Is Your PHT Actually Sciatica?

: On today's episode, is your PHT actually sciatica? course, bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series, and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. PhD rehabbers, thank you for tuning in for another episode. And today we're going to be talking about Cydica because I thought it actually be nice. I was scrolling on Twitter and saw a helpful article about Cydica. So that's what we're going to cover today. Um, but thought it would be a nice episode because of the, I guess, overlapping symptoms and the over diagnosis or misdiagnosis of. the two together, PHT and sciatica. And some people might have a diagnosis of sciatica and actually turns out to be PHT and vice versa. And I usually think this is, I don't know this to be true, but I generally think sciatica is over diagnosed. It's a very safe diagnosis to make because it's kind of just like a syndrome and no real definitive points. And if you have some sort of buttock pain, that's really hard to define or diagnose, people just label it with cytokine and away they go. Lower back pain as well. People just label it as cytokine. It's kind of, um, like I say, overdiagnosed. And so today, um, I'm going to pull up an article that is from, um, who's the university that's done it. So just redirecting the title of the article itself is Cytica and it's from University Hospitals Coventry and Wurrickshire and it's uhcw.nhs.uk is the website and you can go to there and just click on Cytica if you want to follow this along or if you're interested. I haven't used all of the information in today's episode. But if you want to find all the information, plus there's also at the bottom, some really useful websites and resources and support if you need it, you can go to that because I haven't covered it on today's episode. Some of the resources I'm already familiar with, there's some YouTube videos and some podcasts and those sorts of things. Empowered Beyond Pain podcast is what one of the... resources is linking to. I used to listen to that and it's, it's top tier. It's an Australian podcast. If you have low back pain as well as PhD, then download and start listening to that episode. It's really good stuff. Okay. With that said, let me go back to my notes. Um, Because sciatica is overly diagnosed, I believe it to be so. Let's go through the truth. Let's go through what it actually is, what the common causes are, what the symptoms are, what can be done to help it. I'm going to sort of chime in with some of my final thoughts at the end, but let's start off with sciatica. So what is it and those sorts of things. So the article says sciatica is very common. and is related to pain in the leg where the nerves that travel from the lower back down the leg become irritated and very sensitive. Occasionally people with sciatica can also have back pain. It is important to remember that although sciatica can be very scary, painful and can affect many aspects of a person's life, it is rarely serious. Also most sciatica will normally resolve without any treatment within six to 12 weeks. So we're talking about some cytokine and saying that it can also have lower back pain. It's an irritation of a nerve as it passes out from the spine, out from your lower back. And every level of your spine has certain openings and the nerves can travel out of those openings, one on the right, one on the left, and then start traveling into the glutes, up, like around the back, down the legs, those sorts of things. And so sciatica seems to be the irritation and sensitivity of those said nerves. So the next thing we're looking at is common symptoms, common causes. Sorry, we'll talk about symptoms in a second, but common causes. The article says, The sciatic nerve from the lower back can become irritated or inflamed. A number of factors have been associated with sciatica. These often include, and then they've got a whole bunch of dot points here, a sprain or strain to the lower back. And they have example, lifting something awkwardly or something that is too heavy for what you are physically used to doing. So this is straining yourself. Normally something that involves the lower back and like if you are helping someone move house, very common, if you have some poor lifting strategies or if your lifting is perfectly fine but you've just done too much of it, more than what your body can tolerate, then this can be a cause for sciatica. They say a sudden increase or decrease in your normal activity or exercise levels. So we know that a sudden increase in activity levels can cause a number of injuries, overuse injuries, but they also mentioned a decrease in normal activity. So then we're looking at the deconditioning side of things, cause you can have a strong back and all of a sudden you decondition yourself, it becomes somewhat weak, deconditioned is what, uh, you know, we usually say, and can start affecting the mechanics, start affecting the function, the capacity, and then start running into troubles. They talk about discs. They say that when I talk about the spine and the bones and having different levels, there's a disc in between each level of bone in the spine. And they say the disc-related changes that caused sciatic nerve irritation, inflammation and or