Everything You Need to Know About Sciatica

00:44-01:41Last Week Tonight
01:54-06:21Low Back Alignment
06:23-09:47Sciatica Part 1
10:37-15:12Sciatica Part 2
15:13-17:54Chiropractic and Sciatica
18:01-22:18Health Does Not Mean No Pain
23:40-26:34Vitamin D with K2

Dr. Ben Boudreau: [00:00:07] Without further ado, welcome to Humpday Conversations number 14 with Dr. Clayton Roach and Dr. Ben Boudreaux from Roach Chiropractic Center in Bedford, Nova Scotia. Today’s topic is low back pain and sciatica.

Dr. Clayton Roach: [00:00:22] I like this. Now, as it was, I was lifting up my daughter’s school bag, I was like, oh my God, I got to listen to my own advice. So there’s a lot of books and I just want to. But holy geez. So last week I’ll talk about last week. We always do this. Just kind of summarize what we talked about last time. Topic was carpal tunnel, and we basically covered the areas of the hands, it could be affected by carpal tunnel, which areas of the neck were associated with those nerves that basically make up what’s called the median nerve and so basically cover the fact that it can get trapped at the neck area. But also, as it goes down the arm, there’s many areas where that nerve can get impinged that can create carpal tunnel like syndrome. But it doesn’t mean that it is actually is carpal tunnel where you actually have to go in and out of that surgery. We talked about the ligament that is getting cut and surgery is called the transverse ligament. And sometimes what happens when you cut that ligament, you’ll get scar tissue and that scar tissue over time grows to include that space. And now you have what I like to call post surgical carpal tunnel, because it was created by the scar tissue that was created by the surgery. So that was last week in a nutshell. And then we made a promise to kind of switch gears a little bit and go with the lower back sciatic conversation with tonight. So go ahead then.

Dr. Ben Boudreau: [00:01:53] Yeah. So the low back alignment is crucially important. So just like what we talked about, the alignment, that 40 to degree curve in the cervical spine, we talk about a 40 degree curve in the lumbar spine. And so, like it is in the cervical spine, if you have a Streetdance spinal segment, it can cause the IBS or the little holes on the lateral parts of the spine to actually enclose, and it can impinge upon the nerves that exit from there. But if we’re just looking at the alignment, we can see in the left photo, there’s a nice green line that depicts the perfect alignment of the lumbar spine. And so that is essentially a nice 40 degree curve and you can see how the disc spacing where those lumbar disc are situated are nice and regular and widens and there’s no degeneration. They’re not touching each other. It’s very good.

Dr. Clayton Roach: [00:02:55] Now is no different than when we looked at the neck, this is the exact same thing that we were talking about when we were looking at the neck, except it was 42 degrees, not 40. And we were still looking at the spacing between the vertebrae, making sure that the vertebrae were nice and square.

Dr. Ben Boudreau: [00:03:12] It looks great, and so when we look to the right, you can see that the green line is well where it’s supposed to be and the red line is where it’s not. And so that’s where they’re situated. And these individuals and essentially the curve is hypos or DODIG. And so what that means is it’s flattened out.

Dr. Clayton Roach: [00:03:31] Yeah, so the lord daughter curve in the lower back is the same curve that is in the neck, so Lord Doneck means the curve is going towards the spine. Intifada means going away in the back, so the middle back where people are hunched over, that’s the California curve and the lower curve goes inwards in the neck and in the lower back curve.

Dr. Ben Boudreau: [00:04:00] And you can see just there, because as we’re getting that flattening those right photos there, you can see that those that those disks and those actual vertebrae are pretty osteoporotic as well. They have some degenerative signs on them where there’s actually flattening at the top of the plates of those vertebrates and they look fairly irregular. They’re not assuming the nice square pattern that they normally would. In fact, they’re welcoming degeneration. And you can see the degeneration as you look posteriorly to the actual vertebrae itself or there’s white. And that’s a sign of, well, osteoarthritis, and that’s how it’s shown on X-rays, they come out as a little more radio, opaque, as we would call it, and that’s a sign there of osteoarthritis and degenerative changes in the spine.

Dr. Clayton Roach: [00:04:57] So if you can look at this x ray over here, you’ll see that the vertebrae are somewhat white compared to the space here, which is always going to show up black. So this is somewhat white as opposed to black here. If you look at the space here, it’s almost the same color as the vertebra. So you can see that there’s not a lot of density in the vertebra. And you can see on the top part where the vertebrae are starting to compress. And flat, no, and it’s got what’s called lipping. Right. So that is not a great thing, and that’s something that you start to see, like you said, been with osteoarthritis and you start to see occlusion of the spaces over here and you can see there’s not a whole lot of room for that nerve right there.

