Sciatica: What is the Source?

sciatica_legpainSciatica: What is the Source?

One of the most common things that I see in my office is Sciatica.  In fact, many patients come to their first visit and tell me straight away that they have sciatica.  Self diagnosis is common today as you can find anything you want on the internet.  However, what most people don’t understand is that sciatic symptoms can have multiple different causes.  This means that sciatica treatment can vary depending on the primary cause.  The real trick is to uncover the true source.  Is is stemming from poor soft tissue health in the low back?  Scar tissue build-up in the hips and glutes? Poor pelvis function?  Poor lumbar spine function?  A herniated disc in the lower back?  Poor postural position of the low back and pelvis?  Or more commonly, is it a combination of many of these?  Many times therapists take a cookie-cutter approach to sciatica.  Adjusting the lumbar spine and pelvis, stretches for the piriformis, and maybe some electrical stimulation to the area.  This can sometimes help overcome the pain and symptoms, but most of the times function is never addressed.  This is the real source of the problem.  Some dysfunction in postural positions or movement has taken place that led to the problem.  Unless this is addressed the problem is likely to return.

The other issue I see is that people many times have an MRI that is done because of nerve symptoms that are present.  While this is not a bad idea you always have to remember that the pain is not always caused by what is found in the MRI.  For example, if you take an MRI of someone’s low back, many times you are likely to find that is does not look perfect.  You may find some mild narrowing of spaces or even some mild disc bulging.  This does not mean that you can automatically assign these findings to the source of all the patient’s pain.  This is why many times surgery to the lumbar spine fails to resolve the patients complaints.  The surgeon did a great job at making the MRI look ‘normal’, but it may not have been the actual thing that was causing the symptoms in the first place.  In fact, in the vast majority of cases conservative care will be enough to take care of the symptoms and restore function without pain.  However, there needs to be a comprehensive approach to this care.  You must address the soft tissue health, the proper joint function, the nerve health, postural positions, strength capacity, AND movement patterns.  You cannot just pick one and roll the dice.  If you fail to correct postural and movement patterns then treatment will likely fail or the problem will shortly reoccur.  We see this many times in our office as patients come to us after numerous other practitioners have failed to resolve the problem.  This is not because they are bad at the services they provide, it is simply because they did not address all of the problems at the same time.

Understand the basic premise behind sciatica treatment is taking pressure off of the sciatic nerve, wherever the compression may be happening.  Whether this is caused by scar tissue, poor joint movement, or poor functional patterns, it doesn’t really matter.  All we have to do is uncover all the dysfunctions, restore normal function, and then let the body heal on its own.  If you are suffering from sciatica, just make sure that your sciatica treatment program is comprehensive and addressing all these areas to ensure you the best chance for success.

The Unseen Cause of Recurring Injuries


The Unseen Cause of Recurring Injuries


For many years I have worked to help people overcome injuries and optimize their health.  For many people, these injuries need to be addressed quickly and efficiently so that training can continue and competitions can be completed.  As training intensity and duration increases the likelihood of injury also increases.  It is my job to eliminate as many of these ‘injury variables’ as possible.  This is why our assessments go way beyond just figuring out what hurts.  Uncovering the underlying causes for the injury becomes the real goal.  Some common causes for injury are poor mobility, poor movement patterns, weaknesses, and/or pure over-training.  However, sometimes I see clients who not only have areas that continue to get injured, but also have multiple areas throughout the body that are injured, swollen, and/or are chronically in pain.  When this occurs we have to start thinking outside the box.  For these clients, what undoubtedly needs to be considered is the possibility of some underlying systemic inflammation.  What this means is that there is something causing inflammation throughout the entire body that is really at the core of nagging, recurring injuries.  While recurring injuries can also be due to weakness, poor movement patterns, and/or strict overuse, it can also be due to a limited ability to fully recover.  This is where systemic inflammation plays a part.  This inflammation, even if low-level, can impede the body’s ability to recover completely.  And poor recovery equals a much higher incidence of re-injury.


There are really two common presentations that make me want to consider underlying systemic causes of inflammation.  The first, is when recurring injuries occur to the same area regardless of consistent treatment and proper function.  While this can simply be from continual overuse, systemic inflammation must also at least be considered as a reason for improper recovery and poor tissue health.  The area of injury is really just the ‘weak link’ that breaks down first when excessive inflammation is present.  Eliminating the cause of the inflammation can result in improved recovery, strength, and ability to handle training loads.


