Living Well Exploration
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When the opportunity arose for an early retirement, I took it, in hopes of spending some time to figure out what "living well" meant for me. After some months of exploration, I became interested in Health Coaching. I was excited to leverage my many years of experience fostering adult learning to support others in their own efforts to live healthy and fulfilling lives. I continue to maintain supportive professional relationships with staff and alumni of the Duke Integrative Medicine Health Coach Training program.
Through Live Well Integrative Health Coaching, based in Blue Bell, PA, I offer an array of services to both individuals and groups, in person in the Philadelphia area and also by phone or video conference to people everywhere, all focused on helping people to make the long-term, healthy sustainable changes they need to Live Well. Read the stories my clients have shared to get a sense for the life-changing results that can be achieved.
Client Stories. Rick - Exercise and lose weight. Deb - Manage stress. Ann - Kick the soda habit. Radicular pain is pain arising from the irritation of a nerve root. This may be a sciatic nerve root, or could be a nerve root in another part of the body. For example, my sciatic pain is caused by the irritation of one of my sciatic nerve roots S1 , but I often experience pain in only the lower leg, or only the buttocks, or only the upper thigh, or only the foot, or sometimes a combination of these.
I do occasionally experience pain that literally radiates straight down my sciatic nerve, but that may not be the norm. Radicular pain can take multiple forms. Sometimes it can be felt of as sharp shooting pains and sometimes as a burning sensation. Radicular pain can be thought of as a subset of neuropathic pain.
Neuropathic pain refers to pain related to any nerve in the body including nerve roots , whilst radicular pain refers to pain specifically related to a nerve root. Sciatic pain is a subset of radicular pain and therefore neuropathic pain as it refers to pain related to one, or more, of the sciatic nerve roots. This is called radiculopathy. Radiculopathy occurs because some of the nerve signals are blocked from travelling through the nerve.
The numbness is distributed roughly along the path of the nerve along the relevant dermatome and any motor weakness will relate to the group of muscles that the relevant nerve serves. Although radiculopathy and radicular pain commonly occur together, radiculopathy can occur in the absence of pain, and radicular pain can occur in the absence of radiculopathy.
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It should be noted that some people refer to radiculopathy as including radicular pain. The nerve root affected in radiculopathy may be the sciatic nerve root, but like radicular pain, it could be a different nerve root in the body. Radiculopathy can be thought of as a subset of neuropathy. Neuropathy refers to the symptoms occuring because some of the nerve signals are blocked, but this could be for any nerve in the body including any nerve root. Radiculopathy specifically refers to a nerve root. Some people get radicular syndrome in their arms, arising from irritation of a nerve root in their neck, others may experience symptoms in their legs, arising from irritation of a nerve root in their back.
Radicular syndrome can be thought of as a subset of neuropathy neuropathy refers to any nerve in the body, including nerve roots, whilst radicular syndrome is focused on nerve roots. Different clinicians have different views, and the information available to the public on the Internet, or within books, reflects that lack of consensus.
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My understanding is that in strict and simple terms, sciatica is the name given to pain caused by irritation of one or more of the sciatic nerve roots in the lower back. Pain might be felt anywhere along and around the path of the sciatic nerve, even though the actual irritation is at the site of one of the sciatic nerve roots in the lower back.
Sciatica may be associated with neurological dysfunction, such as weakness and numbness, but strictly speaking the term sciatica only describes the pain element. Strictly speaking I understand sciatica is a symptom rather than a specific condition, illness or disease. Whilst trying to get to grips with this part of the jigsaw, I created a Venn diagram, shown below, which I think illustrates how this strict definition of sciatica fits in with the concepts of radicular pain, radiculopathy, radicular syndrome and neuropathy.
Fundamentally, in the strictest sense, sciatica is a subset of radicular pain, as radicular pain is pain produced from the irritation of a nerve root, and sciatica is the pain produced by one or more of 5 nerve roots, the sciatic nerve roots. I understand there is some debate as to which nerve roots contribute to sciatic pain, but this is beyond the scope of this post. Strictly speaking sciatica is only pain though, and any associated neurological deficits radiculopathy are separate to that, as indicated in the diagram.
Many clinicians and Internet articles refer to sciatica as including both the pain element and the neurological deficits such as numbness, reflex loss and motor weakness. Both the radicular pain and radiculopathy in my case are centred on the S1 root nerve, and the two together explain my diagnosis of sciatica.
Some experience relatively mild symptoms, whilst others have symptoms that are fundamentally disabling. Sciatic pain can be mild or severe, ranging from a dull ache to pain that is described as sharp, burning or shooting. It can be excruciating and sometimes it can feel like a jolt or electric shock. The path of the pain follows roughly the path of the sciatic nerve, which runs from your lower spine to your buttock and down the back of your thigh and calf and into your foot.