Dr. Ben Boudreau: [00:05:48] And so what we’re trying to get out here with this is the abnormal position of your lower back puts increased pressure on your spinal disc muscles. And, of course, the nerves that exit from those folds, those canals like Dr. Roache just circled there. And the research has shown that abnormal Lobach curve positions are associated with early arthritis and disc disease. And so that’s quite sad. I made a little little joke there, spinal arthritis and this disease said.

Dr. Clayton Roach: [00:06:22] So here you can see that the sciatic nerve is made up of different routes. OK, so here you can see L4, L5, S1 as two, S3 three. They convalesced together and come down all the way down to the leg, and at one point they split apart. But as you can tell, they have to go through certain muscles, no different than the median nerve going down the hand that had to go through some of the muscles. So a lot of times people will throw the word out, oh, I have sciatica and doctors will throw it out. But it’s kind of like a blanket statement. You know, if you have pain going down your leg and it’s in the back of the leg. Yeah, it’s probably called sciatica. You’re not a medical doctor, but you know that that’s called sciatica. The key to sciatica is understanding which nerve root is actually involved. Is it L4? Is it all is it s one? Is it a combination of some of those right then?

Dr. Ben Boudreau: [00:07:24] Yeah, exactly. Is it a combination of of those nerves and and being able to decipher which level is involved is the true art. And so you have to be able to know, OK, is directly coming from the misalignment in the spine or are we finding impingement somewhere further down? Is the nerve getting trapped? Like Dr Roach said, there are areas where this nerve can get trapped, namely at the top there. There’s an entrapment site under the pure form as muscle. Many people would come in and say, Oh, I have a cure for this syndrome or you can have an entrapment in the actual hamstring muscle, namely the long head of the biceps there. Yeah. And that’s why a lot of times sciatica will be at its worst in the buttock area, because that’s where the nerve is starting to go through some of these structures, and that’s where typically inflammation is going to live in this area over here. So many nerve root involvements make this a very tricky sort of diagnosis and something that’s a little bit difficult to manage, which is why a lot of people tend to have it, because all of those on average become that one big sciatic nerve. And so whenever I hear someone that comes in and they say, I have sciatica, it’s sort of a loaded term and we want to be able to get down to the bottom, yes, your sciatic nerve might be inflamed, but it’s not all of those nerve roots that are involved and are specific ways to work on that, which is what we do in the office. Yeah, let me just say this, that.

Dr. Clayton Roach: [00:08:56] You getting better and not having leg pain anymore? Is totally dependent on somebody being able to localize with each one of these segments, it is L4, L5, S1 as two as three. And where is the nerve actually being in Tropp? Is it of the spine or because otherwise you are not going to get better because you haven’t identified the exact area of where that nerve is being pinched. So in other words, if this is a big hole, where is the pressure on the holes? And I hate to use that analogy because it’s not really what happens, but it’s the simplest way of of basically explaining it in terms of where which wire is being irritated. So the glitch might be over here and people see how bad the pain is below my leg. And I get it. But it’s coming here. It’s coming from here. No pun intended. I use the word. But.

Dr. Ben Boudreau: [00:09:47] All right. I have another just one last tidbit about sciatic nerve pain as well, is that a lot of people come into our office and their only symptom is leg pain. And so then what will happen is we’ll start looking at the spine and people will be like, well, why are you treating my back like Dr. Roache just alluded to when all of my pain is in my leg? Well, you know, eighty five to 90 percent of sciatic nerve pain that comes in has no symptomatology in the actual back. But when we start treating the back, the symptoms go away. Yeah, really cool. Give you guys something to take away for a few minutes. That happens a lot when somebody comes in with a. You actually have a lower back issue, and that’s always the argument, I have no lower back pain, I understand, but that’s where it’s coming from. So the next slide that we got going up here is the exam. So what we’re actually looking for when we’re doing the physical exam on you guys and what kind of things we’re doing to ensure that we’re finding the correct structures and that we’re making the correct diagnosis. So after this, like people should be able to you should be able to check your spouse.

Dr. Clayton Roach: [00:10:56] Right. Or your love.