The second common presentation is when many areas throughout the body have low levels of pain.  These typically show up in joints.  So, for instance, if a client tells me that they hurt their hip and it is not getting better, but also proceed to tell me that both knees, right ankle, and many finger joints also hurt, I automatically start thinking systemic.  Having numerous areas of the body that are painful is difficult to explain away with simple mechanical issues.  Unless of course, they crashed their mountain bike or were involved in a motor vehicle accident.  However, barring any known massive trauma it is tough for numerous areas of the body, especially on opposite sides, to be explained purely from function.


Now the question really becomes, what areas need to be assessed if systemic inflammation is suspected?  This can be a little tricky, but with the proper questioning and a little digging it can be determined what areas may be necessary to test.  Some areas that can potentially cause systemic inflammation are poor diet, food sensitivities, poor gut health, parasites, bacterial overgrowth, yeast infections, hormone dysfunctions, and many others.  Having the ability to narrow this list down a little bit can be helpful so that proper testing can be ordered and underlying issues can be uncovered.  In my clinic, we use a wide variety of tests depending on what we are trying to assess.  The best part about many of these functional tests is that they are simple to do and most times can be done in the comfort of your own home.


The next level of thinking and true proactive healthcare, for either the office worker or the competitive athlete, is to always assess these underlying causes of inflammation as part of a standard assessment for overall health and prior to creating a comprehensive treatment plan.  Appropriately selected lab work can accurately assess many different systems in the body to check for inflammation itself, or for those things that we know create inflammation.  Treatment programs that miss this piece can many times prove ineffective or at the end be unable to completely resolve pain.  If this occurs, consider seeking out a professional who can assess these ‘other’ causes and get down to the root of the problem.


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Running Linked to Lower Arthritis

A recent, large scale study has shown that running is actually linked to lower arthritis rates than walking.  This study, performed by Paul Williams, Ph.D., analyzed 74,752 runners along with 14,625 walkers and was published in the journal Medicine & Science In Sports & Exercise.  The results surprised even those analyzing the data.  First, it showed that runners had approximately half the risk of osteoarthritis and hip replacement as walkers.  This goes completely against the theory that running is ‘bad for your knees and hips”.  As far as scientific studies go, a 50% differential when comparing two groups is MASSIVE and very significant.

The second major finding came when the author separated runners into categories based on average mileage per week.  The groups were divided into 7, 7-14, 4-21, and 21+ miles per week.  Again, contrary to common belief he found that those who did more than 7 miles per week had a 15-18% reduction in osteoarthritis and 35-50% reduction in hip replacements.  If running itself was so bad for the knee and hip joints this finding would be completely reversed.  It is impossible to know exactly what the reasons were for these shocking results.  However, it can probably be assumed that those who consistently run are overall healthier individuals with an assumed lower BMI (Body Mass Index).  Excess weight can be a large factor in the development of osteoarthritis as the joints are under too much stress.  Running is a great way to burn calories, lose weight, and stay in good shape which would place less overall stress to the joints all day long.  Running also puts force through the joints and in return causes the body to strengthen the bones and cartilage for such demands.

However, the benefits go beyond just reduction in weight and stronger bones.  Running is one of the best cardiovascular exercises that you can perform.  It makes the heart strong and allows the body to become accustomed to handling strenuous tasks.  And as cardiovascular disease is the #1 killer in society today it seems wise to want a strong heart.

Running also helps to boost metabolism, increase the production of endorphins, and is a great way to relieve stress.  In fact, the number of benefits to running are numerous.  The main objection to running for many in the medical field was the assumed damage happening to your joints.  However, with this study we can now see that those assumptions are just not valid.  This is not to say that running is not strenuous to the body, but so is any exercise.  In my opinion, the benefits far outweigh any potential negatives and the rationale to not run because ‘it is too hard on the body‘ is just silly.  Now, we have some literature to back it up.

As a chiropractor, and one who analyzes people heavily on function, it is obvious to see that if joints are misaligned then stress to certain joints will be excessive.  If the joints in your pelvis or low back are misaligned or not moving correctly then the hips and legs are forced to move abnormally to compensate.  Over time, this dysfunction can definitely create osteoarthritis and speed up its development.  It is exactly like the alignment on your car.  If your cars alignment is off, the tires wear down much faster in certain spots.  Your body  does the same and develops osteoarthritis from excessive, asymmetrical wear.  Keep the body functioning properly and it should be able to handle things such as running with no problem.