First, let us define what sciatica actually is and is not. Sciatica is, very specifically, pain along the sciatic nerve stemming from irritation of that nerve. The sciatic nerve is formed from a conglomeration of spinal nerves in the low back which binds together into one sheath. This nerve runs under the piriformis muscle in the pelvic area, then runs in between the two parts of the biceps femoris, also known as the hamstrings. It has become common to call any pain in the leg which is suspected to come from the back, sciatica. However, sciatica is a nerve pain which is the same feeling you get when you hit your “funny bone.” Most leg pain, and consequently what most people call sciatica, is actually referred pain. That is a different post. To be a true diagnosis of sciatica, it must be nerve pain that stems from the lumbar spine and runs into the buttock and/or down the backside and middle of the thigh. Now that we have that out of the way, let’s talk about what causes it!
There you have it. Probably not a comprehensive list but definitely the most common causes. Sciatica is actually rarer than it seems. When you have it, however, it is very painful and can be difficult to treat. If you are experiencing sciatica or any type of pain or other symptoms down the leg, chiropractic can help. And, like all conditions, being prompt and consistent makes for better and quicker healing.
Life tends to be really hard on the discs between the vertebrae in our spines. Discs are made of a flexible cartilage with a thick fluid and a hard nucleus in the middle. Discs are designed to improve motion and provide shock absorption which makes them the most abused structure in the spine. When we bend forward, the disc bulges backward. This can cause weakness due to wear and tear on the inner posterior aspect of the disc. Likewise, placing too much strain on the top can make the disc bulge all the way around. This is seen when someone is overweight, does a lot of high impact exercises, or loads the body with too much weight like with squats.
Each time a disc bulges farther beyond its normal borders, micro-tearing occurs. Tears heal with scar tissue which is, by its nature, not as pliable and can tear again. It is possible to train scar tissue into flexibility and help it act like regular disc tissue but it takes time and training. Too often the more rigid scar tissue will tear and recreate the original problem. This is where traction or decompression comes in.
I may offend some docs who are big into decompression therapy but to me, it and traction are the same thing. I think they started using the fancier word “decompression” because they developed more sophisticated and expensive equipment and needed a word to match. I must confess, though, as a linguist, decompression does portray a clearer and more concise picture of what we are hoping to accomplish. But, I digress. With decompression or traction (and from here I will use the words interchangeably) the goal is to take away pressure from the disc. When pressure on the disc is lessened, the disc can reshape and heal.
Traction can be accomplished in a number of ways. The method I am asked about most is about home-unit to hang upside down. In this case, one straps their ankles into a clamp and then leans backward to a specified angle. Some units will allow a person to hang completely upside down. I recommend 45 degrees to start. That is usually enough to open the disc space without getting a head rush that will shorten the traction time.
There is a host of other traction devices. Most of them can be found on late night infomercials. All of have some legitimacy but some are definitely better than others. The one I have seen a lot recently has the person lying down with their heels resting on a moveable piece that pulls and moves the legs side to side. I am not sure how much traction is occurring but movement is always good. One of the better ones I have seen in the past looks like a big cushy loop that hangs in a doorway. The person is situated so that their upper back is on the ground and their pelvis and legs are parallel with the doorway. Again, the end result is the same and usually positive.
Some providers have very nice decompression machines that are extremely effective in separating the vertebrae thus decompressing the disc. With severe disc bulges and herniations, these machines can be lifesavers. The only downside is the expense which can be significant. In our office, we have available a more hands-on form of traction called flexion-distraction. The table we use flexes at the lumbar level and is spring loaded. The doctor puts one hand on the spine holding a specific level in place and uses the opposite hand to push the table down. The spine separates then accommodates as the spring pushes the table back up. If the chiropractor knows what they are doing, this a very effective form of traction and can make a big difference in the disc.
All of the forms of traction that I mentioned above address the low back. There are, however, various units for the neck, as well. There are three main types of cervical traction. One way uses a harness around the chin and base of the skull attached to a rope and pulley. These units either have a counter-weight, usually a water bag, or a tension spring. The other devices look like a collar between the shoulders and the chin/skull that expand when pumped full of air. Both are effective and mostly utilized at home. The third combines traction with an attempt to restore curvature. This unit is a wedge whereupon a person lies with their head hanging over the tall side of the wedge. Often times there is an elastic strap or a weight that pulls down from the forehead.
Whatever method you choose or whichever method is the most effective for you, the key to success, as with most things, is to apply it consistently over a significant length of time. I have a cervical traction unit that I use when my neck is hurting and I routinely have Dr. Wagnon adjust me on the flexion-distraction table. Discs, just like people, sometimes just need a break from the pressures of everyday life, traction or decompression is a great way to accomplish this.
