Ep 127 – Sciatica and the Proverbial Fork in the Road: “The Rebel MT” with Allison Denney

0:00:00.2 Speaker 1: Anatomy Trains is happy to announce our return to the dissection lab in person, January 10th to the 14th, 2022 at the Laboratory of Anatomical Enlightenment in Boulder, Colorado. We are thrilled to be back in the lab with Anatomy Trains' author Tom Myers, and master dissector, Todd Garcia. Join students from around the world and from all types of manual, movement, and fitness professions to explore the real human form, not the images you get from books. This is an exclusive invitation, email info@anatomytrains.com, if you'd like to join us in the lab.

0:00:37.3 Speaker 2: This episode is brought to you by The Massage Mentor Institute. Diane Matkowski, also known as the Massage Mentor, and Allison Denney, also known as Rebel Massage, have teamed up to bring you The Message Mentor Institute. MMI is a collection of teachings and education opportunities from industry leaders around the world, because your continuing education experience should be whatever you want it to be, they are building community one body part at a time, and they want you to be a part of it. Head over to themassagementorinstitute.com today to see more, learn more and do more.

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0:01:23.7 Allison Denney: Hi. My name is Allison Denney, and this is The Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow, but the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peak at what's under the surface.

0:02:10.3 AD: The ability to apply what we have learned is one of the more difficult aspects of life, it is very easy to sit in a classroom and listen to a lecture and take notes. It is just as easy to watch an instructional video, and it is not only easy but I would argue unavoidable to listen to all the life lessons our parents forced down our throats as we're growing up. Whether or not we absorb them is the question. In each of these cases, when we turn around to put what we know into action, it is a lot harder than it seems.

0:02:44.6 AD: When I became a YouTuber, I realised with stark contrast what the different parts of my brain were doing when I watched a YouTube video, as opposed to when I made a YouTube video. It is one thing to sit in front of a computer or a phone and watch a video and think, "Hey, I could do that," but it's a whole other thing to actually do it. What we see and hear and take in as an audience taps into the parts of our brain that makes sense of the world, what is presented to us gives us a false sense of deep understanding before it really reaches the part of us that makes up the essence of who we are. Turning around and cultivating that learned knowledge into wisdom, into the applied actions of what we do in our practice, into how we operate in our relationships, into how we live our lives. This is a very different part of the brain. This, researchers have determined happens in the insula. Bare with me here. The insula is a small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe.

0:03:53.3 AD: So really the insula is located just underneath the outer part of the brain, kind of above where your ear sits. It is responsible for pain, love, emotion, craving, addiction, and most notably, the processing of bodily sensations, so they may be used to influence decision making. So if higher learning and memory happen in the outer layer, and the ability to be aware of what you just learned happens in a deeper layer, the whole idea of digging deeper just got real. When it comes to being who you wanna be in this world, most of us have experienced a hard lesson or two, oftentimes, this revolves around something that we thought would feel good in the moment and then ended up causing a lot of pain, either within ourselves or to someone we love. Pain as we just learned is processed in the insula. And pain is a powerfully good teacher, not because we understand it logically in the cerebrum, but because we feel it, deal with it and become more aware of future decisions or actions to help us in the long run. For a lot of people, experience is the best educator, for example, as a body worker, if a client approaches me with an anterior cruciate ligament tear, I immediately know what to do because I tore mine. I understand knee pain and scar tissue and old surgery issues, but arthritis, I haven't experienced this one yet, knock on wood, so I've had to do a lot more research to understand it.

0:05:25.4 AD: The problem is we can't break every bone and incur every dysfunction to be the best massage therapist we can be. So how can we really learn to apply ourselves? Some might call it critical thinking, some might call it practical application, I call it being human. And man, it is hard to be human. We are this constantly evolving collection of thoughts and reactions and we have no clue how to handle them all. So we learn some lessons the hard way, and we read and listen and learn some lessons theoretically, then we dig deeper only to find that there are more lessons to learn and more ways to understand things. It's like that old poster from the '80s that everyone I knew had hanging in their garage, a close-up of a nauseatingly cute kitten with the caption reading, "Don't try to find the answers because when you find the answers, life changes the questions." I always thought that poster was silly and now, I think it's profound. I am saying that being human is perhaps our best method of applying ourselves. Finding the balance between the hard knowledge and the deep wisdom, opening the communication lens between the cerebrum and the insula, dropping in and digging deeper and stepping back and looking at the big picture, this is what it means to be human, and this takes an immense amount of self-awareness.

0:06:51.8 AD: I've come to believe that this is also true for the soft tissue in our bodies, not that they like cheesy posters from the '80s, but that they take a really long time to learn about how things work, and how things work is constantly changing and evolving in relation to how the body functions and has been treated underneath all that skin. Their ability to be self-aware is really non-existent. I think though, that it doesn't mean they can't try. Let's take the sciatic nerve, for example, and sciatica too, while we're at it. The former being the anatomical part and the latter being the condition associated with it, both are confusing and both require a sense of self-awareness to be understood. Think of the static nerve as a road with a fork in it, because a fork in the road is the classic symbol of a conundrum that makes one think critically in order to make a decision. The road starts at the low lumbar spine and sacrum, but it doesn't really start, it was just part of one road, the spinal cord, and branched off to do its own thing.

