Sciatica

Sciatica is a common term that many people have heard. Low back and leg pain? Oh yeah, that’s just sciatica. Discomfort after driving for a long time? Oh that’s that sciatica acting up again. Sciatica has turned into a catch all phrase that’s casually thrown around. But what exactly is sciatica? What causes that irritating pain?

Definition and Causes of Sciatica

Sciatica is simply pain and tenderness at some point(s) along the sciatic nerve. Check out the image below of the sciatic nerve. (This anatomy picture is looking at the back side of a right leg. The sciatic nerve is shown coming out from under the piriformis muscle down to the back part of the knee.) 

There is a lot going on around the sciatic nerve. The pain can be caused by irritation of any part of the nerve.

Below is a picture of a healthy spine and nerve roots leaving your spinal cord. You can have irritation of the sciatic nerve starting here! The sciatic nerve is made up of nerve branches from the spinal cord from the L4 level to the S3 level. If any of the discs in this area bulge or herniate (where the inside material of the disc is pushed outwards), they can irritate the nerves exiting the spinal cord. If you have degenerative joint disease (DJD), the amount of space for the exiting nerve (aka the foramen for spinal nerve) decreases in size. The smaller space for the nerves to exit the spinal cord can lead to increases in nerve iritation.  

The pain can also be caused from irritation of the nerve as it travels through/in/around any of the muscles. A common site of irritation can be from the piriformis muscle. In most people the muscle passes underneath the muscle (as seen in the first anatomy pic), but in some people, the nerve travels through or around the muscle. The piriformis muscle is important muscle used in walking and stabilizing the hips and pelvis. If the piriformis muscle gets tight, it can lead to irritation of the sciatic nerve.  The nerve also travels along the hamstrings (which are actually 3 muscles--semimembranosus, semitendinosus, and biceps femoris). Strain on these muscles can also cause sciatic symptoms. 

Signs and Symptoms

Sciatica presents with increased pain and or paresthesia along the back part of the leg to the knee or even all the way down into your foot. This can lead to an altered walking pattern, which can cause even MORE pain. Pain can increase while bending forward like if you were going to touch your toes/tie your shoes/etc. Patients with sciatica can also notice pain in the back of the knee or in the gluteal area, especially when palpated. 

Chiropractic Approach

First off, a chiropractic exam is performed to determine the cause of the sciatica. A series of orthopedic tests, neurological tests, and palpation of the muscles and joints give us a good understanding of what is causing your pain. Through this exam, we can usually identify what the cause(s) of the pain are. The cause of the sciatica dictates the treatment. 

If there is disc irritation from DJD, the patient is usually treated with flexion and distraction. If there is muscle inflammation or strain causing the problem, we will perform muscle release techniques, electrical stimulation, or various other modalities to help relieve the inflammation, relax the muscles, and take pressure off of the nerve. Some patients may have multiple causes contributing to their sciatica, so we treat all the causes. We are also a big fan of home stretches to help eliminate future flair ups. After your first treatment, we will go through those exercises and make sure that you are comfortable with your home care stretches. 

There is no need to live with insistent, irritating low back and leg pain. Call us today! 

Foot Drills

Have you ever suffered from shin splints? Achilles tendinitis? Plantar fasciitis? Ankle sprain? Knee problems? Foot drills are simple, easy, and a free way to combat these issues - if done daily.

The foot does a lot of work for the body. Tremendous stresses are placed on the foot. When running, the foot sustains forces up to 7x your body weight. With jumping activities the forces get up to 20x your body weight. If you think about how you can take ~1750 steps when running a mile, that 7x your body weight really adds up quickly! 

