looks good, her movements look good, she’s strong.
Jurmaine: So, nothing gave away though?
Sarah: Yes, there’s no big glaring one, yes.
Jurmaine: I think that at one – and I couldn’t really remember what I’ve gone through because I do go through a lot of patients.
: What will impact Sarah a lot more than how it will impact me and my decision making is what, how Sarah will be observing the cases and my role is to show as many cases of how it could be a localized issue or it could be a non localized issue. And for Sarah, I think that there was going to be quite important with this case. I vaguely remember that she would have had a back injury because of how she answered the question. Rolling was one thing, her kicking.
Jurmaine : She is a Akito Practitioners, so Akito Practitioners don’t kick, they very rarely and they don’t kick at all really. She’s active and so she tried a kick boxing, I mean Thai kick boxing. Well Thai kick boxing, if you’re not trained from a very young age, a lot of times the impact of how the sandbag or the padding that you are attempting to go at would come back at you, doubled I the impact. So it will have gone into the reverberation. Would have gone into her lower back or her L5, S1 even the [inaudible 16:31] which see your hip flexes. Because that’s what kicking does and that’s what rolling does as well. And in Akito, there’s a lot kneeling, dropping to kneeling, dropping to Cesar positions. Cesar position basically means Japanese positions or from that position you are going to rolling from that position, you’re going to hunch. There’s a lot of lower end work.So that was my hunch and then it was a hypothesis from their own and it wasn’t like It wasn’t a diagnosis, it was like, “Oh, this is a hunch. Let me go find that out.” Yes, so that was my experience with that.
Anchor : So that was two of Sarah’s big cases, so she has known about. The third one has been the one that we are been looking at, which is what we just
mentioned. Jurmaine butt. So we’ve always been training, I’m pretty sure ornot. You have been training, not just [inaudible 17:26?]
Sarah: Jermaine you know your presentation and what was your initial symptom?
Jurmaine: I think I’ve got two, yes I’ve got two. Well, it’s my bad, I’m not [inaudible 17:36] I’m very generous with them.[Laughter]
Sarah: I didn’t call you, I said, “Jurmaine butt”
Jurmaine: Okay, so my gluts are pretty tight,
Jurmaine: Pretty hard because I do weightlifting but not so much weightlifting. It’s more like squatting really and I’m standing most of the time.
Jurmaine: Every once in a while my [inaudible 17:57] is really hard, that was because I had a fall as a child, so yes, so my parents thought it was really funny because I was already turned adult really. But anyway, I fell from the second level of a, I don’t know, do you call it yacht or ship or what do you call them? Ferry.
Sarah: Ferry maybe.
Jurmaine: Yes, Ferry. And just bounced off the stairs [laughs] like Arabian berry, without the bounce, so it was painful.
Sarah: [inaudible 18:28]
Jurmaine: Yes, like a plunking down the stairs really and gracefully right. AndI’ve had – the [inaudible 17:36] pain reveal itself only recently actually within the last four years. And what sometimes I try to do is to tiger balm for our patients, they get tiger balm all the time. Every once in a while I tiger balm my bum and that seemed to release theeffect of the [inaudible 18:54] the pain.
Anchor: So that’s one but that took us a while to figure out as well.
Jurmaine: The second one is I had – one day I was doing lifting and then doing lifting and then I had this random hip joint pain, so I stopped lifting there right now because it was like, well I kind of really stand withoutthat weird ass pain.
Sarah: It took us a while to figure that one out. I kept looking at your posturefor lifting as well.
Jurmaine: Yes, but it was not the lifting because even without lifting it was just standing was really irritating to stand. So it wasn’t going down to a directly done my hamstring, it was going down the side of my – it was not so much the lateral side it was like behind and slightly towards the other side of the hamstring. So during that, I’m not sure about this, that’s I got Jackie to work on the gluts, the rotators, which we talked about in thelast episode as well.
Sarah : Yes.
Jurmaine : And a little bit of the adopters…
Anchor: We also did confuse that at the beginning. We also did, which is where I went and distal as well. We do know Jurmaine has issues with their feet as
well occasionally. And it go distal there initially as well because of the lifting, because of the rolling of her feet, I thought it might’ve been a distal issue where it was, the gate was changing so it was ricocheting sending an upwards. So, this is where I went distal and started, so, and then we went, “No, okay, this isn’t working like the foot’s fine, the foot’s not a problem but that one is still hanging on.” So yes, we went up higher and Jurmaine said “We worked into the glut and the rotators.” We went as far with the solace.
Jurmaine : Yes, so once that was found, it was resolved, and then it was okay. So, I didn’t have to do much with it after that.
Anchor : Alright. So guys, I had one other recent ones. And that was the recent one. It’s one of those patients again, that we’ve discussed, especially that I mentioned in the first podcast where you assume sciatic symptoms equals disc. Now, so this was exactly the case. He told me about where the pain was so automatically we are saying – it was a little bit in the back,but not too bad but feels it predominantly in the hamstrings. So he feels like going down the back of his leg into the side of the leg. Went as far as. I’m pretty sure the knee wasn’t extending beyond the knee. I am like okay, I know the patient, I know they do a lot of manual labor, he is a gardener. I know what you’ve done. I asked, “Has there been any changes?” “No, just been a heavy day at work or what not.” He did it this way, so I’m pretty sure it had something to do with some digging, so it was bent over a fair bit. “So, okay, got you, got the idea.”
