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DR. JAY LIPOFF: Sciatica, A Real Pain in the Aspect of Your Bottom
By Dr. Jay Lipoff
"I know God will not give me anything I can't handle.
I just wish that He didn't trust me so much." - Mother TeresaSCIATICA – A Real Pain in the Aspect of Your Bottom
Sciatica is when the nerve roots exiting the spine are compromised and cause pain down one or both legs. This is also known as a radiculopathy. The sciatic nerve is made up of two lumbar nerves and three nerves from the triangular-shaped sacrum, which is below the lumbar spine, all at your waist. As they combine, they become the largest nerve in the body and travel down both legs, also referred to as, the lower extremities.
So the nerves supply the necessary information to your legs so you can go about your daily life. When the slightest pressure disrupts the sciatic nerve it can cause an increase or decrease in information relayed to your body. You might feel less on one side, have weakness in some of the muscles or have a change in your reflexes. In an effort to reduce the pressure on the nerves, a person will lean away from the side of pain, known as antalgia.
When there is a lot of pressure against the spinal cord and its lower portion, you could lose control of your bowel and bladder. This is called Cauda Equina Syndrome and usually requires a surgical repair.
Sciatic pain does not have to involve a disc injury. Degenerative changes, arthritic changes to the spine, pregnancy, weight, posture, alignment and even tight muscles can also contribute to cause it. I am going to discuss two lesser known causes but these are just as guilty.
A common muscle that can irritate the sciatic nerve is called the Piriformis muscle, which is located diagonally in the buttock. It is connected to the outer hip and the sacrum. The sciatic nerve can run above, through or below the muscle. If this muscle becomes enlarged, tight or inflamed, it can press on the nerve.
Women may experience sciatic pain and piriformis syndrome when they get pregnant. From my experience and understanding of the human body’s biomechanics, I feel that the pressure from inside the womb is not the only reason this occurs.
As women reach later trimesters they gain weight. Sometimes it is a little and sometimes a lot. As the inner thigh becomes thicker women lose the ability for their normal walking pattern and swing of their legs, because one thigh touches the other thigh. They are forced to externally rotate the legs and swing them outward when walking to make an adjustment for this change. This is affectionately referred to as waddling.
This motion can contract the piriformis muscle and irritate it or make it bigger. When this happens there is a good chance the sciatic nerve can be pinched.
I’ve seen many patients with this condition in my office over the years. Darn kids.
SHORT LEG SYNDROME
Sometimes the sacrum is tipped and causes the spine to curve sideways, much like a house with a crooked foundation. If it has a slope, then when you build the next floor, it too will tilt.
Many cases of Scoliosis and Low Back Pain have a short leg syndrome associated with them, in which both legs are not the same height. Sometimes the upper leg bone, the femur, may be shorter or the lower bone, the tibia, may be the problem. This is as common as people not having the same size feet. It’s true. None of us are perfect. Sorry to be the bearer of bad news.
Many patients wonder why they have problems with short leg syndrome now if they’ve had this condition their entire lives. Well I could lift a 25-pound can every day with my left hand and a 50-pound can with my right without a problem. If I had to do it for years it would become cumbersome and eventually wear the right side down. The same thing happens when your body carries your bodyweight unevenly. It will support you for awhile but eventually the body will get tired and cause symptoms.
If you look in the mirror you may notice one side of your pants is higher than the other with one pant leg hanging longer on one foot. You might even notice uneven wear of the heels of your shoes. For example, try poking your side above the waist with your thumbs and slide down until you feel a bone. That is the iliac crest. If you keep your fingers there and look into the mirror, does one finger appear higher?
To visualize the movement, take your left hand’s pointer finger and the middle finger, and try to press down on just the tips of those fingers like the fingers walking for the yellow pages ad. You will notice the easiest way to do this is to bend your middle finger.
A classic sign of this is when you stand. Do you feel stable? Is it more natural to stick one leg out? That is because it would be uncomfortable to stand on the longer leg, or middle finger. The shorter one would be floating.
