Looking to get in touch with our office? Send us a message here. We are in Costa Mesa CA but we can help people virtually very efficiently. Discover why sciatica often returns and learn essential tips to prevent it with nerve expert Michael Shacklock. In this episode, we dive deep into the causes of recurring sciatica, exploring both common and overlooked factors that contribute to this persistent condition. Michael Shacklock, renowned for his expertise in nerve mobilization, shares effective treatment methods and discusses the latest advancements in sciatica management. Listeners will gain valuable insights into preventative measures, including exercises, lifestyle changes, and ergonomic adjustments to keep sciatica at bay. Shacklock offers practical advice for both healthcare professionals and individuals suffering from sciatica, emphasizing the importance of understanding nerve health and the role it plays in chronic pain. Learn about the science behind nerve pain, discover how to manage and reduce sciatica symptoms, and uncover strategies to maintain long-term relief. Whether you're seeking to enhance your professional knowledge or find personal relief from sciatica, this podcast provides a comprehensive guide to understanding and tackling this common yet challenging issue. Tune in for expert advice, actionable tips, and the latest research on keeping your nerves healthy and staying pain-free. Michael Shacklock's Contacts: https://www.neurodynamicsolutions.com/ https://www.instagram.com/neurodynamics/ DOCTOR LINKS BELOW PREMIUM PODCAST LINK (for Clinicians only) FREE GROIN WEBINAR (LAYPUBLIC) Sebastian Gonzales (00:41): Hey, everyone, it's your host Sebastian, with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time at a show. Welcome. You've missed a lot of different shows in the past. I think we're around 200 and almost 90 right now. We've covered various things from sciatica to sports hernias to hip pain, to neck pain, nerves, and so on. Many, many, many different things. So I've had guests on, more guests on in the past, and as of the recent years I found it easier to just sit in my own little room here and just podcast with myself or some of my associate doctors. So I wanted to have Michael Shacklock about a year ago. I've had him on before, but we got lost in communication by email a little bit because he is on the other side of the world. Sebastian Gonzales (01:24): I've been to multiple of his workshops before. They're excellent. I've seen him speak multiple times. Every single person I know from chiropractor to PT to doctor or let's say medical doctor orthopedic that I've ever met, who's watched him speak the dang everything that he said was missing parts of the puzzle for treating people with sciatica. But I had no idea. I didn't know it. I remember one friend I've had on the show, Cody Dimak before. He said, you have to go to his workshop. Basically, if you know all the stuff that you know, this is a part that you cannot afford to miss if you're treating people with sciatica. So I thought we would call this podcast Why Sciatica Comes Back, tips from Michael Shacklock Nerve Expert. But gosh, I hope I don't change the name of the podcast, but I want it to be something really catchy and really precise for you guys. Sebastian Gonzales (02:17): Because here's the thing, I've met a lot of people who have had lower back pain before, just generalized lower back pain. And a lot of 'em heard of, have heard of the Mckenzie Method. Robin Mckenzie was a famous therapist who put together a methodology that really, really helped a lot of people. And then for other people who have been experiencing low back disc pain, a lot of you have heard of Stuart McGill. Stuart McGill is an excellent source of information. He's well researched. He's done a lot of research on his own in his lab, and he's written quite a few books. The books, I think both Robin McKenzie and or I don't know if Robin actually wrote it, but the McKenzie institute wrote it. And McGill wrote for the lay public, I think we're excellent. Mckenzie's is called Fix Your Own Back. Sebastian Gonzales (03:04): They have Fix your own neck, fix your own shoulder in various methods. Stuart McGill has The Back Mechanic, which I think is excellent as well. So there's these types of treatment methodologies that are synonymous with these problems. Even. I'm hoping one day to have Jill cook on for tendinopathies. And then you'd think that everybody who has these problems should probably know about these people and the information that they have come across in order to get themselves better, quicker. The sad reality is a lot of us end up having encounters as clinicians with people who have just not been doing the best things at the moment. You know, sadly and there's a lot of great information out there that we just have to become exposed to. So in this podcast, this is intended for lay public. Sebastian Gonzales (03:54): My intention is, I want to course Michael one day to write a book, almost like Fix Your Own Nerve. You know, like he doesn't just work with sciatica. He doesn't just talk about sciatica. He talked about the whole nervous system. And so I hope his information today is clean enough and informative enough to help you guys find that there is gonna be a solution, even if he tried other things before. And then I'm hoping one day that he actually puts together a provider list of people who have been through his workshops. I think we've talked on email a little bit, and he said that possibly over the next year, he will be a little busy. But I think from my struggle as a clinician, I've met people from different areas and they say, I have this sciatica. Sebastian Gonzales (04:36): Where should I go? You know, I wish I knew who took that workshop because I know everybody who's taken that workshop has the relevant information and can probably treat you really well with simple