Sciatica is a disorder involving pain in the buttock that may radiate down the leg and is characterized by:

• Deep, sharp pain in the buttock and/or leg that is worse when sitting and bending forward at the waist
• Sometimes accompanied by lower back pain
• Burning or tingling sensation down the leg and sometimes foot
• Weakness, numbness, or difficulty moving the leg or foot
• Constant or intermittent symptoms

WHAT CAUSES SCIATICA?

Sciatica is caused by compression of the sciatic nerve or neurons that comprise the sciatic nerve.  The neurons (individual nerve cells) originate in the brain and travel down the spinal cord; branch out from between the lumbar vertebrae and sacrum as nerve roots and finally combine in the buttock region to form the sciatic nerve.

This means that compression of nerve tissue anywhere along this path is capable of producing sciatica.  In fact, although rare, brain tumors can produce sciatica symptoms.

The three most common compression sites for sciatica are in the central canal of the lumbar region of the spinal column, the lateral canals, and under the piriformis muscle of the pelvis.

Stenosis, or narrowing of a spinal canal is often the source of compression especially in older patients.  Stenosis occurs with degenerative joint disease, where bone spurs occlude the canal, pinching or rubbing against nerve tissue, as shown in the model above.  This is the top view of an L4 vertebra , showing narrowing of the central canal due to spondylosis, or vertebral bone degeneration.  Notice how the bone contacts the nerves (yellow structure in the canal).  This contact fires the nerves, causing shooting pain and/or numbness and tingling down the legs.

Thickened ligaments can also be a source of stenosis.   For a person with stenosis, bending the spine in certain directions may exacerbate or alleviate sciatica.

A bulging disc can also cause stenosis and produce sciatica by narrowing the lateral canal and pressing against a nerve root.  This is also called lumbar radiculopathy.

Piriformis syndrome is a less common form of sciatica and occurs when the sciatic nerve is pinched by the piriformis muscle, a deep pelvic muscle that externally rotates the hip.

Rare, red flag causes of sciatica are brain tumors, spinal tumors and pelvic masses; and maybe even viral infections of the sciatic nerve.  Check with your doctor to make sure none of these apply to you.

Seek immediate medical attention if you have progressive lower extremity weakness and/or loss of bladder or bowel control.

DIAGNOSING SCIATICA

Sciatica from spinal stenosis is diagnosed by X-ray or lumbar MRI.  Simple muscle strength and sensory nerve tests can be done to determine if the nerve is not functioning 100%.  But basically, if you have nerve pain down your leg, it is fair to assume the nerve is compromised somewhere.

If you know the source of your sciatica after being diagnosed and informed by your doctor, you should have a better idea of your prognosis, or chance of eliminating it.

If you aren’t able to see a doctor for your condition for whatever reason, asking yourself a few questions may help you  identify what is causing your sciatica:

• Did you experience sharp, low back pain at the same time as your sciatica?  If so, this points to lumbar radiculopathy (sciatica from nerve root compression) by lumbar disc herniation.
• Are you over 50, had a heavy labor job most of your life; have a history of accidents or injuries to your spine or engaged in a high impact sport for many years?   If so, this points to central or lateral canal stenosis from degenerative joint disease of the spine.
• Do you sit long hours and/or do squats or other activities that strain the buttock muscles?  If so, this points to sciatica from piriformis syndrome.

These aren’t definitive assessments, of course.

The likelihood of being able to self-resolve sciatica depends on what is causing it:

Sciatica caused by central canal stenosis from degenerative joint disease has the worst prognosis.  These cases eventually require spinal decompression surgery.

Sciatica caused by lateral canal stenosis has a better chance of recovery.  Certain exercises and manual procedures may be able to widen the opening and remove pressure from the nerve root.

Sciatica caused by piriformis syndrome has the best chance of recovery.   Manual techniques such as stretching, posture correction and hip mobilization can often correct the problem.

 

Cartilage, more specifically hyaline cartilage lines the ends of long bones in joints, protecting them from abrasion during movement and weight bearing.   It is also found in the nose, ribs and ear.

