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017 Sciatica part 3

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017 Sciatica part 3

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Final episode on sciatica. Just because you experience sciatica, it does not mean that you have blown up your disc. Listen to this episode where we also share our personal experiences with different back issues.

SHERMAIN [17:42]

So my glutes are pretty tight. Yes because I do weightlifting but not so much weightlifting it’s more like squatting really. And I’m standing most of the time. Every once in a while. My coccyx really hurt that was because I had a fall as a child. So yeah my parents thought that it was really funny because I was a very rotund child, a rotund adult really but anyway. I fell from the second level of a I don’t know, do you call it yacht or ship, what do you call them?

SHERMAIN [19:21]

Yeah. But it was not the lifting … because even without lifting it was just standing it was really irritating to stand. So it wasn’t going down directly down 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 outer side of the hamstring. So during that I was I’m not sure about this but that’s why I got Jackie to work on the glutes, the rotators which we talked about in the last episode as well. And a little bit of the adductors. ​

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 017: Sciatica part 3

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. Today's podcast is the last of 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 discuss constitutes as advice on any sciatica presentations. And if you have any concerns, please contact your health care practitioner. I have Dr. Shermain Wong, and Cera's spondy. So we'll start with Cera's spondy, which is when we say spondy it's talking about the spondylolisthesis, which we sort of touched base on in the first podcast. So I'm hoping you guys listened. This was where there's a fracture between, where there is a past defect they call, which is where there's a little fracture between two areas on the spine on one or two particular vertebrae on each side. So it means that they start slipping, one particular one starts slipping off the top of the other one, and ends up taking the whole vertebral column along with it. Whatever's above it ends up taking along with it.

SHERMAIN [01:32]

It's not a whole vertical column, the vertebra above

JACKIE [01:38]

No, but they talk about the That's what I mean. Oh, it tracks it along with it. And as a result, it can end up in sciatica presentations just depending on what level it's at. So Cera is our prime example here. Shermain has been treating Cera primarily. So I think Shermain's got a bit more information on this where you guys or Cera herself does, anyone at all. Please feel free.

CERA [02:06]

I can describe the pain. Well, it's not really pain per se, I typically feel tightness along my right butt in 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 glute, in my right hamstrings. And when I'm doing things like Good Mornings or 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 it's my more flexible side. And when I actually do the splits, I do it with my right foot forward. So technically

SHERMAIN [02:50]

Split, as in split jerk?

CERA [02:53]

No, no, splits itself.

Yeah, well, I'm right leg forward.

SHERMAIN

So are you flexible enough to do that?

CERA

Yeah.

Challenge accepted. I won't attempt it now.

SHERMAIN [03:10]

No, it's like a bit of a trivia about Cera that I didn't know about. Yeah, so now the world knows about Cera being able to do the splits.

CERA [03:19]

Only on one side. So that's the patient presentation and we'll hand over to Shermain to talk about.

SHERMAIN [03:28]

When Cera first came in, I thought that when she first came in, I thought that she presented with a lot of stiffness a lot of instability in her pelvic region, a lot of locking up in what I would describe as a immobility or locking up in her hip joint. So it almost looked like, it almost looked like she had to compensate high into a high higher level in her spine, in her thoracic spine. So that would be her ribcage and her shoulders. So if she, at that point in time she was doing CrossFit. And also on top of CrossFit, she was quite diligent with her weightlifting training, and she came to me and she said to me. Hey, Shermain, I've got a fusion in my L5S1. And I was like alright, that's quite common. It's not uncommon, what it looked like

SHERMAIN [04:34]