Have you ever bent over to pick up something only to experience a pain like someone shoved a hot poker into your low back and then started pulling your muscles apart? Yeah, most of us have felt that at some point. Hopefully, it never happens to you, too, but if it does, here is what you do.
One of the most fulfilling yet difficult aspects of my career is helping people navigate their journey to better health. Healing is a process that can take a lot of time. We tend to think of that process as a straight road from disease or injury to health but that is the exception rather than the rule. Often, things feel worse before they feel better and there are always plateaus and valleys. Helping patients to have faith in the process and continue care inspite of bumps in the road is a worthy challenge.
Everyone comes into the office with disfunction. Not all disfunction is symptomatic but it all has potential to become so. Sometimes people come in with symptoms that are just starting to show but during further examination, I discover that those symptoms are just the tip of a very large disfunctional iceberg. I know that when I start chipping away at the disfuntion below the surface it is going to make those symtoms much more obvious. This can be very alarming. In addition, symptoms can change or move locations. People who are more prone to worry, often need a lot of reassurance to stay the course. There are several signs and symptoms that may cause concern but are actually indicative of progress. Most of these happen in early stages of care.
Pain will often increase with increased movement. Adjustments are designed to move joints that have been stuck or moving improperly for some time. Getting them to move again can cause pain. It is not always pleasant but it is a necessary step. As a rule, the pain should be more of an ache or soreness. Furthermore, pain can centralize and therefore increase in intensity. Centralized pain, or pain that is focalizing on the disfunctional joint, is usually more painful than a broad spread out pain. In this phenomenon, the pain is going back to where it belongs which is a very positive step. The closer your symptoms are to the structure that is actually causing the symptoms, the better the body will be at promoting healing in that area.
Symptoms often change especially when nerves are involved. If a nerve is significantly injured, the worst thing is complete numbness with zero sensation. There is actually no pain. When we lessen the irritation, the sensation is one of pins and needles and achiness. This can be followed by soreness. These symptoms will wax and wane for some time before a complete recovery.
Another change that can happen that will cause a patient mental anguish is when a symptom switches sides. We often see this is disc related injuries. This is not necessarily a bad thing either. It tells me that the disc is not completely stuck in one bulging position and can change or, even better, that it has not degenerated to the point of no return. The ability to change means it can heal.
I find it much better to not focus on symptoms but to look at movement patterns, muscle tone, and inflammation. If range of motion is improving and muscles are calming down, then progress is being made, and it is only a matter of consistency and time before symptoms start to go away for long stretches of time. When people ask if they are getting better, or complain that they are not any better, when I know they are, I usually ask them how they feel after an adjustment. More often than not, they feel significantly better but it just does not last as long as they think it should. As we get better, we also tend to forget how bad the pain was. The contrast of any pain when you have experienced little to no pain promotes the idea that one is not improving. Perspective is the key.
If you feel like chiropractic is not helping you, please take a step back and consider the big picture before you cut your care short, thus nullifying all of the hard work you and your doctor have done to help you become functional again.
The great Aristotle once wrote that “The more you know, the more you know you do not know.” For me, the more experience I gain, the more I realize my limitations. People who know me well, know that I do not lack confidence. I try not to be arrogant but I do my best to assure myself that I can be a force for good in this world. That saying, I must confess that no matter how much I may want to make everyone better, there are just some people that I cannot help.
Recently, I had a patient come in that I hadn’t seen in a couple of years. She did not come in for an adjustment. She came in to explain why I couldn’t help her. You see, back then I gave her several adjustments which provided little to no relief and then she started heading south so she discontinued care. As a doctor, that is the most helpless feeling. It is made significantly worse when there is no explanation why. In her case, she was born with a birth defect called a Chiari Malformation where the lower part of the brain drops below the skull. This can lead to a syringomelia, a pocket of fluid in the spinal cord which can be very painful and dangerous. Anyway, this was never mentioned in her MRI report from years earlier. The neuro/spine specialist that she saw some time after seeing me saw it on the MRI. This little bit of information explained everything. I am grateful she came in and shared that with me.
There will always be conditions that are too far advanced for me to help. I don’t like it, but that is the way it is. We do not always know when a condition is beyond help until after we have tried. I have had many patients with serious back pain come in and ask if I can help. As a chiropractor, I know I can adjust them. In most cases, this will help in the healing process. At the very least, it is a conservative start. Most patients get better and we can manage. Others do not. I have recommended MRI’s and surgery when it is beyond my help. For the most part, those patients have seen good results and have come back to me for care after their surgeries.
Finally, there are people who either do not really want to be helped or have unrealistic expectations of how long and what it will take to heal. Healing takes time and effort. One adjustment can make a big difference in how a patient feels but it does not mean that their injury has healed. Consistent care is tentamount to healing properly. Likewise, just because there is still pain, it does not mean that injury is not healing. Pain can be tricky and is not a very good indicator of the level of damage.
