Sock Doc 22: Sciatica (Or Is It?), Supporting Healthy Perimenopause/Menopause, And Steve’s Top-3 All-Time Tips

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On this episode we have The Sock Doc, Dr. Steve Gangemi, joining us for one final episode as EP winds down. Steve is a natural health care doctor who founded and practices at Systems Health Care, an integrative wellness center in Chapel Hill, NC. Steve is also a longtime endurance athlete and is a wealth of knowledge for athletes looking to optimize wellness.

We are continuing our series, “When Things Don’t Go As Planned,” that dissects your health and injury issues that come up when you least want them and can negatively affect your training and race season–how to heal, prevent and overcome going forward of common (and not so common) issues that athletes face. Listen to No. 1 of the series here, and No. 2 here.

When Things Don’t Go As Planned

Part 1: Sciatica, Sciatic Pain—Or A Misdiagnosis?

• A lot of people think they have it but they really don’t.
• Pain in the glute or down hamstring doesn’t automatically mean sciatica.
• Sciatic nerve is really more from back of the knee down.
• Sensory innervations of the sciatic nerve is really only beyond the knee (distally–knee to foot), according to some research.
  • But this is debated and some disagree.
• Common to misdiagnose sciatic pain (when it’s in fact something else).
  • Sclerotogenous pain– this is a type of referred pain from lumbar spine/sacral area in the glute area or even hamstring that can get mixed up with sciatic pain.
  • Whereas sciatic pain is more like numbness, tingling, sharp-stinging-type pain all the way down into calf and foot
  • They both can come from lower back issues or piriformis, muscle imbalances, etc.
• If you do have sciatica—the #1 muscle involved is the piriformis muscle, in which the sciatic nerve can be in different places even going through this muscle in some people.
• Who is susceptible? What are contributing causes?
  • Whether it is sciatic or something else, a lot of the causes and treatments are similar; don’t get too wrapped up in terminology if the roots to healing are all similar.
  • Hormonal connection, i.e. sex hormones and stress hormones—muscles of pelvis can be affected when over-stressing the body in this way that leads to hormonal imbalances.
  • Those with better hormonal status have better core strength and thus likely to have better performance.
  • Or also an inflammatory condition or lack of offsetting inflammation in the body, including dietary stresses.
  • The role of biomechanics and form in all of this.
• Path to healing
  • Steps to healing will depend on the patient you may not need to dive into in-depth testing right away, and maybe you start with the mechanics and then see if influence with hormones.
  • Assess the person: some are more hormonal based and others more mechanic based.
  • Correlation between sciatica with menstrual cycle? Not so clear compared to hip pain for example.
• Trigger point therapy
  • No static stretching, usually just irritates things more (despite temporary pain relief).
  • Trigger point work in hip area: under the sacrum, piriformis muscle; ...