Unlike muscle, organ and skin which is mostly comprised of cells, cartilage itself is mostly comprised of a matrix secreted by cells called chondrocytes.   The chondrocytes secrete and “live” in this matrix, called the extracellular matrix or ECM.

ECM is comprised mostly of collagen, a type of protein that has elastic properties, and proteogylcans which are molecules containing a protein attached to a glycosaminoglycan; basically a sugar molecule bound with an amino acid.

Glycosaminoglycans are highly polar and attract and bind with water.  They are therefore useful as a lubricant or as a shock absorber; hence their role in joints.

Healthy cartilage is very smooth and sturdy.  In fact, if you ever cooked soup bones, which are usually sections of beef hip and knee joints you probably noticed that it’s not easy to hold onto them because they are so slippery; almost frictionless.

Because of cartilage’s water content, it can absorb pressure (bear significant weight and repeated impact forces).  Remember from physics that water is non-compressible and is therefore great for redistributing forces.   Hydraulic pistons are able to move heavy things thanks to this property of water.

But even with this wonderful design, joint wear and tear is inevitable especially if you aren’t careful or if you are unlucky and injure a joint.

Take your knees, for example.

Knee osteoarthritis is the result of progressive cartilage deterioration in the knee, which is very common in people over 50.  It is so common that osteoarthritis is viewed as a normal part of aging.  In fact, about 4.5 million Americans have at least one total knee replacement (TKR).  Over 650,000 TKR surgeries were performed in 2009, and there was an 87% increase in TKR surgeries from 1997 to 2009 (Healthline.com)

But, don’t resign yourself to thinking that osteoarthritis is normal and that you will get it in a matter of time.  I believe that you can avoid knee osteoarthritis by being mindful of your health and following a certain preventive routine.  You don’t have to go down the “osteoarthritis path” as you age.  More on this to follow.

How Osteoarthritis Gets Going

One of the affects of aging is that the hypothalamus secretes less human growth hormone (HGH), the “youth” hormone.   And one of the functions of HGH, true to its nickname is to maintain muscle mass, and cartilage in the knees and elsewhere.  This is why kids are able to run and jump off rooftops and keep going with no problem.  Doing this is not such a good idea if you’re over 40.

With lower levels of HGH, the cartilage starts to thin and lose elasticity, probably because of less water content and degraded collagen strands from oxidative stress.

The pounding from walking forms tiny cracks to appear, which develop into pits that can gradually expand in size.   If you are overweight, it compounds the problem.  Small fragments of cartilage break off the bone and deposit inside the knee, interfering with movement and generating an inflammatory reaction.   Bare bone is exposed and walking becomes painful.  This is the typical sequence of events that lead to knee replacement surgery.

What Limits Cartilage Healing

Cartilage doesn’t have a direct blood supply, which makes injury healing sluggish.  The same goes for ligaments and tendons.   When you have a direct blood supply to tissues, nutrients and reparative cells like fibroblasts can get there fast.  With no blood supply, the injured tissue has to rely on absorption or other means to get nutrients in.

This is why joints, whose main structures are cartilage, ligaments and tendons, take so long to heal when injured and often require surgery.  Once you hurt it, it can take months, even years before it fully heals, if it does at all.  ACL tears of the knee; meniscal tears, rotator cuff tears, and tendonitis are known for their stubbornness in healing and their tendency to become chronic.

But, do you really need a direct blood supply in order for chondrocytes to make cartilage?  That’s the assumption.

Let’s talk about where these chondrocytes originate.

The Origins of Cartilage

Chondrocytes– the cells that make cartilage– start out as mesenchymal stem cells, or MSCs.  These are cells that originated from the mesoderm, one of several embryonic (fetal) tissue types that together eventually form the human body.  The mesoderm transforms into cells that make up bone, connective tissue and blood.

Mesenchymal stem cells are still present in adulthood and still have the ability to transform (differentiate) into bone, tendons, ligaments, cartilage and blood, a trait called pluripotential.  Certain genes (specifically BMP4 and FGF2) are known to increase differentiation of MSCs into chondroblasts.  Cell signaling and environmental factors probably play a role in MSC differentiation as well.