compression. Now, this is where it gets a bit tricky because Disc degeneration is extremely common. It's more common than not in the healthy population above, I think, 40 years old. So we wanna be very careful with how we interpret symptoms. But if you do have the discs that do have some sort of irritation, inflammation, or compression, it can start to impede the exiting nerves at that spinal level. So... This article says that there can be an association with there. Another dot point, other conditions such as osteoarthritis, rheumatoid arthritis, or fibromyalgia, which is a pain syndrome, these can be a common link or common cause with Cytica. Then they talk about more of the psychological side of things, they say common causes are following a period of increased stress. worry or low mood, following period of poor sleep, fatigue and feeling run down, other lifestyle factors such as being overweight or smoking. And then lastly, they say a flare up of long standing side occur or low back pain. So if you've had side occur in the past, one of the common causes is that same injury just having a flare up or reoccurring. I'm glad they put in the stress, worry, low mood, sleep, fatigue, all those sorts of things, because we know that this can influence your capacity. The first thing was making sure that we don't over strain or overload or lift awkwardly or lift more than what we are used to. That would lead to an overload, but we can also overload our bodies by lifting something within our means, but our current state being underdone or suboptimal and we know this to be the case when there's sleep, lack of sleep involved, poor fatigue, increased stress, low mood, all those sorts of things. So there's some things that can overlap here. First of all, let's just say, PhD that is brought on by you doing something in the gym, doing too much like deadlifts. We know that deadlifts are very correlated to the upper hamstring. That's why some people try and rehab their PHT. They do deadlifts. They start off at a level that's way too strenuous and it flares them up only because that's what deadlifts are designed to do. They're designed to target the upper hamstring, but it also puts a strain on your lower back. So based on these dot points here, you could theoretically develop doing deadlifts or overdoing them or awkwardly having an awkward technique, just doing too much too soon, those sorts of things. It can potentially have some overlapping causes with sitting. We know sitting for long periods of time or sitting on a hard surface beyond what you can tolerate might trigger or arise PHT. But if you're doing a lot of sitting, and it involves a lot of slouching, a lot of lazy kind of postures or a posture that you're not used to, that can cause sciatica. I wouldn't say a slouched posture because you could be, you could have a posture that you're adapted to. Say like my couch in the living room, you sort of sink into that couch and it was my girlfriend's couch and then we moved in together and I started getting low back pain from it, but got used to it. I slouched into it, sort of, propped it up a couple of pillows behind me when I very first started using it. Now I've sort of got to the point where I don't need a lot of pillows. And it's not the slouching that's the bad thing. It's just me used to being in that position was the uncomfortable thing. When I got this computer chair, I found one that felt comfortable and I bought it and then started getting low back pain when I started sitting in it. And it's not that it's a bad posture or poor posture. It's because I'm not used to being in that posture. But then after a few weeks, I don't have pain anymore. I just got used to it because my body adapts to it. Uh, so just bear that in mind. I thought I just put that out there. There's often a misconception of, you know, you have to have a perfect posture or, um, those sorts of things. And it turns out it's just something different, something that your body just doesn't just isn't used to. Um, So there can be some overlapping things. You could sit in a posture you're not used to, get low back pain or get sciatica, but you can also get PHT. So some overlaps there. The other one I wrote down was cycling. Like if you're slouched, when I started cycling and I was doing long distance cycling, I started getting low back pain. But again, it's just the position that I was in just needed to get used to it. but could also call sciatica because you're in that sort of slouched over posture. And if that's too much or too awkward or something you're not used to, it could go one way or another. You could get PhD from cycling. I know people that have developed PhD from cycling, but sciatica is also within that realm. Um, so with, with that, there's also some things in here that I think are not overlapping. So we can kind of rule some things out, or it might increase our likelihood that it's not these things. Because one thing they don't mention in these common courses are things like running, like being upright and moving seems to not really put much strain on the back. Because it likes being upright, it likes being in that position, likes movement, likes activity. So running I don't think running would cause whatever cause side a car, but running