things and get you better faster. Now, if you're compelled in this podcast to think, you know what? I really need that type of care. I need help. I need to get better. I need to know all the things that I should be doing, should not be doing, and how to progress my care. What type of sciatica do I have? What are the causes? I need some education. You're thinking all that kind of stuff. You should find somebody who's been trained by Michael, if you can't see Michael himself, but certainly see someone who's been trained by Michael or his disciples. So you can go to neurodynamics solutions.com. Hopefully very soon he's gonna have a provider list up and find somebody who practices neurodynamics. If that listing's not up, you can certainly ask one of your local providers, Hey, do you, do you know anybody? You can even email us. There's a contact in the podcast as well. Just ask us if we know anyone around you, and we'll certainly do our best to find somebody. So without further ado, let's meet Michael. And here he has to say about all things sciatica. It's morning time, right? Michael Shacklock (05:47): Yeah, that's right. It's 9:30 AM Sebastian Gonzales (05:49): I thought we'd narrow the topic to sciatica more so than other types of nerve problems. And can you tell everybody why you're so qualified to talk about this topic? Michael Shacklock (06:01): Well, that's a really good question. I find it hard to answer because even though I've been studying the area for a long time Yeah. And treating patients the more you know, the more you realize you need to know. And so people say, you know, do you know a lot? Or you're an expert? Well, maybe, but certainly there's a lot more to know. And you know, even though we do know a lot, so I'm gonna say yes, I might be an expert, but let, let, let's talk about what we dunno as well. 'cause We need to learn, you know? Sebastian Gonzales (06:31): Okay. So, we're not gonna call you a guru or anything, right? Michael Shacklock (06:35): Oh, well, just Michael Shacklock. That's all I need. Michael . Sebastian Gonzales (06:39): Okay. So for everybody, just to give context again this is gonna be lay public based. So no big need to talk about clinical stuff. If there are clinicians listening, then they should know there's other podcasts. Taylor and Brett interviewed you very well recently too. So there's lots of other references and everybody should go to his course. So can you explain for the lay public, at least in regards to sciatic distribution, what's the difference between something like a neurodynamic problem and something more like, say a diabetes neuropathy? 'cause I think those are confused sometimes. Michael Shacklock (07:15): Yeah, yeah. First of all, what is sciatica? Sciatica is simply symptoms. And it could be pain or pins and needles or numbness itching. It could be all sorts of symptoms in the area that would cause it, it follows the course of the sciatic nerve. So usually it's the back of your, your buttock, right? It could be anywhere in the area, the back of your buttock, right down to the, to your foot on the back surface of your leg or your lower limb. That's generally where it is. It can vary a bit because people's anatomy is not completely uniform. And, and so that's the general description. The next step is what's it caused by, because as many possible causes, you could have a little swelling in your sciatic nerve that can produce sciatica to occur. But that's not the same as low back pain with a pinched nerve root by disc, for instance. Michael Shacklock (08:08): That can produce symptoms in the same area 'cause it's a pathway. And if you, if you think of a garden hose and you block, you block the garden hose, you can affect all the flow all the way down that hose. And so part of our, the issue from defining it for the layperson is what's, what's the cause it's a symptom in sciatic is just a symptom. The next thing is what's the cause? And that's where the health practitioner enters the picture and tries to establish that so they can plan a treatment. And so really it's symptoms in the area where the sci nerve goes. Yeah. Sebastian Gonzales (08:42): But can I, can I ask a couple questions on those two? Michael Shacklock (08:44): Yeah, of course. Is Sebastian Gonzales (08:45): Is it allowed to jump, does it need to travel all the way down your leg in Michael Shacklock (08:48): Continuity? No, it doesn't. No. No, it doesn't. You could have a buttock pain and a pain in your calf down the bottom of your leg, two areas, but it's coming from, could come from a similar general area. So that's technically a variation on sciatica. But people don't usually call it that because they're not so aware if the, if the, if someone's not, hasn't looked into the area in detail, they might say, I've got a buttock pain and calf pain. So what's the cause? Is it two things or is it one or so forth? So it doesn't have to be in continuity? No. Sebastian Gonzales (09:18): Do they have to, does it have to feel like electricity? Are there other different qualities? Michael Shacklock (09:23): No, no. That's a subcategory of sciatica. So if you imagine you have pain and aching down your leg, that could be sciatica. But if you had burning pins and needles or something like that, itching even, that could be a nerve called neuropathic, which means something that's related to definitely abnormal function of the axons. The little, the little, the nerves inside your nerve. But nerves have connective tissues around them as well, and they can cause aching. So different parts of the nerve can produce different types of responses from, and from a science or health perspective, we can define them differently. But for the umbrella statement, it's still sciatica. Different components of it though are different types. Sebastian Gonzales (10:06): Okay. And so I know there's a phenomenon with sciatica that comes on with movement. You know, when you lay down, it goes away or bends forward or you kick, you know. Mm. Michael Shacklock (10:19): And that's what I call neurodynamic pain. 