Recently, a friend of mine told me about a Dr. who was a lot like the Sherlock Holmes character – except this Dr. was no mere investigator. He was a detective who solved crimes using his vast amount of information.
Doctor Spencer Nadolsky is a podcast host and clinical professional in the field of mental health. As a podcast host his show is about finding answers to his audience’s toughest life questions. He strives to be the # 2 Doctor Who on the planet – no one has more followers on Twitter, and he is the top-ranked psychiatrist in the world on iTunes.Sometimes sciatica pain can be caused by a damaged intervertebral disc. But surgery is not always necessary. This month, Dr. Detective meets a truck driver who literally has a sore butt from work-related stress and treats him with stretch marks instead of surgery.
Eat less and move more. All in all, an excellent recipe for improving your health and body composition. However, this does not always work.
Even with an excellent exercise plan and a solid diet, some people suffer from mysterious symptoms and ailments that seem incomprehensible when you consider how much effort they have put into their fitness and health.
When we meet clients whose problems cannot be solved by exercise or diet, let alone their own doctor, we know that there are few experts in the world to whom we can turn. One of them is Spencer Nadolski.
Dr. Nadolski holds a doctorate in osteopathic medicine and has also studied exercise physiology and nutrition. The college wrestler, who won the title of America’s best college wrestler, is still an avid athlete and a brilliant doctor who practices what he preaches to his patients: treat preventable diseases first by changing lifestyle (rather than prescribing drugs).
When clients have no one else to turn to, Dr. Nadolski transforms from a cheerful, athletic doctor into a meticulous, intolerant forensic physiologist. He pulls out his microscope, analyzes blood, saliva, urine, lifestyle – everything you need to solve a medical mystery.
When Dr Nadolski offered to collaborate on a regular article on case studies, we jumped at the chance. After following these fascinating cases, you will see exactly how a talented practitioner thinks. You will also learn how to improve your own health.
In today’s case, we meet a man with sciatica pain who was treated by our doctor with stretching instead of surgery.
Ernest, 55 years old, suffered from sciatica.
A colleague of mine had examined Ernest about two weeks earlier and determined that he had lumbar radiculopathy. No, that doesn’t mean Ernest was funny. That means he had burning pain in his leg.
Lumbar radiculopathy is a so-called symptomatic diagnosis. Derived from the Latin radix (root) and the Greek pathos (disease), this eloquent term simply refers to a stabbing pain in the leg, probably originating in the lower back.
Like other terms like arthritis (joint inflammation) or sciatica (your sciatic nerve must be bruised), this diagnosis simply tells us what’s going on. It doesn’t really explain why the patient is in pain.
My colleague sent Ernest for an x-ray to see if there were any structural abnormalities. Now Ernest is back in my office getting the results. And to inform me that his radiculopathy has not improved. In fact, the pain was even worse.
Lumbar radiculopathy, also known as sciatica.
Signs and symptoms of the client
Ernest wasn’t in the best of shape, but he cared enough to come for his annual checkup. He worked as a truck driver, which he says prevented him from exercising. His work also influenced his diet. He ate a lot of fast food. However, he hasn’t had too many health problems yet……
Although I read my colleague’s note like a good detective, I also wanted to hear the story directly from Ernest. We sat down and he repeated his story.
For about a year, he explained, he had been suffering from pain in his buttocks.
Or at least, that’s where the pain started. Then he fired a shot into his right knee.
He never bothered to check it out because he mostly noticed it when he was driving his truck. It passed as he came out and moved. So he decided it probably wasn’t something very important. But lately he’s been in more pain than usual. And it really bothered him.
Come to the point, Doc! he begged. Tell me what’s going on here! Do I need surgery?
Ernest thought the x-ray would show a structural cause of his hip pain, such as a hernia. But his x-ray was negative, which is quite common in such cases.
This was a job for the medical detective. I still had to undergo a medical examination and ask Ernest a few more questions.
Neurological symptoms should not be taken lightly. As a doctor, you have to be careful not to miss something serious, like… B. bruising of the spinal cord caused by a tumor or a severe deformity of the spine.
Fortunately, Ernest did not suffer from the severe symptoms usually associated with the disease, such as… B. Urinary incontinence (fainting) or parasthesias during bowel movements (numbness between the legs). This was good news.
|Symptom||My thoughts are potential problems|
|Burning pain from buttock to knee||It could be a vertebral problem, but probably not a tumor, no abnormalities of the spine on x-rays, possibly problems with the pyriformis.|
Tests and classifications
I was particularly interested in learning more about Ernest’s musculoskeletal system. He said he had never had surgery or an injury. And of course I already knew he had been in the truck all day. Ernest said he had never had any unusual pain in the past.
I inspected his boots: Worn nickels. Hmmm. He also carried his large, thick wallet in his right back pocket and said he did this regularly. Again. My detective’s nose sniffed out clues.
Musculoskeletal system assessment
A complete osteopathic examination of the musculoskeletal system was then performed. I first asked him to stand up so I could check his alignment. I then asked him to run a brief analysis of the process. (Usually physical therapists do a gait analysis using a video, but this was a quick screening).
Ernest had a very common pose in Donald Duck, the lordosis, where the pelvis is tilted forward. He shook his leg slightly as he walked. They may have something to do with her pain, but it’s not necessary.