definitely causes PHT, running long distances, running fast, heel running, definitely running fast, like speed workouts are a big common correlation. And so just a roundabout way of saying, if you are a runner, you've done a lot of speed work, you've started developing this glute, upper glute, the lower glute, upper hamstring region pain, and you... head to a health professional and they say, oh, it looks like you have sciatica. Based on the symptoms, based on the history and where symptoms arose, I think that's highly, highly unlikely. So something to bear in mind. The next thing we talk about is common symptoms. And this is where we can start to differentiate between hamstring stuff and sciatica stuff because there are some things that we can mean mean it's less likely or those sort of things. So common symptoms, the article says these include pain that you feel, pain that you may feel in your back, your buttock, your hip and down of down the back of the leg sometimes traveling as far as your foot. So again we have some overlapping symptoms with PHT but not all. We have pain in the buttock, That's where PHT would reside, lower glute, upper hamstring, that sort of region. So yes, sciatica symptoms can produce that, but sciatica symptoms also produce back pain, which PHT won't, and lower down the leg, travelling as far as your foot. If you have pain travelling past your knee, it's not PHT. PHT is a over... it's a reaction of the tendon and will mainly stay localized, stay localized to the upper hamstring, kind of feels like it's lower glute, but doesn't travel anywhere else. So if you have pain that goes further down into the foot, you could still have PhD, but it needs to be something else. You have something else going on if it's traveling down into the foot, something to bear in mind. And it continues, so. We have stuff there that overlaps, we have stuff there that doesn't overlap. So if you've done deadlifts and you've developed some sort of pain and it's in the lower glute, upper hamstring area, it could still be sciatica or. PhD, but you know, if you did deadlifts and you had low back pain, it won't be PhD cause PhD doesn't travel up into the lower back. Okay. They continue common symptoms. Burning or electric shock pain, tingling, numbness, coldness, cotton wool or heaviness feeling in your leg and or foot. Back pain, but the pain in the leg is often worse. So maybe mild back pain, moderate to severe leg, foot pain. This really rules out the PHT stuff. So burning, electric shocks, like all of this sort of stuff is nerve related pain. experience sharp sensations and I think that's nervy. My dad called me up two days ago and said I've got low back pain. I think it's a nerve like pain and it turns out it was just sharp. I think it's more like a facet joint but because he was getting sharp pains in his back with certain movements he sort of interpreted that as nerve pain and I explained to him nerve pain is usually burning, shock. electric shock, pins and needles, numbness, coldness, tingling, all that sort of stuff. And he didn't experience any of that. He said, okay, it's probably not nerve related. But this is what we're talking about when it comes to sciatica because we're dealing with the nerves. Yes, pain can be there. But again, with this overlapping stuff and ruling some stuff out, if it does, if you do have any tingling numbness, pin pins and needles burning, it's not PhD, you could have PhD, but there's something else going on. Um, so, oh, they also say common symptoms, which again, let's look at this overlapping stuff. So common symptoms for sciatica difficulty sitting, difficulty standing, difficulty bending, difficulty kneeling, walking or lying down and disturbed sleep. So sitting PhD, yes, bending PhD, yes, less often standing, kneeling, walking, lying down. I have had some people have PHT-like symptoms, lying down, lying on their back, or lying on their side at nights, but that's less often. And some people get Cytokine symptoms when standing. So if you get pain with standing, it's more likely to be Cytokine, less likely to be PHT. All right, what can I do to help it? This is where the article goes next, and it's talking about some sort of like guidelines, self-help tips and those sorts of things. Like I said above, normally resolves without any treatment within six to 12 weeks, but there's a few dot points here. So the article continues. In the first few days after an onset of Cytica, changing or reducing your usual activities may help. However, there is strong evidence that trying to keep active and gradually returning to your usual activities and exercise will help your recovery. So this follows, you know, what this podcast is all about. Because if you have PhD, we're trying to not rest too much because we enter that pain, rest, weakness downward spiral. We're trying to preserve a lot of your strength, we're trying to preserve a lot of your capacity and do as much as we can. get away with as symptoms allow. And so the same seems to be for Cytica. And to be honest, the same is for most injuries, most low back pain, overuse injuries, running related injuries, all that sort of stuff. They continue, it is normal to experience some pain during your activity, but it does not mean that you are causing