Sciatica: What You Need To Know
COMPLETE VIDEO TRANSCRIPT
In this video, Dr. Irvin Sahni discusses some of the causes and treatments for Sciatica. Spine Center of Texas has helped thousands of people get back to doing the things they love by eliminating the source of their pain. You don’t have to suffer sleepless nights or miss out on the things you love most in life. We have a wide variety of treatment options ranging from non-invasive to minimally invasive surgery. Call Spine Center of Texas today to start living pain-free.
Dr. Sahni: 00:01 All right, Lori, and I believe Alma both had a question regarding the SCIATICA. And so, uh, I spoke a little bit earlier about Kyphoplasty, which again is going to be our topic this Friday and wound or planning or talking about kyphoplasty. We covered this in a facebook live a few weeks ago. Turn off the, the back of the leg or the sign, the back of the leg or the leg, uh, that people associate with having a pinched nerve, Sciatica, it can be caused by mechanical compression or it can be caused by chemical irritation. So most people, when they think of Sciatica and they think of a pincher, they think of a herniated disc, big fat, herniated disc, putting pressure just like me putting a clothes pin on your nerve and squeezing it. And that certainly is how many, uh, cases of Sciatica or that is certainly the cause of many cases of SCIATICA.
Dr. Sahni: 01:03 But another possibility is chemical irritation or known as chemical. Radiculopathy. Radiculopathy means that a nerve is being irritated as in because the case with say Attica, and so you can have a tear in your desk. And we’ve talked about this, but I’ll, I’ll say it again, the center of your disk, which is called the nucleus pulposus it as opposed to the covering of your dear, surrounding your disk, which is called the annulus fibrosis, that center of your desk, that Jelly in the Jelly donut has chemicals in it called cytokines. Cytokines are very normal cytokines or something that naturally occurs in your body as part of your immune system. Saudi concert for instance, what causes fever, interleukin water aisle, one aisle to caused fever. And so, uh, and there’s lots of other cytokines that have other types of inflammatory jobs and your body, well, when those inflammatory mediators are cytokines, leak out of your desk and get on your nerve, they can cause the nerve to burn, if you will, to heavy chemical reticulopathy to be irritated, to be inflamed and sin, pain down your leg and costs I Attica.
Dr. Sahni: 02:14 So I think specifically what both Laurie and Alma we’re asking is, hey, you know, my, my husband, or maybe it was them as well, but I think they said their husbands, you know, would have this intermittent sciatic pain. And why is that? Why does pain sometimes come and go? Well, it certainly can be positional. You can be bending and twisting into a certain position that makes the room for your nerve or the space available for your nerve, minimize and compresses the nerve and causes that mechanical compression. You can also have flare ups because you just have a high level of inflammation in your body and your, those, those chemical mediators that can leak out of the disc through a tear in the annulus. Fibrosis it’s called an annular tear can cause irritation, kind of like pouring hydrochloric acid on your nerve. And as you move around you exercise, you go out of that position that mechanically compromises your nerve or you, uh, that inflammatory state becomes less heightened.
Dr. Sahni: 03:09 You drink some antioxidants, you exercise, you increase blood flow or whatever it takes to sort of wash away those irritative chemicals away from the site that’s causing the irritation. Or your body is just kind of going through a natural cycle of having pain and not having pain. Very common for people to quote-unquote throw their back out. I even throw my back out once a year and sometimes it’s just bending over to pick something up. Usually, I can look back as, yeah, I started lifted in a way that was not ergonomically correct or was not a good healthy weight. In other words, arch in the low back and lifting with your quads as opposed to bending over and putting all that stress, um, across the disc spaces in your back. So how you lift or how you maneuver certainly can have an effect on that pain, but it’s very common to have these intermittent flare-ups and generally speaking when someone just having occasional pain, then they can be treated conservatively.
Dr. Sahni: 04:01 It isn’t until that pain is constant, a severe and constant and basically is affecting your ability to function. Then we have to get more aggressive and start doing things like shots and in some cases surgery depending on exactly what the problem is. So again, by strengthening your core, by hydrating well, by stretching your hamstrings, I believe a couple of you think both your, both of your posts, you talked about how you’re told to stretch that stretching of the hamstrings. Stretch all of your muscles, you want it, your whole body, you to stretch all the time, especially before a workout and even if you don’t work out with weights or whatever. If you’re going to partake in a sporting activity, athletic activities should certainly stretch, but stretching is a very good way to help alleviate back, alleviate back pain, strengthening your core to to supply more, or to increase the musculature around your lumbar column so that more of the load is taken up by the muscles and not purely by the bones and the disks and the facets is also a very good idea. Hydration, I believe sauna therapy and there’s a nice one hour facebook live and sauna therapy that you can read that you can watch and you can read Dr Lawrence’s a Orange Wilson’s book on Sauna therapy. If you want to do that, find it on Amazon. A sauna therapy is a great way to detox. Increased blood flow to all areas of your body.