Standing up, I asked him to do a standing flexion test to assess the function of the inner spine (i.e., proper biomechanics of the sacroiliac joints). His test was positive on the right side (in other words, the test showed pain and dysfunction on the right side).
Examples of standing flexion tests to check the mechanism of the pelvis, spine and hip
I put him face up on the table for a leg lift test, which was negative. People with disc problems that cause leg pain sometimes have positive results. This ruled out a hard drive problem in Ernest’s case – more good news. But it also deepened the mystery. If Ernest’s problem wasn’t pressure on the sciatic nerve, what was it?
I checked the alignment of his anterior colon and asked him to turn around to check the alignment of his posterior colon. They’ve been deported.
And this was about personalities. I had to feel her piriformis.
In other words: I had to put pressure on his cheeks.
Because I suspected that the source of the discomfort might be the piriformis, a flat band-shaped muscle located at the bottom of the buttocks, behind the gluteus maximus and near the sciatic nerve.
Ouch! Ernest screamed as I penetrated his soft spot. This was exactly the pain he was talking about.
Bingo! The pain really seemed to be coming from a muscle.
Assessment of osteopathic alignment
To eliminate this pain, I need to align her bowel with the muscle (osteopathic stretching technique) and allow her piriformis to relax.
I turned Ernest over so that he was lying on his stomach. (At that moment he must have felt like a pancake, because everything was upside down). Then I did a special hamstring stretch on his right leg.
First, I held Ernest’s leg straight and found a barrier – the end of the stretch where the leg can’t continue. At that point, I asked Ernest to press his foot against me for three seconds and then relax. This contraction-relaxation cycle, called proprioceptive neuromuscular facilitation (PNF), uses the muscle’s natural neurological response to open the range of motion.
I pushed his foot a little further down the track and a new barrier a little further. Relax again. A little more freedom of movement. We repeated this sequence three times.
Here is an example of what this type of stretching looks like. My office is not so good, though.
Finally, I checked his intestines again.
Fortunately, I was able to get his alignment back to normal with this technique. Poor posture may or may not contribute to the piriformis problem, but there is no harm in correcting it.
Now let’s go back to the piriformis. I rolled Ernest onto his stomach and found the sensitive spot on his right buttock – to his shock.
I wanted to do what we osteopaths call a counter tension technique. To do this, I held my finger on the painful spot and moved my foot in a position that reduced the pain as much as possible from 8/10 to 3/10. Then I held this position for about 90 seconds.
Ernest’s leg was now hanging off the table and bent. When I returned it to its original position, I checked the sensitivity again. Instead of rating sensitivity and pain as 8/10, he reported that the pain was about 4/10. This was an excellent result.
Dr. Detective to the rescue. Ernest suffered from piriformis syndrome: His sciatic nerve was irritated by the piriformis muscle.
This syndrome, which is not necessarily recognized by conventional western medicine, is quite common in the practice of any osteopath. I told him that we would handle it permanently and that there was no reason for an MRI of the spine or an expensive surgery at this time.
Ernest’s recipe was simple:
- Take the wallet out of the back pocket. A large wallet is a good problem to have, but if you keep it in your back pocket (especially for years), it can irritate your sacral and sciatic nerves.
- Stretching exercises. I demonstrated the exercises Ernest should do at truck stops and at home whenever possible, including a good piriformis stretch where he stretches his leg across his body. I decided not to send him to a physical therapist because his work limited his time and I wanted to see how he would do without additional care.
- Take fish oil. I told Ernest it wouldn’t hurt to take fish oil every day, as it would likely support his overall anti-inflammatory diet. I also told him he could take Tylenol if the pain became unbearable during the trip.
Example of stretching of pyriformis
Here is an example of one of the simple stretching exercises that Ernest could do even sitting in his truck.
Cross, sitting, one ankle over the other knee. Lean forward slightly from the hips and keep the spine straight. This stretches the piriformis of the thigh (the photo below shows the right piriformis).
Self-massage at home
We are big fans of foam rolls. You can do something similar to loosen a piriformis by placing a tennis ball, lacrosse ball or baseball under your hip. Put the ball under your buttocks and roll until you find the spot that makes you say wow.
Ernest returned a month later. He took my plan to heart and felt much better. Now he only feels pain on long trips. Needless to say, he was very pleased.
Summary and recommendations
Sciatica can have many causes. It is important that the underlying cause is correctly identified, as some conditions are dangerous if left untreated. Fortunately, Ernest’s problem was easily solved – he had another trucker’s butt.
- If you feel a sharp pain radiating from your lower back to your leg, get checked out! The solution can be simple – grab your wallet and stretch, but it can also be a sign of something more serious that needs medical attention.
- When you see your doctor, tell him or her about your daily routine and activities. You’ll often find a clue. Common causes of sciatica are sedentary work, driving, putting pressure on the hip joint (including sleeping on a hard mattress such as a futon) and/or running or biking long distances.
- If your doctor gives you a treatment plan, stick to it. Ernest was faithful to his routes, which brought him almost immediate and dramatic relief. Rehabilitation can be slow, but being consistent pays off.
Have you ever suffered from sciatic nerve pain? What did you do to feel better?
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