In short, I sleep at night knowing that I do my best to help others live healthier lives. There are always challenges and there will be people that despite my knowledge, skills, and determination, I cannot help. For those people, I am sorry. I feel bad for you and hope there is some one out there with the answers and approach to help you in your journey.
When we talk about “the core” of the body, we are typically referencing the musculature around the abdomen and low back. These muscles consist of the abdominal muscles (rectus abdomini, internal obliques, external obliques, and transversi) and the muscles of the back (lattisimus dorsi, serratus posterior inferior muscles, erector spinae, multifidi, interspinalis muscles, lateral intertransversi muscles, quadratus lumborum, and to some degree the iliopsoas).
Strengthening the core has become a fairly popular mantra these days. Many of us are walking around with poor posture and a fair amount of dysfunction as a result of poor core stability. A weak core leaves one susceptible to a host of joint and disc injuries as well as overly tight butt and leg and muscles. In contrast, a strong core can prevent a host of back injuries.
The word strength, however, needs some clarification in the context of strengthening the core. When most people think of strengthening muscles, they picture muscles moving against significant resistance like lifting weights or power movement against gravity or some other force. These type of exercises can actually be detrimental to the core muscle and increase the risk of injury to the spine. Coordinating the movement of all of these muscle is what is most beneficial.
I mentioned in my last article that postural muscles are slow twitch, white fiber muscles designed for endurance. They need to be strong enough to hold you up all day. Strength in this case does not come from bigger muscle fibers but from having all of the muscle firing in a controlled and proper order. For example, if you lift a box, ideally your abdominal muscle and your spinal muscle would contract at the same time to stabilize the body so the shoulder and arms and hips and leg muscles can utilize their power to lift it. What often happens is that core muscle lay dormant until a significant strain forces is to respond. So, when you lift a box, you first engage your back muscles until you are upright then, if you go past vertical, the abdominal muscles will engage. Then, they will fire back and forth while they try to find a semblance of stability.
I bring this all to your attention to encourage you to strengthen your core appropriately. Exercises that promote coordinated movement like yoga, pilates, and modified exercises from yoga can make a huge difference. It can take time to build coordination and it takes a consistent effort. In the following videos I demonstrate four very useful exercises for coordinating core muscles and therefore, strengthening it.
The purpose of this blog post is in no way to belittle or degrade the medical profession. My best friend is a medical doctor and I have several friends whom I admire and respect who are medical doctors. Furthermore, I have many medical doctors who refer patients to me on a consistent basis. No, this article is for those medical doctors who refuse to educate themselves on the benefits of alternative health care. Lately I have had a few medical doctors tell our mutual patients that they should not get adjusted anymore. Every single one of them cited arthritis as the reason why they should discontinue care with me. I hope this article will educate you as a patient of such physicians and maybe even influence some of them to do some research.
First of all, arthritis is a very generic term. Medical doctors routinely use it for any ache or pain in a joint. Most of the time calling it arthritis is technically true but over simplistic. It seems to me like they use it liberally because they do not want to explain what is really going on. Arthritis means is inflammation in a joint. It can be caused by auto-immune conditions like Rheumatoid or Lupus but more often it is caused by wear and tear. This is rarely explained to a patient so I am going to.
When doctors tell you that you have arthritis, most of the time what they are saying is that they can see signs of degeneration on your x-rays. Examples of degeneration are decreased joint space, bone spurs and misalignment. Essentially, instead of seeing nicely aligned joints with smooth edges, they see jagged edges with varying degrees of misalignment. This happens over time. How quickly is determined by how dysfunctional the joint is. The more dysfunctional the quicker it degenerates. Dysfunction of a joint means it is either not moving properly or not moving at all.
In the spine, the vertebrae have discs that can degenerate. Usually, this is associated with a disc herniation or bulge. Degeneration in the spine can lead to stenosis or narrowing of the openings where the nerve roots travel. Spinal degeneration or arthritis can come in varying degrees and complications. I am very aware of the risks involved with adjusting a highly degenerative spine.
Let me repeat that. I am very aware of the risks of adjusting a spine that has arthritis or degeneration! I also know the benefits. For this reason, I am very frustrated with these MD’s who are telling my patients to stop. Do they think I am unaware of my patient’s condition? Do they believe that I have no regard for my patient’s health? To be honest, I don’t believe they consider this, at all. I see fear derived from ignorance.
The truth is that an adjustment of a degenerating joint can be very beneficial. Retraining the joints to move properly can decrease inflammation and increase the nerve flow to that area which will at the very least slow down the degenerating process. Increased function will lead to improvement to the health of the joint. Are there risks? Of course. There are risks to everything. I believe the greatest risk is doing nothing. It is certainly the most predictable risk.