Using your left hand, try to move the fingers and simulate walking. You will notice when the middle finger tip is making contact, the pointer finger is up in the air and moves freely. When you place the pointer finger down, the middle finger hits the surface before it can swing unless you tip your hand to the short side and swing the middle finger outward.
In relation to your anatomy, when you stand on the long leg, the short one can swing fine as you take a step. As you drop to the lower side, the longer leg will hit the ground and start to wear the heel down. You then compensate by externally rotating your hip, or toeing outward, to create more room for the long leg while tipping more of your weight onto the shorter side. This overworks the piriformis muscle.
The other problem with having a short leg means that one side of your body is carrying more weight than the other. So in addition to having the lumbar spine curve toward the low side, your unequal distribution of weight causes uneven wear on the hips. This will result in increased whitening on x-ray or calcium being deposited to strengthen that area due to increased stress.
One hip socket will have a joint space that degenerates and becomes smaller due to the stress over the years. Sometimes patients will note a clumsy feeling when they walk or that they constantly catch one of their heels on the ground as though they are stumbling.
A functional short leg is when the legs appear shorter due to ankle pronation, flat feet, a tipped and rotated pelvis or a difference in knee angle when compared to the other side.
Anatomical short leg could be due to a healed fracture, joint replacement, misalignment, tight muscles or from normal development. Whatever the source, correction is needed before the curve develops or becomes irreversible and leads to more serious problems.
A common way to evaluate this is to lie on your back, bend your knees as though you were about to do a sit-up and have your feet together. If you looked at the knees from the side you might notice one knee sticks forward more or is higher than the other.
Some healthcare practitioners measure from certain reference spots in the pelvic region. These include the belly button or the front of your hip bone on the side, down to the inside of your ankle while lying down, or to the floor when evaluating you while standing.
Another evaluation technique is to shoot an x-ray with the patient standing, so the patient is weight-bearing, and the film will show you what the body is doing inside. Lying down films will allow hypertonic, or tight, muscles to distort the pelvis on the film. It will make it look the opposite of what is really happening when you are weight-bearing. I have several sets of films that were taken supine, or lying on the back, and then again standing. The difference is amazing.
If you are suffering from leg pain of any sort please see your medical or chiropractic physician. They can recommend a good course of treatment including chiropractic, medications, physical therapy, yoga, acupuncture and massage for instance. You don’t need to live with it or heal yourself. We’re here to help if you let us.
If you want to ask a bunch of providers a question in person, join us for our 2nd Annual Wildewood Shopping Center Health and Wellness Fair Saturday June 9th from 9 – 1pm. Bring the whole family!
These topics come from my book, “Back At Your Best; Balancing the Demands of Life With the Needs of Your Body.” It is available in book and Kindle format at Amazon, www.BAYBBook.com and at my office.
If you have any type of personal health concerns or questions, feel free to email me at DrJay@BackAtYourBest.com. I will answer them in private or in this section in a week or two.
Dr. Jay M. Lipoff is the owner of Back At Your Best Chiropractic & Physical Therapy, LLC, which is located in the Wildewood Shopping Center. He received his Bachelor of Science degree from Syracuse University in 1990, a Doctorate of Chiropractic (D.C.) from New York Chiropractic College (NYCC) in 1994 and he became a Certified Fitness Trainer (CFT) in 2005.
Dr. Lipoff is an Executive Board Member, International Chiropractic Association Council on Fitness and Sports Health Science; has a radio segment: Back At Your Best in 5 Minutes or Less, Co-Founder, Drug Free Training USA; Member, NY Strength-promoting the importance of physical conditioning; Board Member of Public Relations Committee, Maryland Chiropractic Association; has done over 15 nationally broadcasted radio interviews, has articles in print and referenced in over 100 print papers, magazine and on websites, President, Wildewood Business Network-promoting better business relations and community outreach.
* DISCLAIMER: THIS ADVICE AND ANY OPINIONS MENTIONED ARE THAT OF DR. JAY LIPOFF AND NOT OF THE BAYNET.
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