In adults, MSCs are found in small amounts in the bone marrow.   The ones that are destined to transform into chondrocytes start by transforming into so called chondrogenic cells at the location of chrondrification; in this case, the ends of the long bones.  Then, they transform in to chondroblasts and start making extracellular matrix, forming cartilage.

The chondroblast matures into a chondrocyte and rests inside the ECM in an inactive state, but can still make or degrade cartilage tissue depending on the conditions.

Formed Cartilage May Not Have a Direct Blood Supply, But Chondrocytes Do

So, given that chondroblasts are formed from mesenchymal stem cells in the bone marrow, which has a blood supply and is therefore able to get nutrients for tissue repair, it makes sense that these cells can make new cartilage where it is needed— those small cracks and pits in the cartilage that line the weight bearing long bones; i.e. your knees and hips.  Even though the final cartilage tissue/ extracellular matrix does not have a direct blood supply, the tiny cells that create it do have access to a blood supply when they live in the bone.

My point is that, even though the reality is that the body cannot grow back the large areas of cartilage damage in advanced osteoarthritis, there is still that potential for cells to grow cartilage, since MSCs still exist in bone marrow and they still are able to transform into cartilage-making cells.

But when you are older and the number of MSCs are few (about .01% of bone marrow cells)  it is understandable that the potential for your body to grow back damaged cartilage is not very strong.   But that possibility is there, nevertheless.

As it stands,

The best treatment available for severe cartilage damage is surgery to replace the damaged joint with an artificial one. Because MSCs can differentiate into cartilage cells called chondrocytes, scientists hope MSCs could be injected into patients to repair and maintain the cartilage in their joints. Researchers are also investigating the possibility that transplanted MSCs may release substances that will tell the patient’s own cells to repair the damage.

~ Euro Stem Cell

That being said, I believe a better approach, if you are in the early stages of osteoarthritis, is to attack the problem nutritionally:  do things that get those chondrocytes busy making cartilage.  They will be slow, but slow and steady wins the race.

• Increase green plants and vegetables in your diet; half of them raw
• Consume bone broth soup regularly, which contains lots of collagen and other cartilage constituents
• Avoid excessive trauma to your knees and hips; strengthen your muscles instead using closed kinetic chain exercises like squats.
• Use Red Light Therapy and Pulsed EMF to stimulate cartilage growth.  Check out the video below where I explain how to use them:

 

Lastly, if you have chronic knee pain and are concerned that knee replacement surgery is a few years down the road, here’s an inspiring article.  It’s a story from a guy who actually experienced natural cartilage regeneration:

Knee Cartilage Repair: How One Patient Proved His Doctors Wrong

The Bottom Line:  First and foremost, to avoid a future of osteoarthritis of the knees or hips and all the limitations it causes, think prevention — diet and lifestyle modification.  Natural cartilage repair and regeneration is still possible, but it is extremely slow and only works if the damage is minimal.   Intervene early, not later.  Go heavy on nutrition that supports cartilage growth because, as this blog post asserts, the cells that make cartilage are still alive and active.  They just need some help.

If you recently injured yourself, or had a sudden onset of low back or neck pain, take note:  inflammation is responsible for creating your pain sensations.

I didn’t say this was good or bad– just that inflammation, or the inflammatory response to injury/ tissue damage is maintaining the sensation of pain.

Understand that despite its negative connotation in the media, inflammation is a natural, protective response to injury that is necessary for healing.

Inflammation:

• triggers the proliferation of white blood cells that attack microorganisms and remove debris;
• dilates local blood vessels and increases their permeability (swelling) to bring more oxygen to the area (more oxygen is needed for the high metabolic activity of damaged tissue);
• produces heat which speeds up activity and makes it difficult for germs to thrive;
• results in pain to discourage you from using the injured area while it is vulnerable.
• quarantines the damaged site from the rest of the body

Normally, after an acute injury such as an ankle sprain, inflammation goes through three phases:

• lots of swelling, redness and pain initially for the first 72 hours (acute phase);
• followed by a gradual reduction in swelling and pain as debris is cleared and special cells called fibroblasts lay down collagen fibers for repair (sub-acute, repair phase); then
• remodeling and strengthening of the new collagen fibers over several weeks (post-acute, remodeling phase).

