Mark: Hi, it's Mark from TLR. I'm here with Simon Kelly. He's a physiotherapist that Insync Physio in Vancouver. They are multiple time, best physios in Vancouver award winners as voted by their customers. And Simon's going to talk about leg nerve irritation. What, what is this all about Simon?
Simon: Hi Mark, how's it going?. Thanks for having me again. Yeah. Just going to talk a little bit about the leg nerve irritation and you know, a lot of times it's hard to pinpoint where the irritation is actually going from. But most of the time that actually come from the lower back region, somewhere between L1 down to L5 vertebrae.
A lot of times, you know, people get quite worried that it can be something quite serious, like a disc irritation or a disc compression and things like that. And on occasion it actually is those things, but the very, very small percentage of people that actually need to go for surgery. So it's good to be not too scared in the beginning, but of course it's good to get checked my physiotherapist as well.
The other thing just to bring to mind just for some people as well, is when the nerve is already irritated, as it comes out in the lower spinal column, it kind of brings down the threshold of nerve. So we've all heard of the sciatic nerve pain, but you know, it's things that are usually not painful, like sitting and then become painful.
So I kind of use the analogy, it's like water coming out of a hose and then you step on the hose and the water stays coming out and it doesn't really affect it that much, but then you step on it in another location, irritated in the nerve root and then irritated from sitting. And it's the sitting then can drive the threshold down. And that's when people really come into us reporting lots of tingling, numbness and irritation, referring down to leg. Call it double crush syndrome, which actually sounds pretty scary actually. But a lot of the time it can be really fixed.
Mark: So if I was experiencing this, I might not necessarily be feeling pain in my lower back, but I might feel it in my legs. Is that why we're kind of referring to leg nerve irritation?
Simon: Yeah, absolutely Mark. Yeah, like it doesn't always have to be linked with a major nerve, like traumatic back injury. Sometimes it can just be progressive in nature. And, you know, as we get older, we get stenosis, that's like a narrowing in the spine in the lower back as well.
Lower population or lower aged population people usually it's not like a stenosis or degeneration and things like that. But in my experience 99% of the time, once you kind of eliminate the information at the primary source, whether it's the lower back or sometime as it passes through to the bum muscle, aka the sciatica, will eventually go away.
That's where we come in then in the clinic and it's all about the education on what movement somebody can do. And if you know, you can fix the back pain, but if you don't tell someone not to sit for long periods of time on a hard surface, that's going to keep irritating that nerve and it's going to be ongoing for quite a long time.
Mark: So how do you treat it?
Simon: So that's it yeah, first of all, when the client comes in, we do need to figure out, first of all, where it's coming from if we can. Either the back, usually it is the back or usually as it passes down through the bum muscle and sometimes it is two areas. So we have to treat both. So in clinic we do a lot of hands-on treatment. We do a lot of needling in the lower back just to kind of decrease, it's kind of like the hypertonicity of the muscle, so the muscles get really tight around the nerve. And this is a common mistake that a lot of people make is oh, the muscle must be tight. Let's stretch it, but stretching in this occasion is not really, the muscle is tight because the nerve is sending a signal to the muscle to protect it.
In other words, please, please leave me alone. But what people do then is they kind of throw petrol on fire and by stretching it, and that really really irritates the nerve. So a lot of the stuff we do is actually a nerve flossing or nerve glides, we call them. Where you're actually gliding. You're actually gliding the nerves. You're not actually stretching it. You're actually just moving the nerve as one unit by different movements in the clinic, I can't really show you on the video here now, but that helps desensitized the nerve. And once the nerve becomes desensitized, it stopped sending the signal to the muscle and the muscle relaxes and it's not in spasm. Preventing you from moving or causing pain essentially.
So by eliminating inflammation around the nerve, obviously you can do ice in a bit of rest for that too. And by doing these nerve glides, especially in the earlier stages of rehab, you can eliminate all that spasm that a lot of people complain about.
Mark: And is that why you use the needling? Is that also help with the relaxation of the nerve?
Simon: It kind of helps more so the muscles around it Mark, to be honest, so the muscles it does help relax the muscle around it. But the primary objective will be to get that nerve moving normally without, without irritating by fully stretching it, or we all like that feeling of a nice stretch, but in this particular occasion that's really, really, really bad to do.
But you're right yeah. The muscle spasm, the needles just help release that to give someone a bit more mobility in their back. Again, in the earlier stages. Once that's all the settlement and we have certain tests in clinic we use to kind of see what the nerve mobility is like. We can obviously go back into strengthening it, and a lot of core work, a lot of lower back stability stuff. And obviously depending on what the client does, back to running or higher end plyometric stuff.
Mark: So what's a typical treatment protocol like this. What does it normally take for somebody to get back to doing some of that stuff? Of course it's individual, but what would be the typical timeframe?
Simon: Yeah, absolutely Mark, it is very individual dependent on a person's circumstances, but you're probably looking at maybe 8 to 10 weeks, like kind of from start to finish and obviously take that with a grain of salt, depending on the population and different ages and different activities. But yeah, 8 to 10 weeks, depending on the irritability and also dependent on when we kind of catch it.
How limited and how what kind of was the mechanism of injury as well, may also have to be taken into account for sure. Was a traumatic or was it more gradual? For example, traumatic can sometimes take a little bit longer.
Mark: So what's the common cause of this kind of leg irritation referring from the back?
Simon: Yeah. One of the common cause, just lots and lots of excessive sitting even Mark, especially if it comes on gradually and naturally grows, especially in this pandemic or in general. Sitting for long periods of time, sitting on hard surfaces. You know, if you kind of think about it, like older people get a lot of pressure sores because they can really move their body in bed when they get very, very odd.
It's kind of a bit like that. I mean at an extreme level, obviously somebody can move a little bit in the younger population. But you're kind of depriving the nerve of sort of nutrients through blood flow as well. And eventually it hits a certain threshold where it gives you that signal of maybe tingling down the leg, where it's like, wow, you really need to get the pressure off this nerve as it's passing through the bum muscle.
There is obviously traumatic, more traumatic stuff as well. If you had a fall off a ladder and you injured your lower back, for sure, that obviously you'd have to go for x-rays to make sure you had no fractures or anything like more serious, but once all that's been cleared, you know, it's a matter of really just getting rid of the inflammation. The treatment is not very different. It might take a bit longer though on a traumatic situation.
Mark: So if you've got tingling in your legs. If you've got pain, that you suspect might be from your back, but it's in your legs, in your sciatica. Get in to see Simon Kelly at Insync Physio. You can book online at insyncphysio.com or you can give them a call (604) 566-9716 to book your appointment, you have to call and book ahead. He's busy, but he'll get you feeling better as fast as possible. Thanks Simon.
Simon: Cheers Mark, thank you