And I also know that this particular person prone to not necessarily standing in the correct positions so I wasn’t listening, watching it or watch the movements and then also made sure to check a few of those orthopedic tests that we use for discs just in case. Wasn’t thinking disc at all. I did know in my head that this particular person would have by now Googled whether they have done a disc or not, which we later on I also was treating. I specifically asked that question saying, “So at any point in time did you think you’ve blown a disc?” And the follow up answers, “Oh my God. Do you think I did? As I googled exactly that. I was googling my symptoms and it came up, but it might be a disc.” “I knew you would, that’s why I was asking.” But I said, “No, that’s why we check it, the way that we did.” I’m not concerned currently that it’s a disc, treated it as what we discussed in the last podcast as the Piriformis Syndrome, so predominantly the Piriformis muscle and hamstrings as well. So where it can get caught in either of those two. Treated it predominantly with the – literally treated those two areas and as far as on it and I saw him yesterday in a social setting and he is perfectly fine. Has not had any issues going down his leg anymore and this was only a couple of days earlier that I’m seeing him. So, he just caught the side in bolster under the Piriformis muscle and in the hamstrings just because of his positioning at work those two days prior. So what he’d potentially thought was potentially a disc, we pretty much managed to clear and he’s now no longer having it, he’s not panicking.
So this is one of those cases where I said, but just because you’ve got the Sciatica nerve pain, don’t automatically assume you’ve blown your disc. Don’t panic yourself if you – the symptoms unfortunately a lot of the time when you do Google, it does come up. If you Google “Sciatica” or “Sciatica nerve pain” or pain of any sort that we just described, it does come up one of the first causes and I think it’s so much. It’s the first one that usually, yes, it is. I’ve got Sarah here nodding at me. Usually, it does come up with the first cause, the main cause is usually a disc issue of some sort, so.
Sarah : Besides, I did a quick Google. [Laughs]
Anchor: Yes. So, just always be aware of that, but it’s one of the keynotes that I do want you to take on board.
Jurmaine: Sometimes, we come and people go, “Oh, I’ve got Sciatica and I’ve got Chiropractor, and then they say that there is a physio or someone who said
it’s a disc.” That is really, really common and how we do it here as well. There are differential diagnosis tests for just issues so…
Anchor : We did discuss this in our previous podcast as well.
Jurmaine: Or sometimes it could be a very simple case of asking them, like asking them questions like, “Did you slip and fall recently?” “Yes.” “Maybe there’s a hamstring strain?” And that is quite common.
The other one, so then we go like, “No, it’s not a disc who don’t it’s a disc? A number of people, where did they get this information from? Google.” “Okay.”
Anchor: Or, the other one is, “I had an X-ray done. It showed up on X-ray.”
Jurmaine: Oh, really?
Anchor: That one’s a common one. That one’s a common one. Yes, Sarah is just making a face going [making sound]
Jurmaine: It does not show on X-ray.
Jurmaine: It shows on an MRI.
Anchor: CT as well.
Jurmaine: And CT. And the other one could be very common is a sprain and strain of the ligaments between the pelvis and your sacrum and your L5. You can go upto Google or use it all right, “Pelvis, Sacrum, L5.”
Sarah: Sacrum Electron.
Jurmaine: That’s right.
Anchor: Or the Sacrum ligaments.
Jurmaine: And the Sacrum ligaments. So those ligaments are very strong, but at the same time they are also, because they need to be mobile, they are very
prone to been sprained or strained.
Anchor: No, Sprained, a ligament gets sprained.
Sarah: Muscle strain, ligament sprain. Hey, we learned something today. [Laughs]
Anchor: Sorry guys, just some region whilst we’re talking to you.
Jurmaine: Can we count this as CPD?[Laughter]
Anchor: We can actually.
Sarah: We can.
Jurmaine: Oh, yes.
Sarah: Even well.
Anchor: Even well CPDs, yes.
Sarah: 20 hours.
Anchor: You got 20 hours of informal.
Sarah: 20 hours CPD every year.
Anchor: And we got 24 hours.
Jurmaine: We got 24 hours. Well, Jackie clocks about a hundred CPD every year I think too.
Anchor: Jurmaine clocks about 500 minimum.
Jurmaine: Minimum every year, I was like, “Oh my God, [inaudible 16:57]”
Anchor: Don’t worry, Sarah is going to get on the CPD train too.
Sarah: I am starting on Thursday.
Anchor: Sorry guys.
Anchor: At least, sacrum ligament.
Sarah: Sacrum ligament.
Anchor: Okay. No, I’m done.
Anchor: So, we’ve established that if you sprain a ligament and you strain a muscle.
Sarah: Right, this is an off note there.
Anchor: So guys, we hope you enjoyed our series on Sciatica and that has given you some more information on this rather common clinical presentation. We
also have a couple more podcasts left before the end of the year, so stay tuned guys. So if you like what we’re presenting, please give us thumbs up
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difficulty in expressing your or executing your movement patterns. Please do connect with us via our website, which is www.jurmainhealth.com.au and
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and last but not least, since this podcast is made for you, our clients, patients, and fans, if you let us know what else you might like to hear about. So guys, that’s us for today. Have a good week. See you. Bye!