Eventually, everything gets back to normal.

So for most cases of straight-forward joint sprains/strains R.I.C.E.– Rest, ice, compression and elevation is all you need.

• Rest it– don’t splint it unless necessary; just avoid placing a load on the injured joint, or avoid moving it through its full range during the acute phase
• Apply ice in the beginning only to keep the swelling from getting excessive/ out of control and to reduce pain; about every two hours for 15-20 minutes a session.
• Compress it– this is the least necessary, but some people find it helpful to compress the area to help encourage the swelling to go down.
• Elevate it — use gravity to assist the flow of blood back to the heart.  If it’s your ankle, lie down and place the injured ankle on a pile of sofa pillows so that it is above your heart.

Let the inflammation take its course and trust in your body’s wisdom to heal; helping it as needed.  Unless the pain is so bad that it’s preventing you from doing things you need to do, avoid taking NSAIDs like Tylenol, Motrin or Ipuprofen.  Although NSAIDs can reduce pain, they do interrupt the body’s natural attempts to heal a damaged area and may even delay healing.

When inflammation is not so good

Now, if all goes well your injured body part will be back to normal before long.  But what if it is six months later, and you still feel pain?

It could mean a number of things.

• Perhaps you have a bone fracture.  Fractures take longer to heal.
• A torn ligament or tendon takes longer to heal, as these tissues are not directly vascularized.
• Infection can complicate healing.
• The nature of the injury is causing a joint to be abrasive to adjacent tissue during movement.

In these cases, the cause needs to be addressed with a secondary treatment regimen.

But another possibility is that the inflammatory response has gone haywire.  It continues at high levels long after the injury has completed its healing.  Why this happens is unclear.  In rheumatoid arthritis, it’s attributed to the body’s immune system attacking joint surfaces, which creates a continual state of inflammation and pain.

In cases of excessive inflammation, you may need to take NSAIDs to dampen the process and essentially tell your body “it’s time to stop producing inflammation.”

The other possibility is that you have a pre-existing state of systemic inflammation that is driving the process.  “Systemic” in this sense generally means “widespread throughout the body.”  This can be interfering with the local inflammation of your injury site.

Causes of systemic inflammation include:

• allergic reactions
• obesity
• exposure to pollutants
• diet comprised of highly processed food

In most cases it’s difficult to “feel” systemic inflammation because it is usually sub-acute/ chronic.  But despite this, systemic inflammation wreaks havoc on your health.  It is associated with most chronic, degenerative diseases such as type 2 diabetes, cancer, cardiovascular disease, arthritis, Chron’s disease/ colitis, and Alzheimers disease.

Blood tests that can indicate the presence of systemic inflammation include C-reactive protein (CRP), erythroctye sedimentation rate (ESR), tumor necrosis factor (TNF) and homocysteine.  If your levels are high in any one of these, it is prudent to assume you have an inflammatory condition and take the necessary precautions.

First and foremost is to see your doctor to rule out pathologies/ disease processes.

Second, switch to a low calorie diet centered on whole, naturally-occurring plants and protein.

Next, increase intake of the following herbs/ supplements/ superfoods:

• Curcumin
• Ginger
• Fish oil
• Dark cherries
• Nattokinase
• Green leafy vegetable juice

Drink adequate amounts of water throughout the day, reduce your stress and get eight hours of restful sleep.  As your inflammation resolves, you will notice faster healing, more energy and strength, clearer mind and a leaner body.

Often it’s the simple things that are within your control that have the most powerful healing effect on your body.

As Hippocrates said, “make food your medicine and medicine your food.”

If you experience chronic pain, check out my book on Amazon, Erase Your Chronic Pain:  Unleash Your Body’s Full Healing Potential.