Dr. Ben Boudreau: [00:10:58] Just get it. Yeah. So like we’re alluding to there in the title, we look at motor and sensation, and that’s not the only thing. Those are just the two things that I wanted to include on the slide there. But if we look at the left picture, we can see the cutaneous or the skin innovation of the sciatic nerve. So because it’s made up of so many nerve roots, it can cover a large area of the leg. So the green on the leg there to the left is the entire distribution that the sciatic nerve would cover in the skin, that it innovates. And so people will oftentimes come in and they say, you know, I’ve got sharp shooting pain or numbness down the back of my leg and into my foot. And so that’s that distribution. And that’s why you’re coming in with that pain. So when we know, like we know that people have a side nerve irritation, a segment and innovative by that when they describe that pain. So, guys, if you’re coming in and you’ve got pain on the front part of your thigh, it cannot be sciatica because the sciatic nerve, none of the routes that we were looking at before, none of them go to the front part of the thigh. So it cannot be sciatica. So we can start to run different diagnoses by virtue of where the pain is, because we can always trace it back to the nerve that’s in that area. Right. So when you take a look at the operating nerve that’s actually just on the inside of the thigh here, it’s a very small patch.

Dr. Ben Boudreau: [00:12:33] So when people look at that and say this is where the problem is, then right away light bulb goes on in our head saying. That’s the operating room, well, where does that nerve go then we trace it back to the spine. We’re talking about tonight with the go ahead. Yeah, and so just like we’re doing it for the median nerve, we’re always looking at the entrapment sites and where it could be entrapped in the spine or in the lower back. So we’re always trying to cross correlate. So we’re cross correlating the distribution of pain, the cutaneous innovation to the skin with the motor or the muscle strength also involved. And so if we have a distribution of pain that’s going down the leg, we want to be able to check the motor to see if it’s associated with a certain spinal level. So, for instance, if the S one nerve was involved, we will see a lack of sensation under the foot, just under the foot, because that’s where as one is distributed to. And then we would see a lack of strength when the individual tries to tilt and lift their ankle outwards like this, and then we try to resist and push it in. So that’s the S1 muscles there, all the fibulas group on the outside of your leg. And so we try to cross correlate between the two and determine what’s going on. Now, the last thing that I didn’t mention is reflexes. And so we’ll also check reflexes to see if they’re diminished again, to find the exact area involved.

Dr. Ben Boudreau: [00:14:08] Yeah. And for us as chiropractors, I mean, as a medical doctor, it doesn’t really matter, because if you’re just giving a pain reliever antiinflammatory, it doesn’t really matter if it’s coming from four or five. This one is two or three. But for us as chiropractors, we want to mobilize and give an adjustment to the exact area for Elfy. That’s one in this matter. Which one is? We need to figure out which one it is so that we can deliver the exact adjustment to the exact joint that’s creating that irritation in that area. And like you said, we can trace it back if it’s the bottom of the foot. Chances are likely it’s coming from this one. So correlating the sensation, correlating the weakness in the muscle that’s associated with Edner, totally important. Yeah. And so then we like to look at the presentation of the individual as well. Some people will come in with a drop foot. And so what that means is that the five nerve is involved. The person can’t keep their foot up like this when they walk and so it drops. And so that area gives us a key indication that L5 is involved. To the research, so chiropractic care versus sciatica, chiropractic care on sciatica. So what they found is that people who had sciatica pain and low back pain. We’re being treated by a chiropractor and then we’re also being given sham manipulations and so false adjustments excuse me, so the individuals who are receiving the chiropractic adjustments saw a reduction in local and radiating acute low back pain.

Dr. Ben Boudreau: [00:15:41] So what that means is that they saw a reduction in that low back pain as well as that leg pain, that sciatic nerve pain. And this was judged by a pain scale, which is our VA VA as one and Vaska. They had fewer days with moderate to severe pain. And so they were actually also seeing less days with pain and they consume fewer pain medications compared to the control group. And so those that were receiving the sham adjustments, who weren’t receiving anything at all, had to take still need to take their Tylenol and their painkillers to get rid of that lobach. And whereas those who were being treated by a chiropractor didn’t need them anymore. Chiropractic care for back pain is tied to lower odds of opioid use in general, and so if you’re seeing a chiropractor, you’re sixty four percent less likely to use opioids under the chiropractic management, which is huge for people who have a huge list of medications that are trying to manage other things. Because when you’re trying to cross correlate an opioid with, say, another type of of of drugs, something for, let’s say, depression or heart disease. Yeah. You don’t want to have that that potion mixture as well. Chiropractic demonstrated a clear superiority over NSAIDs like antiinflammatory drugs for back pain relief. And so this is another idea that people should be thinking about. If you’re looking to wean off some of your some of your medications for back pain.

