The Sciatic Nerve

Sciatica essentially refers to compression of the sciatic nerve, the largest and longest nerve in the human body. The sciatic nerve originates in the lower back from a number of nerve roots exiting off the spinal cord which then join together to form the sciatic nerve. The nerve then travels down the leg and is responsible for supplying sensation and function to all the structures of the leg.

Compression of the nerve can come from different sources, but the most common is a disc protrusion, commonly referred to as a ‘slipped disc’. In reality the disc doesn’t ‘slip’, but it can bulge, protrude or herniate. I usually describe it to patients as similar to tooth paste being squeezed out of the tube. There can be just a small amount ‘peeking’ out of the tube (bulge), or, with more pressure on the tube, a larger amount comes out (protrusion) and with even more pressure some of the tooth paste can actually ‘break off’ and separate from the rest of the tooth paste in the tube (herniation).

Sciatica and Back Pain

The nerve bulge, protrusion or herniation usually occurs as a result of a strain or injury that causes a tear in the fibers that support and hold the disc in place. Because these fibers do have pain receptors there can be some lower back pain in the initial stages, however usually the back pain does not persist for very long before the leg pain takes over as the primary problem. 

Who should manage and treat sciatica?

The Chiropractor

In my 27 years of practice I have found that chiropractic management and treatment of sciatica is can be very effective and should definitely be the first ‘port of call’ for patients with sciatica.

Results with a disc bulge or protrusion are usually excellent, but results may be variable with a disc herniation.

Aside from the pain in the leg, patients can present with or without neurological signs and this would depend on the degree of nerve compression. The greater the pressure, the more the chance of ‘hard’ neurological signs such as decreased or absent reflexes, marked tingling, pins and needles or numbness and even muscle weakness.

These are more serious signs and should not be allowed to persist for an excessive amount of time with out referral for an MRI scan

The Neurosurgeon

If patients are experiencing unrelenting severe pain as well as ‘hard’ neurological signs I am of the opinion that a neurosurgical consult is warranted.

Management and Treatment

The first thing to note is that there is no ‘quick fix’ with true disc problems, as can be the case with mechanical back pain.

My approach is bed rest for 14 days, yes, strict bed rest! 

The bed rest is coupled with using ice packs intermittently to help reduce inflammation and chiropractic treatment 3 times a week in those first 14 days. I always recommend natural muscle relaxant supplementation and, occasionally, if the pain is very severe I may recommend anti inflammatory medication as well.

Sitting is to be avoided at all costs.

Even if the symptoms improve after 7 days I still caution patients about being too optimistic as I have seen too many instances of where retuning to normal function too soon causes a more severe relapse.

There are times however, where surgical intervention is necessary and this is usually to relieve the excruciating leg pain. Rest and conservative treatment, however, should always be given a chance. There are risks with any surgical procedure and a documented failure rate of around 20% for surgical procedures for sciatica. The research also clearly shows that at 12 months the results of conservative vs surgical management are exactly the same.

Please feel free to share this blog, comment or email me at klentin@iafrica.com for more information

That basically translates to the fact that lower back pain is basically an epidemic. The most common type of lower back pain is what is referred to as mechanical lower back pain. This relates to the mechanics of how the joints between each vertebra move and articulate.

The spinal joints are the ‘moving parts’ that allow you to bend and twist and just like any other moving part they are subject to wear and tear and therfore damage. There are three situations that will cause back trouble.

1. Pathological conditions

These are medical type problems such as an infection or a disease.

2. Disc conditions

Here the shock absorber pad between the vertebra bulges, or herniates (a bit like tooth paste being squeezed out of a tube) and touches the nerve route causing the pain the radiate, usually down your arm if your neck is the problem or your leg if the problem is in the lower back.

3. Mechanical conditions

These are by far the most common and are caused by one, or a combination, of three things:

- trauma

- repetitive strain

- over use syndrome

This is the typical type of pain that has made the chiropractic profession famous!

Countless studies support chiropractic as the modality of choice for the management of lower back problems, typically types 2 and 3 above.

Why not consult a chiropractor about your ailing back?

Every day I am confronted by patients that are submitting themselves to any one, or even all, of these things and so many  of them are in varying stages of dis-ease, disability and, if they continue on the same path, heading towards premature death.

I ended the last blog saying that being subjected to chronic on going stress (the first of the deadly sins) puts your body into a state of ‘defense physiology’ .

What does this actually mean? Well, firstly, remember that your body is actually one big chemistry set, actually a bio-chemistry set. Nothing happens inside your body that isn’t akin to an orchestra comprising 1 trillion instruments (all the cells in the body) playing the most complicated composition with out a single note being out of place or badly timed. The orchestra is conducted by a group of super highly intelligent conductors (endocrine glands) that know exactly what to do to have each and every instrument ‘come in’ with exactly the right note at exactly the right time.

