Understanding Sciatica

By Dr. John A. Papa, DC, FCCPOR(C)

The sciatic nerve is the longest nerve in the human body.  It is made up of five separate nerve roots originating from the low back region on each side, and runs from your pelvis through your buttock and hip area and into each leg.  It controls many of the muscles in your legs and provides feeling to your thighs, lower legs and feet.

"Sciatica" is a common term used to describe any type of pain/symptom that radiates into the leg.  "True sciatica" occurs when there is a mechanical and/or inflammatory irritation directly affecting any component of the sciatic nerve.  This differs from “referred” pain/symptoms which can arise from a bone, joint or muscle that can send pain/symptoms into the leg.

True sciatic symptoms may be felt almost anywhere along the nerve pathway.  These symptoms can radiate from the low back region, into the hip or buttock, and down the leg, into the calf, and even the toes.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and leg muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as bending forward or to the side, walking, prolonged sitting or standing, and even coughing or sneezing may aggravate sciatica.

Below is a brief summary of three common causes of true sciatica:

1.  Spinal disc herniation/bulge – Spinal discs separate and cushion lumbar vertebra.  Repetitive and cumulative loads or a single heavy load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.

2.  Degeneration and Osteoarthritis – The normal aging process causes lumbar disc degeneration, osteoarthritis of lumbar joints, and occasionally vertebral slippage.  The consequence of these processes is that mechanical irritation from bony spurs and vertebrae, along with inflammation can cause symptoms of sciatica.  This most commonly occurs in adults over 50.

3.   Lumbar spinal stenosis – This condition causes sciatica due to narrowing of the spinal canal and/or nerve pathways.  This puts pressure on the spinal cord or nerve roots and causes neurovascular irritation.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.

Other causes of "true sciatica" include: direct irritation of the sciatic nerve by the piriformis muscle; direct trauma or injury to the sciatic nerve or nerve roots; and postural and mechanical changes associated with pregnancy.  Some common causes of sciatic-like symptoms or "referred" pain include: muscular trigger points and ligament sprains from the low back, hip, gluteal and pelvic regions; sacroiliac joint dysfunction; and arthritic low back, hip and knee joints.

Sciatica is a set of symptoms of a problem, rather than a diagnosis for what is irritating the nerve and causing the pain.  This is an important point to consider because the treatment for sciatica will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis from a qualified health professional.

When sciatica strikes, there are conservative treatment options available.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, laser therapy, acupuncture, ice/heat application, electrotherapy, and rehabilitative exercise.  A qualified health professional can determine the cause of your sciatica and prescribe appropriate therapy, exercises, and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Common Back Pain Myths

By Dr. John A. Papa, DC, FCCPOR(C)

80% of all Canadians will suffer from at least one significant episode of back pain in their lives.  Below are some of the common myths surrounding back pain and what modern science has to say about them.

Myth 1:  If you’ve injured a disc (i.e. herniation, rupture), you must have surgery.

Truth:  Surgery to relieve back pain should only be used as a last resort.  Even if specific testing reveals a damaged disc, recovery often results without surgery.  An injured disc in the back may become inflamed and put pressure on nerves and surrounding pain sensitive structures.  Non-surgical treatment aims at minimizing pain and discomfort from joint irritation and muscle spasm, and prescribing specific exercises to help with recovery.

Myth 2:  Most back pain is caused by injuries or heavy lifting.

Truth:  Injuries caused by heavy lifting do not account for all back pain.  In up to 85% of cases, individuals can’t recall a specific incident that brought on their back pain.  Back pain can result from a single exposure to a bending or twisting incident or it can be small cumulative loads placed on the spine over time.  Scientific research also links the following risk factors to back pain: smoking, being overweight, poor posture, poor physical fitness, and stressful life events.

Myth 3:  X-ray images, CT and MRI scans can always identify the cause of pain.