harm or damage to your Cytic nerve or back. Pretty much. along the same lines as what I talk about saying that, you know, you can do deadlifts, you can run cycle with PHT, but needs to be low levels of pain needs to return back to baseline quickly. And just know that if there is pain in the tendon, you're not doing more damage. Some people think that they're worried to do deadlifts and really load up the tendon because they're worried about a tear or tearing it further or complete rupture and those sorts of things. Just know that if there is pain during activity, you're not doing more damage. The same is here for the nerves and the back. Try some of these self-help tips is what the next part of the article is. Apply heat or ice pack to the painful area. So contrasting to do you use heat or do you use ice? Try one and the other. See which one you find the most beneficial. And it says do it for up to 15 minutes, but never apply heat or ice directly on the skin. You want something in between, like a cloth or some light clothing, all those. Yeah, some of that stuff. A short course of simple pain medication is advised by your pharmacist or GP, and it may help reduce pain and allow you to move more comfortably. So if you are, if you have a, flare up of side of car and you're really struggling to move, really struggling to get through your day, compensating a lot with your bending, walking, sitting, all that sort of stuff, then yes, it's probably advised and your pharmacist or GP would advise for you to take some simple pain medication. They continue finding a balance between taking some rest and regular movement in the early days is often important. So back to just trying to remain as active as possible. They say Regular movement and exercise is safe and helpful for sciatica in the long run. It is important to build up gradually. The exercise or activity you enjoy most is likely to help your recovery. I love that. Sometimes people are like, oh, what exercise can I get back to with PhD? Like, what am I allowed to do? One of the things I ask is what do you enjoy the most? Because... We wanna develop some goals that are really meaningful for you, might be golf, might be basketball, might be running, cycling, swimming. We wanna get back to doing what you enjoy. And if you can only tolerate a little bit of that right now, but you're doing it and you enjoy it, then that's really gonna help your recovery. If sitting causes pain and your job involves long periods of sitting, adopting varied and or relaxed postures may be helpful. So try not to be too tense your postures, changing things up, sit, stand, desk might be helpful. But just making sure that we're not too rigid, aiming for a perfect posture and keeping tense and straining yourself in that sense. We want to be careful of that. On the recovery side of things, they suggest good sleep habits and managing a stress may help to cope better with your pain. I love that. Just focusing on the psychological side of this biopsychosocial pain and recovery that we're so fond of. So good sleep habits helps you recover. Managing stress helps reduce the pain sensitivity and helps give your body the environment for recovery. So glad that they're covering all their bases in here. We don't usually see this sort of advice, which is why I thought it'd be so helpful to include, do a podcast episode about it essentially. Some facts about sciatica. Now we're getting into the nitty gritty about a few misconceptions and those sorts of things. How many are there? There's about 10. Sciatica is rarely linked to serious tissue damage or life threatening condition or a life threatening condition. Really good that we put this at the top because if you have like severe low back pain or pain radiating into the foot and it's becoming numb and it's getting pins and needles, it can be scary. Uh, when I was working in clinics, uh, you know, private practice, physiotherapy, just seeing treating anyone that walks in the door. I think 70% of everyone who walked through the door had some sort of low back pain. That's what they're coming in for. It's just so prominent and it comes, people come in with different threat levels. People say, Oh yeah, I just, um, this is a work, just pick something up a bit awkwardly. Just have a little bit of. lower back but should be fine. I'll get back to work tomorrow. Other people are like, okay, I've had this severe low back pain, I've picked something up, I've picked something up and I've got this shooting pain down my leg. And my dad had the same thing in his lower back and he ended up in a wheelchair. Am I going to end up in a wheelchair? Is this ever going to get better? And they've only had this for 24 hours, this pain, and they've catastrophised only because for some reason, lower back pain, some people really just catastrophize things. So, sciatica is rarely linked to serious tissue damage and or a life threatening condition. So, important to put in there. Sciatica is often caused by nerve irritation and or inflammation. We've mentioned that above. If the sciatica nerve is compressed, you may experience numbness and or weakness in your legs. The next point, discs. Discs do not slip. in or out of place. They are strongly attached to the bones in your back. So I think, you