Now when you experience on going stress all of the orchestra members (the cells) are expected to ‘up their game’, play harder and faster to ‘defend’ you against the continued bombardment by the things that are stressing you; this is what’s called ‘defense physiology’..

In the case of stress the lead conductor is a pair of glands that sit above your kidneys called the adrenal glands. They produce a range of different hormones whose job it is to assist you to manage the stress.There a number of these so called ‘stress hormones’, but one of the main ones that help you to physically cope with the stress is NORADRENALIN. 

…more on noradrenalin to follow…stay tuned and look out or my next post on this interesting topic.

If you have any questions or would like more personal information feel free to email me on klentin@iafrica.com

Happiness is

Yesterday I was sharing some thoughts on Facebook around factors that predispose us to disease, disability and early death.

Number one factor is stress. I was saying that there are 2 types of stress, acute stress i.e. usually an ‘emergency’ type of stress (an accident, a huge fright, a big dog chasing you etc.). Our bodies are actually quite well equipped to manage these types of stressor, through the flight or fight mechanisms, providing they aren’t on the extreme ranges.

The second type of stress is called chronic or on going stress. This is the continued bombardment by stressful stimuli, coming at us from all angles. Work related stress (deadlines, pressure, personality differences, boredom etc. etc.), relationship stress, financial stress, health stress, traffic stress, ‘home life’ stress – the list could probably go on and on. I often describe it to my patients as life.

This type of stress forces your body into a state called ‘defense physiology’…

to be continued…stay tuned for more fascinating information on the effects this state will have on you…physiologically

He talks about the fact that there are no coincidences in life. Everything happens for a reason and while the reason may not be completely obvious at the time, he recommends just being aware of the synchronicity. So, just be aware!

Then, while taking a sort ‘inspiration’ break from writing this blog I picked up my birthday present from dear friends, Dr Per Rehn and his gorgeous wife Susan. It’s a beautiful book titled A Passion for Wine and Surf by Linda Suhr, where Susan provided ALL the text for the book, and there I find this quote;

‘All new beginnings come from some other beginning’s end’
(Roman Philosopher, 1st Century A.D.)

and here the title I chose for this blog is New Beginnings!

As the New Year has just begun it got me to thinking about how I should approach my year from my blogging perspective…

That then got me to thinking about where my passion in life really lies and it was easy for me to realize that it’s with helping people create the kind of lifestyle, on whichever level, that they desire.

So this year I will share lots of information and suggestions around lifestyle. I will hopefully be able to impart the knowledge that so much of what we thought was impossible, out of our reach or beyond us, is actually so much closer at hand than we think.

Where then does one start on this journey?

Well, I think the very first place to start is by asking your self a question. What is it that I really want from, and for, MY life?

As I often say to patients, ‘If you don’t know where you are going, how do you ever expect to get there?’

It’s also vital that you know exactly what it is that you want for yourself first. This isn’t being selfish. This is because if you aren’t personally connected to where you are heading it’s not possible, I think anyway, to offer direction, assistance, support or guidance to anyone else. You wouldn’t be coming for an authentic place if you were trying to assist a family member, friend, colleague or any one else with their journey, if you were floundering yourself.

So, as a starting point, my humble suggestion would be that you take yourself off somewhere peaceful and quiet. Somewhere where you feel at peace, comfortable and relaxed and a place where you can access your deeper feelings.

Have a piece of paper with you to write down your responses and begin a dialogue with yourself. Ask yourself the following questions:

• What would make me the happiest person in the world this year? (answer this as if there were ABSOLUTELY no restrictions to this being a reality)
• What would be the one thing that would really inspire me and make me feel more worthy this year
• What is the one thing I could do to better the life, or lives of others this year

Answering these few simple questions, honestly, will, in most cases, offer you more direction than you have possibly ever had.

At this stage do not worry about the HOW part. Remember, Dr Wayne Dyer’s words, ‘There are absolutely no limits to what I can create with my intent’.

Nothing begins without the initial intention. But your intent has to be more than a just a cursory, um, maybe, sort of intent. It has to be the kind of intent that you are serious about, that means A LOT to you, a more than anything kind of intent.

If it isn’t this kind of intent I can assure you that your chances of succeeding in accomplishing your desires will be significantly, if not completely curtailed.

If the answers to the 3 questions don’t spontaneously pop up don’t quit. Stick with it. Pick up a book that you really enjoyed and that inspired you – is there perhaps a clue there? Think back, even years perhaps, to something you used to do that inspired you and provided a sense of fulfillment, joy and well-being – perhaps there’s the clue. Talk about it with a good friend, colleague or relation. Is there a time that they have witnessed you being more ‘alive, excited and motivated’- perhaps that’s the thing you need to explore more.

Before moving on to anything else – keep searching for the answers to these 3 questions…

For more help and direction feel free to contact me.