But what it looks like as well, at the same time, we, it was still quite unstable each week, not each week. I don't think I was seeing her each week I think I was seeing her once in three weeks or something like that. Sometimes six weeks even. So she will get better but so you see, and 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 Cera who sees them they are all on a timeline. Everyone needs to be on a timeline, on a progressive timeline. So Cera's timeline was quite intermittent. 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 to the rate and I was quite ecstatic about or I was excited about. When that happened, to be honest, I felt a little bit frustrated. I was a bit at a loss of what was going on, but I chose, what I actually choose to do. I think I just chose to just monitor her progress or if it's stalling, it's not okay. But there will be a movement there will be something that is going to show and present itself sometime down the road. And that requires patience and waiting for that to happen but that what happened eventually was a little bit of a what we call it incidental finding. In the previous podcast we were talking about risks and how Cera generously shared her case study was how she injured her wrist and during that time, we sent her for two MRIs. One 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 years ago. What came back really shocked us. Well, I when I read it, I was a bit distraught, I think Cera 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 was she has been training with her, with a very unstable spine. So with that, I decided to, I consulted Cera and said, look this is what we are going to do from here on in. When a patient goes through that it's very, it can be quite debilitating on several levels, including their mental health, their quality of life, identity that comes with it. Well, Cera is a physio and she's a coach, and she's a weightlifting coach now, so she's got a lot of physicality behind her. At the same time, this Wonder Woman in my mind, I was like, Oh my God. This terrible but why is she not feeling these serious sensations of the severe instability that's.

CERA [08:10]

I have no back pain people.

SHERMAIN [08:12]

Yeah she has no back pain.

JACKIE

Other symptoms can present themselves.

SHERMAIN [08:22]

Her symptoms 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? Really? That CrossFit workout that you do a lot of cleans in a very short time? I don't know.

CERA [08:43]

Grace

SHERMAIN [08:44]

Grace. Yeah, she was doing many cleans in a very short period of time. She was doing jerks overhead and

CERA [08:52]

Comps

SHERMAIN [08:53]

and she did competitions and the seriousness of her issue is quite alarming at best

JACKIE [09:02]

It's a severe one. It's one of those ones where as Shermain has been kindly pointing out that I use this too often. It this would be a more of a case where it would be, it could be a medical emergency if you play a contact sport. Her spondy is classified as a grade two, which means it's highly unstable. So potentially, she'd be one of those that if she was to play, if she wanted to play a contact sport she would be ruled out. They would not if she wanted to play professionally, they would not allow her to play for the sole reason or if she copped the hit in the back. It could end up paralyzing her. It would not, it's at that level where

it's a potential threat in this case.

SHERMAIN [09:48]

So as a result of that.

We discussed that, and I asked Cera to investigate what is happening within her, you know, physiology, usually when this happens, there are some other things that we need to, we need to think about. One is that it'sendocrine, neuro endocrine means hormones, hormone levels, nutrition, not so much of nutrition levels, but is quite specifically hormonal levels that we are 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 the immune system that we are talking about, build up the hormonal levels that we are talking about, and also build up the recovery of the bony tissues and how the body tissues are laid. So what happens is that for some people, for a lot of people, if the hormone levels are all over the place, the bony level, the bony tissue cannot repair itself quite as well as it should.

CERA [11:14]

So we're in the stages of balancing out my hormones so that it's gonna take time with this kind of thing. So just being patient with that, and I am shopping around for a surgeon

So if anyone has any suggestions feel free to send them through.

So right now it's no lifting for me. For now, I really would like to play a sport. No contact sport for me. I did play social netball though.

JACKIE [11:48]

You don't do that. It's a bit rough. Don�t do that.

CERA [11:51]

Ran plenty of that. Oh my god. Yeah. I don't know how I'm still standing.

CERA [12:02]

Now I am so mindful, like when I'm bending down or it's teaching me to move differently.

SHERMAIN [12:09]

So it's been a big year for Cera. It's a big 2018 for Cera.

We are crossing our fingers. Certainly I want to get her back on track as quickly as possible. And she is for some things and she is on �away� for other things. And so we are looking forward to 2019 being a better year for her. There is another case, Cera, that you know about was sciatic like symptoms.

CERA [12:37]

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.

SHERMAIN [13:00]

She does aikido.

CERA [13:01]

Yeah, aikido martial arts instructor. So being able, again being able to be physical is important to her. So yeah

SHERMAIN [13:12]

so how did she present when she first came?

CERA [13:15]

She was just tight everywhere, right? Yeah, she was tight. But her main presenting complaints this pain in her foot, Shermain started working around, keep working upwards and upwards and upwards and then realize it's actually a almost like psoas and glute type issue which we've been doing. So we've not actually worked on the distal part, which is her foot much, we spend majority of the time working more centrally closer to the spine and in the butt and that's actually been effective and spot on. Her pain has now gone upward. So went from her foot and 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.