know, decades ago, we always talked about slipped discs. Oh, that's very alarming. That's very alarming language. And turns out it doesn't exist. Discs don't slip. And it may feel like something has slipped. It may feel like it might make sense if someone tells you. Oh yeah, it slipped out of place, it's now compressing on the nerve, that's why you have numbness. Just keep in mind, that's not what happens. A disc can prolapse and essentially bulging out rather than slipping out of place. But the next point is, if there is a disc prolapse, it often shrinks and returns to normal over time, and they're put in brackets around about six months. And they add, in fact, the bigger the disc prolapse, usually means the better and faster a person is likely to recover. They continue, regular movement, exercise, good sleep, relaxation, managing stress, and improving your general health can help reduce inflammation and help sciatic nerve pain, irritation. This goes back to that beyond pain. podcast that they had in those resources earlier. They constantly talk about this, just getting good health, like, you know, lose a bit of weight, start eating a bit healthier, start getting better sleep, start looking after your stress, start looking after your environment and how much stress you have during your family time and work and all that sort of stuff. Just look after you and your body sets itself up for healing. Really does a good job of doing that. Okay. Gradually loading your back by including bending, lifting movements is safe. And they put in capital letters and put it bold. These movements are safe. In fact, running exercise has been shown to increase the strength of your discs. So if you're a runner, you're strengthening your discs when you run. But I'm glad that they put gradually loading your back and including movements like bending and lifting is safe because A lot of times people are really, really scared. Once they're better, they're really scared to bend, to lift, to do all these things because they're worried about pain returning. How often do we see it? People with PHD, they get better, but then they're worried about sitting, they're worried about bending, they change how they pick something up off the floor. They just don't return to sitting on hard surfaces or sitting without a cushion. And you should note that these things are safe. And... Returning to these things helps your mental health, helps the avoiding that catastrophization, just getting back to normal, always a very good thing. They put there is no perfect posture. Slouching will not damage your back or discs. So that kind of alludes to what I said before. It's okay to slouch, but if you aren't used to slouching in a certain way and you do it quite often, then your back is going to get sore. But. you can push beyond that and get used to and adapt to it. And then that slashing posture is normal. It doesn't cause pain. Treatments such as medications and injections can help in some cases, but surgery is rarely needed. So some medications and injections can help. And it says can help. Doesn't necessarily know it will help, which is why you need to sort of have a talk with your health professionals about that. But, you know, very rarely would we. try or recommend surgery. Your statica can often improve with the right management. So even if you have had it for a long time, regardless of your age, do not give up and try to work with a healthcare professional who can guide you with a self-management plan that you can stick to. I've had a couple of people think that they are unable to heal because of their age and It's just a limiting factor that they've put on themselves and they've just totally made it up. So good to know that it's put in here that you can heal regardless of your age. Don't give up. Just keep trying finding a better management plan, better self care plan, and having a good health professional to guide you along the way if required. Those are the facts about Cytica. I have one more section, which I thought I'd talk about before I dive into my final thoughts. So the final section is, do I need an X-ray or a scan? Let's go through these quickly. So they say X-rays or scans are not usually required to diagnose Cytica. X-rays or scans are not able to tell us how much pain you are experiencing. They often show normal age-related changes and often this does not change how you manage your pain. So often, once you get beyond 40, every single decade of your life increases the changes, arthritic deterioration changes in your back even though you are completely healthy. It is, it gets to the point where it's actually uncommon for you not to have arthritic changes and disc changes and disc bulges and all that sort of stuff in your lower back even though you are healthy. X-rays and scans are best used where a serious injury or conditions such as cancer, infection, quarter equina syndrome are suspected. So a serious injury would be something like a broken bone. If we suspect a stress fracture or a bone stress reaction, yes, we'll go scan you because it's a serious condition. If we suspect something sinister like cancer or infection, the quarter equina syndrome is like a, if I go back to my uni days, the spinal fluid in and around your lower lumbar sacral area