Truth:  Even the best imaging tests cannot identify a muscle spasm or ligament sprain that may be the cause of pain.  Imaging is usually reserved for special cases such as those suffering trauma in a fall or accident, surgical candidates, unresolved cases of severe chronic back pain, and suspicion of underlying tumor, infection or other serious disease.

Myth 4:  If your back hurts, you should take it easy until the pain goes away.  Bed rest is the mainstay of therapy.

Truth:  Clinical data indicates that individuals who remain active do better than those who try bed rest.  Remaining active means continuing with daily activities as tolerated and easing back into a regular routine.  Activities may have to be modified while recovery occurs, but movement is important for recovery provided it does not put the individual at risk for further injury.

Myth 5:  Diagnosing back pain is simple and straightforward.

Truth:  The causes of back pain can be complex and difficult to diagnose.  There are many biological tissues that can generate pain in the back.  These may include muscles, ligaments, bones, nerves, and joints.  Quite often it is a combination of several or all of these structures that can manifest into back pain, and potentially radiating pain into the buttock or leg regions.  Sometimes stress and depression can also contribute to back pain.  A licensed health practitioner who deals with back pain is best trained to diagnose the source(s) of your problem and prescribe appropriate therapy when required.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Understanding A "Pinched Nerve" In The Neck

By Dr. John A. Papa, DC, FCCPOR(C)

About two-thirds of people will experience neck pain at some point in their lives.  Occasionally, neck pain can spread to involve other structures such as the upper back, shoulder, and arm regions.  Pain in these regions is often dismissed simply as muscle pain.  However, a “pinched nerve” originating from the neck can radiate pain to these nearby anatomical sites and be a significant source of discomfort.

The “cervical spine” is the medical name given to the region of the neck.  Nerve roots originate from the cervical spine on each side.  These nerves send off various branches that travel to distinct regions in the upper back and arms to supply strength to muscles and provide sensation/feeling.  The term “pinched nerve” is often used to describe a mechanical and/or inflammatory irritation directly affecting any component of the nerve root(s) in the neck/cervical spine.

A “pinched nerve” in the neck can cause symptoms almost anywhere along the nerve pathway.  This may result in neck symptoms only, and/or symptoms that radiate into the chest, upper back, shoulder, arm, hand and finger regions.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and arm muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as movement of the neck or shoulder, prolonged sitting or laying down, lifting, and even coughing or sneezing may aggravate the symptoms.

Below is a brief summary of three common causes of a "pinched nerve" in the neck:

1.     Spinal disc herniation/bulge – Spinal discs separate and cushion cervical vertebra.  Repetitive and cumulative loads or a heavy single load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.

2.     Degeneration and Osteoarthritis – The normal aging process causes cervical disc degeneration and osteoarthritis of the cervical joints.  The consequence of these processes is that mechanical irritation from bony spurs on the vertebrae along with inflammation can cause irritation of the nerve root(s).  This most commonly occurs in adults over 50.

3.   Cervical spinal stenosis – This condition may cause “pinched nerve” symptoms due to narrowing of the spinal canal and/or nerve pathways, which puts pressure on the nerve root(s) or spinal cord.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.

Other causes of a “pinched nerve” in the neck include: direct irritation of nerve tissue by overlying muscles; direct trauma or injury to the nerve root(s); and mechanical changes in the neck associated with poor postural habits (i.e. head poking forward in the sitting position).  Some common causes of symptoms that act like a “pinched nerve” in the neck include muscular trigger points, ligament sprains and arthritic joints from the neck, upper back, and shoulder regions.

Treatment for a “pinched nerve” in the neck will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis.  A proper medical history, along with physical examination consisting of range of motion, strength, neurological and orthopaedic testing, along with diagnostic imaging (if necessary) should be performed to aid in the diagnosis.  It is extremely important to rule out rare causes of “pinched nerve” symptoms such as spinal tumors, fractures and infections.  Disorders of the esophagus, trachea (windpipe), heart and thyroid can cause symptoms that overlap with those of a “pinched nerve” in the neck.  These potential causes require appropriate medical referral when applicable.

