Low Back Pain Sciatica with Iyad Salloum
Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum, he's the chief clinical director of Insync Physio in North Burnaby. And we're going to talk about a really common thing. A lot of people call it sciatica. It's actually low back nerve pain. What's going on here typically, Iyad?
Iyad: So sciatica is kind of a broad term to describe pain along the sciatic nerve distribution. And I mean, if you think about it, the sciatic nerve kind of runs through the entire back of your leg. So it starts in the gluteal area and it goes down through your hamstrings, into the calf, into the foot. So broadly speaking, anytime you have pain on that distribution, it's called sciatica, but the sciatic nerve doesn't just come out of the back.
You have a bunch of little roots that joined together to form the sciatic nerve. So any disruption or injury or sensitization in any of those nerve roots could contribute to sciatica. And then after that, it travels through a bunch of tissues, so it goes through your gluteal muscles into the hamstrings down behind the knee, into the calf. And then it also feeds the front of the leg, like kind of your shin in the back of your calf.
So once you think about it that way, you can have sciatica from multiple, multiple things. Typically the most people associated with some kind of diagnosis of a low back injury or a disc herniation with pressure on a nerve root. We don't see that being always necessary. That's not the only way you can get sciatica. There's a lot of reasons why a nerve can hurt.
I'll tell you the funniest one I've seen in clinic, which is a person sitting on a toilet seat too long playing candy crush and their feet go numb. And then they're diagnosed with sciatica on the phone. But it's really simple for that person. We just don't need to apply direct pressure on that. And then there's the more kind of traumatic injuries. For example, somebody fell, hit their back on a post and then they start to develop these what we call radicular sites, where the nerve root is getting impacted. And they tend to lose a bit of the function in that nerve.
Mark: So what would the typical symptoms be that somebody would, it's just a low back pain? Is that, or is it a low radiating into your butt and your legs?
Iyad: So it tends to be that exactly. We're looking at the low back cluster of sciatica or let's call it the nerve root issues. Yeah. You'd have a bit of low back pain or sometimes a lot of low back pain. It really depends on the person. Some people complain more of leg symptoms than back symptoms. And the pain radiates down the leg. And that's a really good sign that you should probably get it checked out. If you're getting some kind of sensation, it could be tightness, numbness, tingling, burning. Those all kind of tend to be nerve symptoms.
Some people just have pain and they're like, it just hurts. I just don't know what to describe it as, it's just painful and it's uncomfortable and I can't sit. So that's what we'll end up seeing. But back pain tends to be usually associated if we're looking at the nerve root issues that contribute to sciatica.
Mark: And generally, does it show up more when people are sitting or does it show up in movement and in walking and standing?
Iyad: Excellent question. You have both. That's the confusing part. We used to think that it was only in sitting because when we used to think of things very mechanically and only that way. Yeah, we were like, oh, so if it hurts with sitting and it feels better with standing that it's gotta be this. And then what we're finding is, the more we study people and the more we look at it, it's not quite as simple as that. So it tends to be varied. You can have actually two people with the same injury presenting in exactly the opposite pattern.
So one feels better when they're standing and one feels better than you're sitting. And then vice versa. And then you have people who say, I love it when I walk by pain goes away. And some people say I can't walk because anytime I straightened my leg, I got a bit of a zinger going down my leg. So it really depends on that. Tends to be just like, if you just get assessed properly, we would be able to figure out what kind of way we can kind of manage that person, because again, you could have the exact injury in completely different presentations.
And the other thing that's kind of confusing about this is, and this is where people sometimes, if you go on a kind of a wild chase to see what's going on with my back and you get imaging and people will come in, for example, without any symptoms of, let's say sciatica or pain down the leg, but then they're showing on an MRI that they have a disc bulge and they're confused. They're like it says here that I should be feeling leg pain, but I'm not, well that also can happen because a lot of people can have abnormal findings on scans and not present with any symptoms.
And that's the biggest breakthrough that we've had in learning about how to interpret imaging findings. You know, when we're seeing a disc bulge or degenerative disc disease on scans, they don't always correlate with symptoms. And that's where if you're just going hunting for something and you try to find something, you might find it, but we still can't say confidently that that's what's causing it.
So it tends to be largely a diagnosis done in clinic, based on what we find. We move you through a bunch of stuff. We do a bunch of tests, and then we will treat you that way. Regardless of what your scan says.
Mark: So the diagnosis becomes critical then in terms of determining what your course of treatment is going to be?
Iyad: Yeah, because like we said, imagine if let's say two people have a symptomatic disc bulge, especially on the nerve, but one of them feels really good when they bend forward. The other one feels really good when they bend backwards. If we were to just treat based on just the imaging findings and not actually assess that person in clinic, we could be really making them suffer. One person really suffering the other person feeling good, for example. If we had just kind of like progressively pushing somebody into that sore spot.
So what we ended up finding is usually the first assessment tends to be trying to figure out what's affected. So we would do a very thorough exam, like of the back. We would scan their nerves. We would do a bunch of testing for reflexes to see if the conduction spine. We're always vigilant for any potential red flags that we would need to send out to the ER, in cases like where and those tend to be very rare, but we're always vigilant for those obviously. And then we will try to figure out what positions and what movements that person's comfortable with. Get them moving slowly and kind of gradually. And they tend to do really well with the rehabilitation program, which is the good news, I guess.
Mark: If you have some back pain and you're not sure exactly what's going on, get to see the experts at Insync Physio. You can book in North Burnaby online at insyncphysio.com. You can also book for the Vancouver office if you wish to go there. If that's closer for you. To call the north Burnaby office they're at (604) 298-4878. Get in to see the experts. They'll look after you and make sure that your back is doing better, properly and for the long run. Insync Physio. Thanks, Iyad