that can start to impede on the branching out nerves and can be quite serious. You get pins and needles and numbness in the saddle area and yeah, can get quite serious. So we'd send people for scans if we suspect that. They say a scan may be used if you experience weakness and pain in your legs. that is worsening and is significantly affecting your daily function. So if that's the case, then we might send you for scans because it might be something serious or, you know, we, we want to rule out a few things. So my final thoughts, um, if you're listening to this and if you are unsure, if you have PhD or if you have Cydica, if it's overlapping conditions between the two, um, a few things, one, you can just treat it like a tendon and see if it behaves like a tendon. A lot of times, not necessarily PhD related, but where I position myself as an online therapist, because I can't put my hands on people and do certain tests and increase my diagnostic accuracy. What I would do is say to someone, look, if you're happy for us to continue working together, you can go get an assessment in person. Not telling anyone they can't, but if you decide to work together, let's treat it like what I think it is. And if it starts getting better. then it increases our likelihood that it is what we think it is. So if you are unsure if it's the cytokine or PHT, maybe you can treat it like PHT and see if it gets better. And if it does get better, then it's likely that it's PHT. There are some assessments that you can do for PHT, which if positive or if showing a response does increase our likelihood that it is PHT. I've talked about it on the early episodes of the podcast, the heel press test. So you lie on your back, on the floor, you have your hip and knee bent at 90 degrees and your calf and foot are resting on chair or something like that. And then you just drive your heel down into the chair, you don't lift your bum up like a bridge, you just drive your heel into the chair and see if that elicits any pain. You can also do the shoe off test. And I actually have had a few people reach out to me and say, oh yeah, I didn't know what I had, but then you talked about the shoe off test and that is me down to a T. That increases your likelihood that it is PhD. Tendons are often localized, I sort of mentioned that earlier. Tendons don't really radiate. If it's really severe, really irritated, then yes, it might be a little bit more widespread, but it doesn't travel down the leg, doesn't travel into the foot, stays put for the most part. Tendons have an analgesic effect. So if you load something up, if you load up that tendon under the right conditions and the pain subsides, that's an analgesic effect and you know, nerves don't do that. And so if it behaves in that fashion, then increase the likelihood that it is a tendon. But not all tendinopathies have an analgesic effect either. So we can't rule it out if it doesn't produce an analgesic effect. Tendons respond well to slow, heavy, progressive load. I've talked about this on every single Almost every single episode of this podcast. So just bear that in mind. If you're responding to slow, heavy loads, probably the tendon, similar to my first point, treat it like a tendon, see if it behaves like a tendon. Um, PhD reacts to running, especially speed work and sidekick. It doesn't. So if you try, if you have flare ups, every time you increase your running speed, or if this came on due to some speed work. more likely PHT than Zydeca. And just as my final point, I just said, let treatment be your diagnostic tool, which is kind of what I was talking about before. We have a suspicion, we treat it as such, see how it responds, based on how it responds, we then move one way or another in terms of what we think it is. And it's often safe to do that. If we suspect something serious, we wouldn't. do this because this takes time takes preparation takes several weeks to see if it does respond. If we suspected a stress fracture, we probably wouldn't spend several weeks trying this out, but would send you for scans straight away. But you know, in most cases, let's just treat it like spend a couple of weeks treating it like what we think it is. And if it gets better, then increase our likelihood of it is if it doesn't get better, then we broaden our horizons again, we consider other options. So hopefully this helps. Hopefully this talk about Cytica helps, I guess, some reassurance that you don't have Cytica or maybe after listening to this, you think you don't have PhD and you actually start treating it like Cytica or maybe talk to your GP and health professional and maybe they say, you know what, maybe it isn't PhD, maybe it is Cytica and then you change it, change your management, start getting better. Maybe that's a good thing as well. So hopefully that helped. Um, I'll put the link to this article in the show notes and you can check out those other resources that are in there. Um, and yeah, hopefully enjoyed this episode and we'll catch you next time. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the run smarter podcast hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device, click on the show description and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future and remember knowledge is power.