There are natural and conservative treatment options available for those suffering from a "pinched nerve" in the neck.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, acupuncture, ice/heat application, electrotherapy, activity modification, postural education, and rehabilitative exercise.  A qualified health professional can determine the cause of your symptoms and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Understanding Sciatica

By Dr. John A. Papa, DC, FCCPOR(C)

The sciatic nerve is the longest nerve in the human body.  It is made up of five separate nerve roots originating from the low back region on each side, and runs from your pelvis through your buttock and hip area and into each leg.  It controls many of the muscles in your legs and provides feeling to your thighs, lower legs and feet.

"Sciatica" is a common term used to describe any type of pain/symptom that radiates into the leg.  "True sciatica" occurs when there is a mechanical and/or inflammatory irritation directly affecting any component of the sciatic nerve.  This differs from “referred” pain/symptoms which can arise from a bone, joint or muscle that can send pain/symptoms into the leg.

True sciatic symptoms may be felt almost anywhere along the nerve pathway.  These symptoms can radiate from the low back region, into the hip or buttock, and down the leg, into the calf, and even the toes.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and leg muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as bending forward or to the side, walking, prolonged sitting or standing, and even coughing or sneezing may aggravate sciatica.

Below is a brief summary of three common causes of true sciatica:

1.    Spinal disc herniation/bulge – Spinal discs separate and cushion lumbar vertebra.  Repetitive and cumulative loads or a single heavy load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.

2.    Degeneration and Osteoarthritis – The normal aging process causes lumbar disc degeneration, osteoarthritis of lumbar joints, and occasionally vertebral slippage.  The consequence of these processes is that mechanical irritation from bony spurs and vertebrae, along with inflammation can cause symptoms of sciatica.  This most commonly occurs in adults over 50.

3.    Lumbar spinal stenosis – This condition causes sciatica due to narrowing of the spinal canal and/or nerve pathways.  This puts pressure on the spinal cord or nerve roots and causes neurovascular irritation.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.

Other causes of "true sciatica" include: direct irritation of the sciatic nerve by the piriformis muscle; direct trauma or injury to the sciatic nerve or nerve roots; and postural and mechanical changes associated with pregnancy.  Some common causes of sciatic-like symptoms or "referred" pain include: muscular trigger points and ligament sprains from the low back, hip, gluteal and pelvic regions; sacroiliac joint dysfunction; and arthritic low back, hip and knee joints.

Sciatica is a set of symptoms of a problem, rather than a diagnosis for what is irritating the nerve and causing the pain.  This is an important point to consider because the treatment for sciatica will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis from a qualified health professional.

When sciatica strikes, there are conservative treatment options available.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, laser therapy, acupuncture, ice/heat application, electrotherapy, and rehabilitative exercise.  A qualified health professional can determine the cause of your sciatica and prescribe appropriate therapy, exercises, and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Common Back Pain Myths

By Dr. John A. Papa, DC, FCCPOR(C)
 

80% of all Canadians will suffer from at least one significant episode of back pain in their lives.  Below are some of the common myths surrounding back pain and what modern science has to say about them.

 

Myth 1:  If you’ve injured a disc (i.e. herniation, rupture), you must have surgery.

Truth:  Surgery to relieve back pain should only be used as a last resort.  Even if specific testing reveals a damaged disc, recovery often results without surgery.  An injured disc in the back may become inflamed and put pressure on nerves and surrounding pain sensitive structures.  Non-surgical treatment aims at minimizing pain and discomfort from joint irritation and muscle spasm, and prescribing specific exercises to help with recovery.

 

Myth 2:  Most back pain is caused by injuries or heavy lifting.