SHERMAIN [14:09]

So when you first saw it, what would you have thought it would be?

CERA [14:14]

I was thinking more of maybe common peroneal nerve kind of issue, like just thinking more locally would have attempted treating the area first. And if it wasn't working, then maybe explore further up.

SHERMAIN [14:29]

So well, when I decided to go straight to the more central location. What were your thoughts on that?

CERA [14:38]

I think you got it, even just from the subjective. Like just yeah, just from talking to her. I remember because I was like scratching my head. How did she end up there?

Yeah. So just through the subjective interview you use, sort of already knew it was going to be in the glute and the back to treat.

She's strong. Her squat looks good. Her movements look good. She's strong.

SHERMAIN [15:03]

Nothing gave away.

CERA [15:04]

Yeah, there's no big glaring ones. Yeah,

SHERMAIN [15:07]

I think that at that point in time, I can't really remember what I've gone through because I do go through a lot of patients. What Cera, what will impact Cera a lot more than how it will impact me and my decision making. It's what how Cera would 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 Cera, 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, and her kicking. She is an Aikido practitioner so Aikido practitioners don't kick they very rarely they don't kick at all really. She's active and so she tried kickboxing, and a type of kickboxing, 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're attempting to go at, would come back at you double the impact. So it will have gone into her, that reverberation will have gone into her lower back, or her L5 S1 or even the iliopsoas which is your hip flexors, because that's what kicking does, and that's what rolling does as well. In Aikido, there's a lot of kneeling, dropping into kneeling position, scissor positions means basically means Japanese kneeling positions or from that position, you're going to rolling from that position, you're going to lunge, there's a lot of lower limb work. So that was my hunch and then it was a hypothesis from thereon. It wasn't like, it wasn't a diagnosis. It was like oh, this is a hunch. Let me go find out that hunch. Yeah, so that wasn't my experience. So that was two of Cera's big cases that she is known about.

JACKIE [17:15]

The third one has been one that we've both been looking at, which is what we just mentioned Shermain�s butt. So we've both been treating it, I'm pretty sure or not, have you been treating it? Shermain you know your presentation. What was your initial symptom?

SHERMAIN [17:30]

I think I've got two. Yeah, I've got two Well, it's my butt I'm not tight arse. I'm very generous with them.

SHERMAIN [17:42]

So my glutes are pretty tight. Yes because I do weightlifting but not so much weightlifting it's more like squatting really. And I'm standing most of the time. Every once in a while. My coccyx really hurt that was because I had a fall as a child. So yeah my parents thought that it was really funny because I was a very rotund child, a rotund adult really but anyway. I feel from the second level of a I don't know, do you call it yacht or ship, what do you call them?

JACKIE [18:14]

Ferry, ferry maybe

SHERMAIN [18:16]

Yeah ferry and just bounced off the stairs like a Ribena berry without the bounce, so it was painful. Yeah. More like a plonking down the stairs,

Really ungracefully right. And I had that coccyx pain reveal itself only recently actually in the last four years. And what sometimes I tried to do is to Tiger Balm. For our patient, they get Tiger Balm all the time, every once in a while I Tiger Balm my bum and that seemed to release the effect of the coccyx strain.

So that's smart, but that took us a while to figure out as well. The second one is I had one day I was doing lifting and then I had this random hip joint pain. So I stopped lifting because it's like, well, I can't really stand that weird ass pain.

JACKIE [19:17]

It took us a while to figure that one out. We kept looking at your posture for lifting as well.

SHERMAIN [19:21]

Yeah. But it was not the lifting � because even without lifting it was just standing it was really irritating to stand. So it wasn't going down directly down my hamstring, it was going down the side of m,y it was not so much the lateral side it was like, behind and slightly towards the outer side of the hamstring. So during that I was I'm not sure about this but that�s why I got Jackie to work on the glutes, the rotators which we talked about in the last episode as well. And a little bit of the adductors.