Dr. Clayton Roach: [00:17:09] Yeah. And I mean, I always joke

Dr. Ben Boudreau: [00:17:11] Around that if you have to buy your ibuprofen or your Tylenol at Costco because you’re getting a good deal, there’s probably an underlying issue as to why you need to buy that much and have to have a good deal, because it’s costing you a lot of money to take all that. So a lot of these are not going to deliver. A lot of them are not good on the kidneys. So sometimes we take it for granted as chiropractors

Dr. Clayton Roach: [00:17:36] For cases like the back pain and sciatica, because we just see so many of them. But this is such a prevalent issue. And I can tell you enough, like in how long I’ve been doing this, the amount of people that pop pills like candy to try to rid themselves of this condition that we’re talking about tonight. So, guys, if you could do us a favor, just make sure you share these episodes, specifically this one, because we’re getting into a very common condition that seen worldwide and definitely guarantee it that there’s somebody in your circle on Facebook that is suffering from this as we speak that should be listening to this and getting some more answers.

Dr. Ben Boudreau: [00:18:22] And you’ll read places that sciatic nerve pain is a self revolving, self resolving issue. Like I was I was researching on this topic over the last few days and over the last week, actually, since we announced it. And I was I was so surprised that the amount of sites that I went on to that said that sciatica is a self resolving issue, which means that it’s an issue that goes away on its own. I mean, I don’t know any single nerve related issue that just goes away on its own over time. Let’s talk about let’s talk about that, because that’s that’s a very good point that you bring forward, because when we say a self resolving issue, we’re going by the philosophy that

Dr. Clayton Roach: [00:19:09] Having no pain

Dr. Ben Boudreau: [00:19:11] Means health and that function has been restored.

Dr. Clayton Roach: [00:19:15] However, you can take enough pills to make the pain go away and zero function has been restored, so, yes, sometimes you can have a sciatic nerve irritation that will be dampened over time. And sometimes people get numb to the pain, kind of the smell that you walk into a room and eventually don’t smell anymore, or sometimes maybe the pain goes away. But what happens? You still don’t have a curve in your back. You still have a 20 degree curve versus a 40 degree curve, and you’re still bending and lifting and sitting. And over time, what happens, the spacing gets occluded. The whole where the nerve comes from gets occluded, the spacing gets less. And now, 15 years later, you get a reoccurrence of that pain. But now with a more destructive spine, because it’s over the years, deteriorated more and more. And they show up in our office and I’m saying, well, you had an episode 15 years ago and they’re like 15 years ago, it’s not related. Of course it’s related because the structure never got restored, but because the pain went away. It’s so-called resolved itself. Everybody thinks the problem is gone. Right. And now it shows up at an inconvenient time where you’ve got things to do. When you’ve got a job or promotion, you just talk and you got kids to take care of and now you’re incapacitated. You can’t get out of bed because the pain’s going down your leg. And what do people do? They make the stupid decision of having surgery where they actually take the disco and the fuse two segments together by doing a laminectomy and a fusion.

Dr. Clayton Roach: [00:20:55] And now you’re getting no movement in one area and a bunch of movement elsewhere that down the road ends up failing again. And now you’re in this circle that’s going nowhere. Right. So self resolving probably means no pain, which means absolutely nothing. It doesn’t speak to the condition of the spine. And then there was a question like, is it normal to have flare ups with sciatica and relapses? Well, if the condition is not being treated properly, right. Because we’re constantly under a state of stress with gravitational force of the year, we sit and we’ve been and we lift kids and we do whatever we do. Then at one point, the tank is full again and then the next drop of water is going to cause a spill over. And that’s the relapse and that’s the the condition showing up again. So, yeah, it is common to have a relapse. So I always say, you know, if if there’s already destruction of the spine and the spacing is bad, then we have to manage that situation because we’re never going to be able to fix it 100 percent because we can’t undo the damage. But on a clear spine, if it’s treated properly and the condition, the function we get restored, then there shouldn’t be relapses. So it depends on the condition of the spine at that point.

Dr. Ben Boudreau: [00:22:19] Yeah, it’s always better to have a spine doctor looking at your back than being able to charge over time and be able to analyze it and know if the pain that you’re experiencing is the usual, usual flare up or if it’s different than the normal flare up. Right. So then we know how to properly navigate the course of action with care.