The foot drills work by developing a clearer neurological pathway from the foot to the brain. When you practice activities, they become easier. The foot drills challenge your balance and proprioception (awareness). Usually the balance and muscle awareness we have come from input from our muscles. Our feet don't have many muscles in them, and so it is harder to develop this pathway to the brain. Also our feet are about as far from our brain as you can get, therefore the neurological pathway is the longest. This is why you need to do the drills DAILY! The more you do them, the better the neurological connection between your feet and your brain. Developing a better brain-foot connection leads to a more steady and surer gait. When your foot strikes the ground, your brain is aware of the process, it controls your foot, and you have a stable landing.

There are a total of 6 foot drills. Each drill should be done over ~25 meters. You can do the drills at your own pace. To do all 6 drills, it takes about 4 minutes. 

1. Inversion - walk forward only putting weight on the outside parts of your feet

2. Eversion - walk forward only putting weight on the inside parts of your feet

3. Toe-in - walk forward with your toes pointing inwards (some people call this pigeon toed)

4. Toe-out - walk forward with your toes pointed outwards

5. Toe walk - walk BACKWARDS on your toes

6. Heel walk - walk forward on only the heels of your feet
    (you can wear shoes to protect against bruising the heel)

Those aren't so bad are they? Pretty simple. You can do them in the office (like Dr. Emily did for the photos here) or right before your daily exercise. The idea behind these foot drills came from Dr. Russ Ebbets. He is a chiropractor with an extensive background with USA Track and Field. He started implementing these drills in his athletes in 1987, and found that if done once daily, his athletes stayed healthy and were able to perform better. 

Golfer and Tennis Elbow

This week's blog post is brought to you by Dr. Keven Hagen. Dr. Keven is a sports chiropractor practicing in Rochester, NY. To learn more about his practice, check out his website. 

Elbow pain is all to common for most competitors. The feared golfers elbow, or the irritating tennis elbow tend to show up in all sports, not just golf and tennis. The elbow is commonly injured by repetitive movement or prolonged positioning, rather than a traumatic event. Most people think it will never happen to them, but if it does it can be very debilitating.

EPICONDYLITIS

The translation of epicondylitis is “inflammation of the epicondyle,” which translates to inflammation of the elbow tendons. There are medial (inside) and lateral (outside) tendons in the elbow that can become inflamed fairly easily.  The medial are generally called golfers elbow and the lateral are generally called tennis elbow, even though some literature has the opposite. Golfers are prone to tennis elbow, and tennis players are prone to golfers elbow. It just happens to be more prevalent within the sport. Repetitive overuse such as typing on a computer, manual labor, gardening, golf, tennis or any activity that requires repetitive hand and wrist movement can cause epicondylitis.

SYMPTOMS AND CAUSES

Lateral epicondylitis (tennis elbow) can be described as an ache which gets more severe with activities involving an open hand or extending your wrist. Medial epicondylitis, (golfers elbow) is generally described as an ache and gets more severe with activities that require a fist to be made.

Both are generally sore to the touch and can progress to a deep stiffness. It is not uncommon for grip strength to be decreased if left untreated.

CHIROPRACTIC APPROACH

By performing muscle release techniques, electrical stimulation, or various other modalities, we are able to have the inflammation relax, restoring normal function. We will provide you with home stretches to help eliminate future flair ups.

There is no need to live with insistent, irritating elbow pain. Call us today! 

Summer Vacation Back Pain

It's summertime!! The official start to summer is June 20 at 9:24 PM (that's the time of the summer solstice). Summer is often filled with fun trips and vacations, but we want to make sure that your trips and vacations aren't ruined or subdued due to back aches and pains. Whether you're traveling by planes, trains, or automobiles, we've got tips for you! 

Rule #1 - Hydrate!
Often times when traveling, we get out of our daily schedule and routine. We can easily forget to stay hydrated and drink lots of water. Or we can intentionally not drink water to avoid rest stops on the highway. Dehydration can cause back pain. This is because the discs in your back have a high water concentration. When you dehydrate your self, they shrink, and this can put more stress on your spine. 