Trusting in your chiropractor to know when to adjust or not is important. Communication is the key! If you have a condition and you are unsure of your chiropractors awareness of it, express your concern. On that same note, avoid taking advice from people who don’t know. They shouldn’t be making recommendations about things of which they are ignorant. That doesn’t seem to be stopping some of them. If you stopped chiropractic care because your MD told you to, but have’t discussed it with your chiropractor, its time to have a frank and open discussion with all the parties involved, OK?
1. Make sure you and the other driver are safe before getting out of the car. If you are in a busy intersection move out of harm’s way (if possible). Make sure you pull as far as you can to the side of the road.
2. Check for injuries. Most people don’t feel injured immediately after an auto accident because of the adrenaline rush. Be cautious. With every auto accident you are going to have an injury; the forces involved are just too great not to. If an ambulance comes, the EMT’s will check things out. They usually recommend you come with them. If you feel like you can drive home then tell them. If not, go. Better safe than sorry. It will be a pain to deal with the ambulance bill when it comes and your claim hasn’t been paid, but your health is worth the hassle
3. Exchange information. At minimum, you should get their name, telephone numbers, license plate and card numbers, and their insurance information. One of the more innovative things I would recommend besides writing down the above information is to take lots of pictures. Most cell phones these days have cameras. Take pictures of the accident but also take pictures of their driver’s license and insurance card.
4. Call the police. Do this just in case. Truth is, most of the time they just tell you to exchange information. It may not feel necessary to call but you never know. If you call and they can’t help you in time then call back later and file a police report. This will help protect you.
5. Inform your and the other driver’s insurance company. The quicker you get the ball rolling the easier it will be for you. There are two sides to an auto accident claim, the property damage and the bodily injury. The car they should fix quickly. Taking the time to see a doctor about the bodily injury before any decisions are made is important (will discuss next). If the accident was not your fault, you should still let your insurance company know. They can back you up if the other person is either under insured or just a pain to work with. You may also have Med-pay which is an extra writer that covers injuries regardless of who may be at fault.
6. See your chiropractor! Chances are you have some pain or discomfort. Even if you don’t have pain, get an exam. In every auto accident you are dealing with forces that cause tissue damage. Sometimes you don’t feel the problems until months later when weak scar tissue tears and starts the inflammation again. In addition, it is tough to argue with insurance companies unless you get checked out soon after the accident.
7. Ice. The protocol for icing should be 20 minutes maximum on the affected area. You want to feel the cold then burn then ache before it goes numb so only use a paper towel or thin t-shirt between your skin and the ice pack. NEVER USE HEAT after an auto accident. This will feel good while it is on but bring a lot more blood to the area and make the inflammation worse. Increased inflammation will slow down the healing process.
8. How should you pay for your care? This could be its own blog post but I will keep it short. If the accident was not your fault you shouldn’t have to pay anything out of pocket. I am happy to treat people on a lien until is settles. If it is your fault you either have to pay for it yourself or have Med-pay on your auto insurance policy. Besides Med-pay, if you are not at fault, retaining an attorney can save you a lot of hassle and stress and should help you get a little extra money for all the things you will have to deal with on your road to recovery.
9. Journal. The more information you have the better. Take note of your aches and pains, when you have to take pain meds, times when you get headaches, days/hours missed from work. One of the most important things you can document is what you cannot do anymore as a result of your injuries from the auto accident. Detail will help convince the insurance adjuster that your injuries are legitimate.
10. Get better. Healing takes time. It is a roller coaster ride that can be frustrating. Don’t stop treatment too early or it could come back and become chronic. Remember, a positive attitude goes a long way to healing.
Proprioception has to do with coordination and position sense. Try this experiment. Close your eyes and touch the tip of your nose with your finger tip. Were you able to do it? The highest number of nerve receptors that sense movement are in the neck, hands and feet. All joints, however, have their fair share. The better these receptors work, the better the body can respond.
Let me give you an example. If a person sprains his or her ankle, they are more likely to sprain it again and again. The reason this happens is because first, the ligaments are weak but more importantly because with injury the proprioceptors become dull. It doesn’t have to be injury either. Posture changes proprioceptors, as well.
The danger of having dulled proprioceptors is a much broader topic than you probably want to delve into at this time. Suffice it to say that if your proprioceptors are not working well, you leave yourself very susceptible to injury. Likewise, pain sensation travels on the same nerve fibers so pain increases as proprioception decreases and vice versa.
The trick to getting these proprioceptors to wake up? Get the joint moving. Lack of motion or improper motion scrambles the receptors. Proper stimulation through movement, improves their function. Chiropractic adjustments and activities that challenge us physically both in strength and coordination are the best ways I can think of to accomplish this goal.