Dr. Sahni: 05:28 Eating foods that are anti-inflammatory, antioxidants, lots of fruits and vegetables. I think that’s a very good idea. Just basically wellness in general. Um, you know, spiritual wellness, relationship, wellness, getting good sleep, all those things are very important and can help with Sciatica and obviously if you’ve got a big bone spur or a disc herniation poking into your nerve and these things may not work. And it certainly, if you’ve gotten to the point where the pressure nerve is so severe that you started to lose strength like I see in today, I saw a patient with a neck problem and he’s actually got weakness in his arm and two different. Most of the groups got multiple levels that are affected. He’s got a nerve test that cooperates. This, an Mri that shows these got very severe compression, not unlike our patient that we talked about a couple of weeks ago on a Facebook live that I showed you the live cervical surgery that I did and he’s going to require pretty immediate surgery, possibly this Thursday, but if not for sure within the next week, it’s not rapidly progressing, but he’s got severe enough weakness that he needed to get to the, to the operating room, uh, sooner than later.
Dr. Sahni: 06:31 So doesn’t have a permanent deficit. And we have a better chance of getting a recovery in him. Um, so, so the treatment for Laura, and I’m a, I know I’m rambling, but the treatment is hopefully nonsurgical. It’s hopefully activity modification and wellness. If not, then we can give shots. Epidural steroid injections. I think one of you mentioned that in your posts as well. That’s very commonly used to take away the inflammation if we can’t get it to, if we can’t get the inflammation to improve naturally than we can get the inflammation to improve with pharmaceuticals. The good thing about epidurals as they don’t have systemic side effects or have very limited systemic side effects because we’re injecting it to a specific area where I giving you a pill or shot in the butt and circulating a steroids throughout your whole body. But just putting it around that nerve itself.
Dr. Sahni: 07:19 But again, even if I tell patients all the time when I give you an epidural steroid injection and I do a fair amount of those, I’m not giving you an immunization against pain. It’s not like I give you an epidural steroid injection and you never have pain again. It is to take the inflammation out of your nerve, break the pain cycle because there’s clear evidence that sometimes just by breaking the pain cycle, the pain will get better or go away. Sometimes that works, sometimes it doesn’t, but we’re giving you a period of theoretical decrease or even a period without pain altogether. That’s the time to swing into action, to exercise, to go walking, to do stretching, to get active and do the things you to strengthen your core. Do you think things you need to get the longterm effects?
Dr. Sahni: 08:01 The steroid injection is not fixing you long, long term. It’s the lifestyle changes, the exercise, the hydration, nutrition, all those things that I’ve previously talked about that really gives you that longterm relief and even if you need surgery, you still need to do those things. You’ve got lots of disks in your back. Just because one goes bad and we fix it doesn’t mean that there aren’t other discs in your back that can also go back and need fixing and the best thing you can do is to be well to engage in a wellness program. Includes exercise, hydration, rest, stretching, core strengthening and all those things. And so, uh, I wish I had a book in front of me to show you Laurie and Alma. Maybe I’ll do that. I’m a little bit later when I have an opportunity and show you some pictures of exactly what the structures are that I’m talking about right now, but when you talk about your loved one, your spouse having Sciatica, that’s the reason that they’re having.
Dr. Sahni: 08:51 And you know, not getting good night’s sleep can flared up, bending the wrong wakened, flared up, eating a lot of inflammatory foods or medications that cause inflammation, can flare it up. And on the converse, things that are anti inflammatory meditation, Sauna Therapy, uh, lots of fruits and vegetables and all those kinds of things can actually counteract that, that hyper inflammation, if you will, and reverse it, reduce it, and improve that paid traction. Traction actually takes importance of mechanical compression even when it’s a chemical radicular apathy. Traction allows better blood flow to urine. It can help wash away some of those irritative chemicals everyone’s familiar with. Um, lactic acid, you go to the gym, you workout hard, especially if I haven’t worked out in a while, you’re sore the next day. That’s not exactly a Saudi pine, but it’s sort of similar. You’re building up an inflammatory chemical and your muscle that causes you to be sore and cytokines can do the same thing.
Dr. Sahni: 09:43 Cytokines run earth can cause it to be inflamed and cause it to hurt and mimics sciatica or mimic a compressor. Everyone thinks of cytokines, a compressive radiculopathy, but having chemicals here to your nerve is just as much. Sciatica is having a mechanical compression. It’s just that you don’t see anything on MRI. So everyone’s like, oh, the MRI is normal. How come I have pain shooting down the back of my leg? Well, that’s because there’s chemicals leaking out of your disk, around your nerves you can’t see on Mri that are causing your pain. Doesn’t mean you don’t have pain. Analogy, I often use this, you know, if I got an MRI every time somebody had a headache, 99 percent of those Mris will be normal. Does that mean the patient doesn’t have a headache? Of course not, so don’t hang your hat too much on imaging studies like Mris, the decision or the diagnosis has to be made by looking at multiple things.
Dr. Sahni: 10:27 Most importantly, the history, the physical exam, honestly, and then things like x rays and were eyes. Nerve tests are all other pieces of the puzzle that helped kind of put the whole picture together and come up with a a useful and valid diagnosis. So I hope this is helpful. You’re question about SCIATICA. What is Sciatica? What caused this I attica? How can you make it better without the help of a doctor? How can you make it better with the help of a doctor but without surgery and then an extreme cases making a better with surgery, a surgical intervention anyway, if there’s any other. If I didn’t answer your specific question, Lauren, please post on the thread and I’ll try to specifically answer your question.