Rule #2 - Don't Sit Still
Since you are going to be super hydrated and stopping more frequently for bathroom breaks, this will be easy. Our bodies love movement. Getting out of your seat and moving around can help prevent aches and pains associated with travel. It also stimulates blood flow around your body. This means your brain can stay sharp and functioning well if you are driving and navigating. It means that your muscles will get fresh supplies of nutrients. It will also help drive the lubrication of your joints with synovial fluid (the fluid that keeps your joints moving like a well oiled machine). You can also do some stretches while traveling! Check out our previous post on good posture stretches! They're great for in the car, too.

Rule #3 - Support your back
Most airplane and train seats aren't designed with spinal alignment in mind. Some cars boast having comfortable seats for long drives, but they still may not offer the support that you need. Whenever going on trips, I like to have a lumbar roll for support. There are tons of options out there, but you can also craft your own. I find that towels can easily be rolled up to make your own lumbar roll. Place the lumbar roll where your low back hits on your seat. This supports your low back, and enables you to sit with good posture while traveling. 

Rule #4 - If you're going to sleep, sleep supported
If you are planning on sleeping on a plane, train, or as a passenger in a car, make sure you are supported. Drifting off to sleep and just letting your head flop whatever direction gravity takes it, can leave you waking up with a stiff and painful neck. The number of travel pillow options these days is absurd but awesome! This website has a whole list of the best travel pillows for every scenario. Personally, I'm a fan of the animal pillow although I'm not sure if they come in adult size (which is a shame). 

Got travel plans for summer? Stop in to get adjusted and learn how to make the most of your trip. 

Chiropractic and Scoliosis

What is scoliosis? Should you be concerned? Can chiropractic help? Should I get a brace? Do I need surgery?

I remember being in middle school getting screened for scoliosis every year in gym class. At the time, I don't think I even knew what scoliosis was. I just knew that once a year, I'd go to gym class, and they'd look at my back, have me bend forward, then look at my back again. June is National Scoliosis Awareness Month, so this week we'll be diving in to scoliosis. 

The simplest definition is that scoliosis is an abnormal curvature of the spine. Your spine is supposed to have curves when you look at it from the side but not from the front/back. Scoliosis is when you have curves that go to the side. 

 The curves you can see in the normal spine help with the natural physics and structure of the spine. In Scoliosis, you get an S or C shaped spine. In 80-85% of all cases the cause of scoliosis is unknown (aka idiopathic in science talk). 

The severity of scoliosis is determined by how big the abnormal curvatures are. The bigger the curve(s) the more drastic the side effects. Doctors will use radiographic imaging (x-rays) to measure the size of the curve. The standard measurement for scoliosis is the Cobb Angle. Using the Cobb Angle, scoliosis is defined by a curve of 10° or more. Using the imaging, the cases are defined as mild (10°-25°), moderate (26°-40°), or severe (>40°). 

When it comes to treating scoliosis, chiropractic care makes sense! Chiropractors are neuromusculoskeletal doctors. We work with keeping the body aligned. Since most cases of scoliosis have unknown causes, it can be tricky to treat them. What chiropractic can do is work with the musculature around the area of the curve. We can work on tight muscles which may be contributing to or a result of the abnormal curve. We can work on maintaining joint movement in the spine. We can also provide exercises to help strengthen the posture muscles and stabilize your body. 

The goal when it comes to patients with scoliosis it to catch it early. If you can catch it early and use chiropractic care to manage your scoliosis, you may be able to help stop the progression and even correct the curve. A study published earlier this year showed that 90% of patients that participated in a chiropractic rehabilitation treatment for idiopathic adolescent scoliosis had curve correction or stabilization. 

If the curve keeps progressing, and it gets to the moderate or severe stages, bracing becomes more pressing treatment option. If chiropractic care and bracing aren't helping, a surgical consult may be the next step. 

If you have questions, feel free to reach out to us at Select Chiropractic and Wellness.