JACKIE [20:00]

We also got confused that at the beginning. We also did. This is where I went distal as well, because we do know Shermain has issues with her feet as well, occasionally. And I did go distal there initially as well, because of the lifting because of the rolling her feet. I thought it might have been a distal issue where it was the gait was changing. So it was ricocheting sending it upwards. So this is where I went distal and started distal. And then we went no, okay, this isn't working like the foot's fine. The foot's not a problem, but that one's still hanging on. So we went up higher and like Shermain said we went into the glutes and the rotators and we went as far as the psoas.

SHERMAIN [20:41]

So that was, once that was found it was result and then it was okay, so I didn't have to do much after that.

JACKIE [20:51]

Alright, so guys, I had one of the recent ones, and my one's the one that 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. So this was exactly the case. He didn't. He told me about where the pain was. So automatically was saying, tells us a little bit in the back but not too bad but feels it predominantly in the hamstrings. So he feels it 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, mate, ok, I know. I know the patient. I know they do a lot of manual labor so my guard is up.

Okay, I know what you've done. I asked has there been any changes? No, it's just been a heavier day at work or whatnot. Get it this way. So I'm pretty sure it had something to do with some digging so he has bent over a fair bit. Okay. Got you, got the idea. I also know that this particular person is prone to, not necessarily standing in the correct positions. So I was listening, watching it all, watch the movements and then also made sure to check a few of those orthopedic tests that we use for discs just in case. I wasn�t thinking disc at all, did know in my head that this particular person would have by now googled whether they have done their disc or not, which later on while I was treating. I specifically asked that question saying so at any point in time, did you think you've done a disc? You blow a disc? And the follow up answer was, Oh, my God, do you think I did? Because I googled exactly that I was googling my symptoms, and it came up that it might be a disc.

I knew you would, that�s why I was asking. No, that's why we checked the way that we did. I'm not concerned currently that it's a disc, treat 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 that in just literally treated those two areas. And as far as I know, and I saw him yesterday in a social setting, and he is perfectly fine. He has not had any issues going down his leg anymore. And this was only a couple days earlier that I am seeing him. So it was it had just caught the, just caught the sciatic nerve in both under the piriformis muscle and in the hamstrings just because of his positioning at work that very that those two days prior. So what he'd potentially thought was potentially a disc, pretty much managed to clear and he is now no longer having, he's not panicking. So this is one of those cases where I said, Don't just because you've got the sciatic nerve pain, don't automatically assume you've blown your disc. Don't panic yourself, if the symptoms unfortunately, a lot of the time when you do Google, it does come up. If you Google sciatica or sciatic 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 I think it�s the first one that usually yeah, it is I've got Cera here nodding at me. Usually it does come up as the first cause the main cause is usually a disc issue of some sort.

CERA [24:11]

Because I did a quick Google

JACKIE [24:13]

just always be aware of that, guys. It's one of the keynotes that I do want you to take on board.

SHERMAIN [24:20]

Sometimes we will come in, people go oh, I've got sciatica and I go to another chiropractor, and then they say that there's a chiropractor/physio someone who says a disc. That is really common. And what, when we, how we do it here is that, well there are differential diagnosis tests, for disc issues. So we can discuss this

JACKIE [24:48]

in our previous podcast as well.

SHERMAIN [24:50]

Well, sometimes it could be a very simple case of asking them questions like, did you slip and fall recently?

Yes. Maybe there's a hamstring strain.

That is quite common. The other one is, so then we go like, no, it's not a disc who told that it�s a disc? A number of people. Where did they come? Where do they get this information from Google? Okay. Or the other one is they had an X ray done it showed up on X ray.

SHERMAIN [25:25]

Oh really?

JACKIE [25:25]

Yeah. Okay, that one's a common one. Yes. Cera's just making a face right. Cera's just making a face going ummmm

SHERMAIN [25:35]

It does not show on x ray. No, it shows on an MRI

JACKIE [25:39]

CT as well

SHERMAIN [25:40]

and CT. And the other one it could be very common is a sprain and strain of the ligaments between the pelvis and your sacrum and your L5. You can Google all these things. All right, pelvis, sacrum, L5.

And the sacral ligaments And the sacral ligaments

SHERMAIN [26:02]

So those ligaments are very strong but at the same time they are also because they need to be mobile, they're very prone to being sprained or strained.

JACKIE [27:23]

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 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. See you, Bye.

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2020-09-08T06:16:03+10:00