0:07:55.1 AD: It then winds its way down the back of the leg, innervating almost the entire lower leg below the knee, forking into two more branches because it really needs to find self-awareness. At this juncture, the branches are given different names, the tibial nerve running along the medial aspect of the lower leg along the tibia and the common peroneal nerve, or the common fibular nerve running down the lateral aspect of the low leg along side the peroneal muscles and the fibula. I guess they couldn't agree on what to name it, so they went with both. They eventually find their way to the toes after branching off into even smaller nerves down at the feet. So here we are with this very thick, very long nerve that does all the things that nerves do, receive information from the outside world and send it to the brain, take instructions from the brain and send it to the muscles and tissues it innervates, and of course, gets tangled up in the complicated web that is the human body. It gets pinched a lot, kind of like how with the road, a tree or a branch falling is probably the most common way to lose access to where you were going, but a lot of other things can go wrong too.

0:09:10.4 AD: There can also be a random piece of luggage that was on the roof rack of another car, or a rusty old exhaust pipe that became unhinged or a flood can hit, or worst case scenario, an earthquake can really shake things up. But the tree falling in the road and the pinching of the nerve is what we see most, where it gets pinched though, and what is doing the pinching is the most important part. Like I mentioned before, sciatica is the name of the condition. When the sciatic nerve is impinged or impeded in some way, irritated or inflamed, we call it sciatica. If you've ever been a victim of this cruel dysfunction, you know that it is incredibly painful. Most people describe a sharp shooting pain into their low back, traveling down the back of their leg and in severe cases, all the way down to the toes. You might even already know that there are two major categories of sciatica. True sciatica, when the nerve is pinched at its exit location from the spinal cord, or pseudo-sciatica when it's pinched pretty much anywhere else along the way, but most commonly where it slips behind the piriformis muscle in the deep hip. Either way the nerve is pinched, there is a painful response and it is demanding attention. Before I dive back into whether or not the sciatic nerve has the ability to be self-aware, allow me to elaborate on the reality of how these two categories can differ.

0:10:35.9 AD: If it is pseudo-sciatica, this is a little like a heavy tree branch on the road that can be moved out of the way pretty easily. If a muscle, group of muscles or a thickened connective tissue is pressing down on that nerve, we can focus our work on easing that tension. Frequently, like I mentioned before, the piriformis muscle is the main agitator. When it gets overused, it can clamp down on that nerve and create all sorts of pain down the leg, luckily this is where we can use all the incredible skills we have as body workers to loosen things up, restore fluidity and keep the peace. True sciatica on the other hand, is if the sciatic nerve is indeed pinched at the spine, either from a herniated disc or a stenosis, a collapsing of the space between two vertebrae or a bone spur, which for all intents and purposes would feel like a dagger here. This can be significantly more problematic. What happens where soft tissue meets bone is a sticky web of parts that can get brittle or hard or misshapen, and that impingement is no joke, it is a lot more like an asteroid falling out of the sky and crashing onto that road. Handling this condition is gonna require bringing in the specialists.

0:11:52.3 AD: Now, the static nerve does not have the innate ability to take a painful experience and transform it into a learning moment, it doesn't have a cerebrum or an insula, but it does have access to them, so how do we get it to become self-aware? The last thing we want is for a sciatic nerve to learn the hard way that it exists. We don't want to wait until the tree falls or the rusty muffler rattles around or the asteroid hits, that kind of experiential learning would be a good one to avoid, but we can bring its awareness to where it sits and all of the anatomical parts surrounding it. We can teach it to develop a sense of deep curiosity for the world it lives in. We can in essence teach it how to be self-aware. As is true for any massage therapy session, talking to a client about what is going on with their bodies and educating them on how their own human form functions is a key element to healing, the more they know, the more they can articulate what they feel. When a client comes in complaining of sciatic nerve pain, compose the session around showing them where the sciatic nerve is, on an anatomy poster or a book or your favorite app, then palpate where it is for them on their body, starting at the sacrum and traveling all the way down through the back of the knee and into the toes. Enlighten them to the difference between true and pseudo-sciatic nerve pain.

0:13:21.2 AD: It is a nerve after all, and it does have the ability to send signals to the brain. That pain it feels may just be its attempt at making contact with the cerebrum, that higher learning part of the brain. The insula is just there to help it process through its journey, but maybe we can teach it to communicate without the pain, maybe we can introduce compression and movement to encourage the insula into processing what the sciatic nerve is feeling in a positive way. Maybe, just maybe, we can get the sciatic nerve to tap into the decision making process that doesn't involve waiting for a painful life lesson. Feeling how we feel is a lot like learning how we learn, if we can make those connections before the hard lessons hit, applying what we know would be a much more enjoyable experience.

0:14:14.7 AD: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately into my brain, via my eyeballs from a computer screen, drop me a line at rebelmt@abmp.com, that's R-E-B-E-L-M-T@abmp.com. I always wanna hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other Rebel Massage dabblings. I'm impressed you've made it all the way to the end, but because you have, allow me to offer a glimpse into our next episode.

0:15:08.8 AD: Tune in next time as we unpack how being the quadratus lumborum is a lot like being the youngest kid in a very large family, often suffocated by the cacophony that surrounds it, but never ceasing to try and be heard.

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