Dr. Clayton Roach: [00:22:40] Absolutely. I just want to say one more thing, too, is the sciatic nerve travels with the femoral artery, which is the biggest artery in in the body, which also travels just coincidentally, with the biggest nerve in the body. So when there’s pressure on the sciatic nerve, guess what’s there? There’s pressure on as well as the femoral artery. So now you’ve got pressure in the system which could actually show up as high blood pressure. Right. And people don’t think about that. So now you’re being given a high blood pressure medication for a condition that actually started in your lower back. So sometimes we’ve got to say, OK, well, why am I taking this for? And always then you ask the question, why? Right. So, guys, again, you know, give us a little bit of thumbs up if you’ve enjoyed this information, if you already know all of this and don’t give us a thumbs up and then we’ll know that we got to up the ante a little bit in terms of how much in depth we go. But I think this was great information. Next up is our vitamin of the month.

Dr. Ben Boudreau: [00:23:39] Yeah, yeah. We got our vitamin D with K2 this month. And I mean, the benefits of vitamin D go far beyond just the fact that you can get it from the sun itself. But actually, a lot of our population is vitamin D deficient and it’s critical for our health for healthy immune system function. And so immune cells have vitamin D receptors and they act like little antennas and they activate the immune system to elicit an antiviral response. So and at the same time, it also increases our killer T cells, which are essentially essentially like the Navy SEALs of the immune system. And so if you’re easily, easily or easily get a cold, you’re likely vitamin D deficient and you should probably be be supplementing with that as a natural supplement. It regulates the absorption of calcium. And so for those people that are like it helps, like the more vitamin D that you have helps with the absorption of calcium, like they travel together and it helps to get into the bone. And so a lot of people who are osteoporotic are are low in vitamin D because they don’t have that calcium there. It also reduces the risk of heart disease, to name another thing, and it reduces the symptoms associated with depression, fibromyalgia and anxiety. And so they find that a lot of people who suffer those types of conditions are actually vitamin D deficient. So one thing I want to mention about this product that actually has to talk to is a substance in what’s called fermented vegetables. When they found out that key to actually allows the absorption

Dr. Clayton Roach: [00:25:14] Of vitamin D three. So, guys, when you live in a climate where it is cloudy, snowy for nine out of the 12 months, everybody should be taking vitamin D like this is no joke. And typically in the winter, I have patients taking like four to five thousand I use. And in the summer they drop down to a thousand. Two thousand I use. So it’s something that is super important. We love this liquid because basically just one drop as a thousand I use versus taking a pill. So if you have to take five thousand, I use it’s five pills because most pills are a thousand. But here each drop is is a thousand. So, you know, this is very cost effective because you’re just getting I think we counted the other day. We did the math was one.

Dr. Ben Boudreau: [00:26:05] It’s five hundred and ninety drops per bottle. Yeah. So it’s crazy compared to, you know, a bottle of capsules.

Dr. Clayton Roach: [00:26:15] So obviously you can get it from natural sources as well. Salmon, sardines, Ezekial, shrimp, yogurt, orange juice. Again, you know, just another tidbit of stuff that you can do, especially in a time where the immune system is so important with everything that we’re going through. So vitamin D becomes one thing that you can definitely do to help with everything. So that is it for now. So, guys, here’s what we want you to do right now. Make sure that you hit the share button, get this information out there. Let’s help people together. And if you guys want to hop on our on our vision of help in our community and increasing the health in our communities, wherever you are, then please hop on board. And the only thing you need to do is make sure that you share this video. If you’re watching it tomorrow on YouTube, make sure you subscribe to our YouTube channel and make sure you hit up the, you know, the the the like button in the heart button, because I see Facebook likes that and actually gets our our video to a lot more people. So thank you for that and everything that you’ve done so far. What’s up? Listen, if you like this episode, you’ll probably like the other ones. Channels are pretty good. So here’s what you need to do. You need to like us and follow us on Facebook. Following means you get notified when these two guys are alive. Next, family, friends, you need to share these episodes because you never know. You might help them because they need this information as well. And guys, if you’re ever missing a. So make sure you subscribe to us on YouTube. That way you can watch

Dr. Ben Boudreau: [00:27:43] The episode over and over and

Dr. Clayton Roach: [00:27:44] Over again. Guys, we love you and appreciate you. Take care.