At any one point in time you may experience, for example, pain in your calf and not your thigh, at another point pain right along the sciatic nerve pathway, and at another point pain in your buttocks. At other times you may experience a combination of these. Sciatic pain can be highly variable, and affects people in different ways.
The areas you may experience sciatic symptoms are different depending on which nerve root is compressed:. If more than one nerve root is compromised, then you may experience a combination of the above symptoms. Even if there is only one nerve root compromised you may experience a combination of symptoms, in fact this is quite common. This is thought to be due to the inflammation surrounding the irritated nerve root spreading to neighbouring nerve roots. Every instance of sciatica is unique. Sciatica can be constant or intermittent.
It can vary according to your activity. Prolonged sitting or standing can aggravate symptoms, and some people find pain can be worse when you cough or sneeze. It may be exaggerated by physical activity. Usually only one side of your body is affected. The following diagram illustrates how I am affected by sciatica. There really is a wide range, from very low level symptoms to more severe symptoms than I have. In simple terms, sciatic pain and other sciatica symptoms are caused by one of the sciatic nerve roots becoming both compressed and inflamed. Common causes for this are:.
My condition was primarily caused by a herniated disc and so that is the cause I will consider here. Looking again at the diagram showing the spinal cord and the nerve roots in the thoracic part of the spine, you can see that the discs between the vertebrae are right next to the thecal sac green column going down the middle of the picture housing the spinal cord and the nerve roots. This is also the case for the discs in the lumbar spine, with the exception that in the area of the lumbar spine we are interested in the thecal sac houses the cauda equina nerves and not the spinal cord.
The following series of diagrams will show how a disc prolapse protrusion , disc herniation extrusion and disc sequestration affects the exiting nerve roots. The diagrams are of a cross section across the vertebra and disc, and show only the exiting nerve root this is for simplicity and understandability reasons. It is difficult to show this second nerve root on these cross sectional diagrams due to their direction of travel, and so I will attempt to illustrate this scenario later on.
The following diagram shows a cross section of a normal lumbar vertebra and spinal disc.
The spinal canal houses the thecal sac, which houses the cauda equina of nerves. The parts that look a little like bull horns, are the exiting nerve roots. In simple terms the disc is composed of two parts, a tough outer part and a softer inner part called the nucleus. Unfortunately, sometimes a disc becomes degenerative or is injured and the nucleus of the disc starts to protrude through the outer layer and pushes on the nerve root, as shown below.
This compression of the nerve root may or may not be enough to cause sciatica symptoms. This varies from person to person. If the nucleus breaks through the outer part and leaks out then this is called disc herniation, or extrusion. The contents of the nucleus is extremely noxious and will inflame the nerve root it leaks onto. Both the compression of the nerve and the noxious substance leaked onto it may cause sciatica symptoms.
Sometimes part of the nucleus breaks away and disc sequestration occurs. This happened in my case. The following diagram looks in a little more detail at the processes involved. Lower down the lumbar spine the area marked in the diagram as spinal cord would be the thecal sac containing the nerves forming the cauda equina. Finding accurate pictures I can use for this blog has been difficult, but perhaps the following diagram helps to illustrate how confusing the information in the public domain can be.
Nevertheless, the diagram does show a useful summary of the stages of disc herniation, and also serves the purpose of illustrating how confusing much of the information in the public domain can be.
Whilst cleaning up this jigsaw piece I discovered I had another major misunderstanding. This caused me great confusion, but it did lead me to discover that as well as the exiting nerve root being exposed to the disc outside of the thecal sac there could be another nerve root that has exited the thecal sac in advance of the lumbar segment that it will exit. In my case the disc herniated in such a way that my S1 nerve root was mainly affected.
In this diagram the lumbar segments are on top of one another, with the discs in between. I had an MRI scan which revealed my herniated disc. Interestingly I have discovered that it is not uncommon for an MRI to show a prolapsed, or even herniated disc, with the person concerned having no symptoms whatsoever. This is entirely normal, especially for the slightly older population.
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There is often nothing to worry about at all. This was the case for me. I have had numerous MRI scans, and my experience is that it is important not to get over-concerned with the results of an MRI report on a back, but to discuss the results with your clinician. This has been another important learning point for me. Surgery to relieve sciatica is usually considered only after an extended period of non-surgical conservative treatment has not proved successful enough.
Depending on the cause and duration of the sciatic pain, one of two general surgeries will typically be considered:.