Truth:  Injuries caused by heavy lifting do not account for all back pain.  In up to 85% of cases, individuals can’t recall a specific incident that brought on their back pain.  Back pain can result from a single exposure to a bending or twisting incident or it can be small cumulative loads placed on the spine over time.  Scientific research also links the following risk factors to back pain: smoking, being overweight, poor posture, poor physical fitness, and stressful life events.

 

Myth 3:  X-ray images, CT and MRI scans can always identify the cause of pain.

Truth:  Even the best imaging tests cannot identify a muscle spasm or ligament sprain that may be the cause of pain.  Imaging is usually reserved for special cases such as those suffering trauma in a fall or accident, surgical candidates, unresolved cases of severe chronic back pain, and suspicion of underlying tumor, infection or other serious disease.

 

Myth 4:  If your back hurts, you should take it easy until the pain goes away.  Bed rest is the mainstay of therapy. 
Truth:  Clinical data indicates that individuals who remain active do better than those who try bed rest.  Remaining active means continuing with daily activities as tolerated and easing back into a regular routine.  Activities may have to be modified while recovery occurs, but movement is important for recovery provided it does not put the individual at risk for further injury.

 

Myth 5:  Diagnosing back pain is simple and straightforward.

Truth:  The causes of back pain can be complex and difficult to diagnose.  There are many biological tissues that can generate pain in the back.  These may include muscles, ligaments, bones, nerves, and joints.  Quite often it is a combination of several or all of these structures that can manifest into back pain, and potentially radiating pain into the buttock or leg regions.  Sometimes stress and depression can also contribute to back pain.  A licensed health practitioner who deals with back pain is best trained to diagnose the source(s) of your problem and prescribe appropriate therapy when required.  For more information, visit www.nhwc.ca.

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Understanding A Pinched Nerve In The Neck

By Dr. John A. Papa, DC, FCCPOR(C)

About two-thirds of people will experience neck pain at some point in their lives.  Occasionally, neck pain can spread to involve other structures such as the upper back, shoulder, and arm regions.  Pain in these regions is often dismissed simply as muscle pain.  However, a “pinched nerve” originating from the neck can radiate pain to these nearby anatomical sites and be a significant source of discomfort.

The “cervical spine” is the medical name given to the region of the neck.  Nerve roots originate from the cervical spine on each side.  These nerves send off various branches that travel to distinct regions in the upper back and arms to supply strength to muscles and provide sensation/feeling.  The term “pinched nerve” is often used to describe a mechanical and/or inflammatory irritation directly affecting any component of the nerve root(s) in the neck/cervical spine.

A “pinched nerve” in the neck can cause symptoms almost anywhere along the nerve pathway.  This may result in neck symptoms only, and/or symptoms that radiate into the chest, upper back, shoulder, arm, hand and finger regions.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and arm muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as movement of the neck or shoulder, prolonged sitting or laying down, lifting, and even coughing or sneezing may aggravate the symptoms.

Below is a brief summary of three common causes of a "pinched nerve" in the neck:

1.     Spinal disc herniation/bulge – Spinal discs separate and cushion cervical vertebra.  Repetitive and cumulative loads or a heavy single load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.

2.     Degeneration and Osteoarthritis – The normal aging process causes cervical disc degeneration and osteoarthritis of the cervical joints.  The consequence of these processes is that mechanical irritation from bony spurs on the vertebrae along with inflammation can cause irritation of the nerve root(s).  This most commonly occurs in adults over 50.

3.     Cervical spinal stenosis – This condition may cause “pinched nerve” symptoms due to narrowing of the spinal canal and/or nerve pathways, which puts pressure on the nerve root(s) or spinal cord.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.

Other causes of a “pinched nerve” in the neck include: direct irritation of nerve tissue by overlying muscles; direct trauma or injury to the nerve root(s); and mechanical changes in the neck associated with poor postural habits (i.e. head poking forward in the sitting position).  Some common causes of symptoms that act like a “pinched nerve” in the neck include muscular trigger points, ligament sprains and arthritic joints from the neck, upper back, and shoulder regions.

Treatment for a “pinched nerve” in the neck will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis.  A proper medical history, along with physical examination consisting of range of motion, strength, neurological and orthopaedic testing, along with diagnostic imaging (if necessary) should be performed to aid in the diagnosis.  It is extremely important to rule out rare causes of “pinched nerve” symptoms such as spinal tumors, fractures and infections.  Disorders of the esophagus, trachea (windpipe), heart and thyroid can cause symptoms that overlap with those of a “pinched nerve” in the neck.  These potential causes require appropriate medical referral when applicable.

There are natural and conservative treatment options available for those suffering from a "pinched nerve" in the neck.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, acupuncture, ice/heat application, electrotherapy, activity modification, postural education, and rehabilitative exercise.  A qualified health professional can determine the cause of your symptoms and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Understanding Sciatica

By Dr. John A. Papa, DC, FCCPOR(C)

 

The sciatic nerve is the longest nerve in the human body.  It is made up of five separate nerve roots originating from the low back region on each side, and runs from your pelvis through your buttock and hip area and down the back of each leg.  It controls many of the muscles in your legs and provides feeling to your thighs, lower legs and feet.

 

"Sciatica" is a common term used to describe any type of pain/symptom that radiates into the leg.  "True sciatica" occurs when there is a mechanical and/or inflammatory irritation directly affecting any component of the sciatic nerve.  This differs from “referred” pain/symptoms which can arise from a bone, joint or muscle that can send pain/symptoms into the leg.

 

True sciatic symptoms may be felt almost anywhere along the nerve pathway.  These symptoms can radiate from the low back region, into the hip or buttock, and down the leg, into the calf, and even the toes.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and leg muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as bending forward or to the side, walking, prolonged sitting or standing, and even coughing or sneezing may aggravate sciatica.

 

Below is a brief summary of three common causes of true sciatica:

 

1.    Spinal disc herniation/bulge – Spinal discs separate and cushion lumbar vertebra.  Repetitive and cumulative loads or a single heavy load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.

 

2.    Degeneration and Osteoarthritis – The normal aging process causes lumbar disc degeneration, osteoarthritis of lumbar joints, and occasionally vertebral slippage.  The consequence of these processes is that mechanical irritation from bony spurs and vertebrae along with inflammation can cause symptoms of sciatica.  This most commonly occurs in adults over 50.

 

3.    Lumbar spinal stenosis – This condition causes sciatica due to narrowing of the spinal canal and/or nerve pathways.  This puts pressure on the spinal cord or nerve roots and causes neurovascular irritation.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.

 

Other causes of true sciatica include: direct irritation of the sciatic nerve by the piriformis muscle; direct trauma or injury to the sciatic nerve or nerve roots; and postural and mechanical changes associated with pregnancy.  Some common causes of sciatic-like symptoms or referred pain include: muscular trigger points and ligament sprains from the low back, hip, gluteal and pelvic regions; sacroiliac joint dysfunction; and arthritic low back, hip and knee joints.

 

Sciatica is a set of symptoms of a problem, rather than a diagnosis for what is irritating the nerve and causing the pain.  This is an important point to consider because the treatment for sciatica will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis.  A proper medical history, along with physical examination consisting of range of motion, strength, neurological and orthopaedic testing, along with diagnostic imaging (if necessary) should be performed to aid in the diagnosis.  It is extremely important to rule out rare causes of sciatic symptoms such as spinal tumors and infections.  Individuals with a loss of bowel or bladder control may be experiencing cauda equina syndrome and should be referred for emergency care.

 

When sciatica strikes, there are conservative treatment options available.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, acupuncture, ice/heat application, electrotherapy, and rehabilitative exercise. A qualified health professional can determine the cause of your sciatica and prescribe appropriate therapy, exercises, and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.