'cause It's dynamic in the nerve. And a, a sort of more umbrella, or a superficial way of describing it would be movement-related nerve pain. Michael Shacklock (10:32): Mm-Hmm. . Okay. Michael Shacklock (10:33): And, and that's, that's reliant on the nerve being center to force, such as movement, stretch pressure and so forth. Sebastian Gonzales (10:39): So there I know that with some of the patients that I've seen, we've talked about what I described as tolerances. So some of the tests that you perform to identify how sciatica or not is, or what's causing sciatica and so on. And we talked about the tension. And like, I know a lot of people who have been down the rabbit hole of looking at things, they think about pinched nerves, and where's the pressure? Can I do nerve flossing? Is that right? Should I stretch my leg? Michael Shacklock (11:08): Mm-Hmm. , Sebastian Gonzales (11:10): You know, how do you identify which things are good for them? Michael Shacklock (11:12): You know, I, I sort of, I feel like I'm on thin ice here because I watch, you know, you really watch social media. It's a way of life now. And unfortunately there's a lot of junk. And unfortunately the lay person is not aware of what is junk and what is accurate. And unfortunately, junk can be just low quality, good stuff, or it can be downright false. And, and so unfortunately the lay person is vulnerable to misinformation. And so if we go to flossing or nerve mobilization or stretching as you call it, there's a lot of stuff outside there saying, Hey, do this for society, do this. It might work and it might not. But the key is finding out why it's there and changing the why. And so nerve flossing is a possibility, but it's not always useful. Michael Shacklock (12:05): Nerve tensioning or slight and so forth, or stretching is also a possibility. But a lot depends on what kind of problem you have. For example, if you are limping into your pal practitioner's clinic because you have severe sciatica, my opinion is give the person pain relief. It's pretty simple. And 'cause that's what they want. The reason they have loss function is their pain. And so why are we applying force to a nerve that's already forced on from a, we know that from a most common diagnosis, disc hernia. So we're, we are applying force to that's already forced on, and we're supposed to help. Now over time that might be true, but today I can't sleep, I can't walk and I need help. And for me, unloading or taking force off the nerve root for pain relief to me is really important for, particularly in the early stage of saying, okay, I'm not saying that, the approach is generally wrong. Michael Shacklock (13:08): What I, but what I am saying is different stages require different needs to have different needs. So we can do different treatments along a spectrum of different mechanisms, of different ways of treating. And I, and I, it's like you, Sebastian, you know, this stuff, you'll be familiar with, okay, this person needs this type of treatment, even though it's still sciatica at, at different stages, the same medical, same classification, if you will, or label actually needs different treatments. And so that's why I really recommend that people see a health practitioner skilled in the area. Unfortunately, it's not always easy to know who is. Sebastian Gonzales (13:42): Yeah. Well, that's why I want you to make that directory Michael Shacklock (13:45): . Oh yes. That's, I take your point. I take your point. Yes. Sebastian Gonzales (13:49): So, but yeah, you're right. And, and I like the, the, since I am on social media and, and you know, we try to provide context to everything that we talk about, but the hard thing is, and, and it's like a common question that we always get is, so I have side, I guess what do I do? I don't know. What do you mean you treat sciatica? Yeah. Michael Shacklock (14:06): So yeah, I'm not saying we shouldn't put that stuff on the internet. I'm not saying that I'm just saying that, that, that the certain aspects are important and you are Right. Situation, context. Sebastian Gonzales (14:15): Yeah. So they're all, they're all situational, I feel like, and what you mentioned to that person that limps in is maybe different than someone who's fully functional, but they can't do, you know, just a few things, right? Michael Shacklock (14:27): Yes. The athletic sciatica can be treated differently from the severe pain sciatica. And one is a, the top one, the athletic one is just, just lost a bit, lost a bit of performance. And, and for example, a hurdler or a hundred meter sprinter or a performing artist, a dancer, a football player who's a peak performance, that a small problem for them is a big problem for them because, because their top 2% of their performance can be the difference between winning a competition and losing in the finals. And so for them, what I would see, I'm not, I'm no athlete. I'm healthy and reasonably fit, but I'm not an athlete. And so my top 2% isn't tested. So I would never know if I've got a 98% sciatic nerve, but an athlete would. And that's why they had to be treated differently. And that's why we have to go into performance strategies that are often more complex and more intricate for the athlete. Sebastian Gonzales (15:28): Okay. So that actually brings up a i'll, I'll tangent around. I know I have a bunch of questions written down here, but let's just say since you haven't tested your, you know, your upper limit of your, your, if you have that 5% sciatica, should you just never try athletic endeavors again and just you'll be okay? Or is it Michael Shacklock (15:49): You mean for, you mean for an athlete? Sebastian Gonzales (15:52): Let's just say for you because like, oh, Michael Shacklock (15:54): For me, yeah. Okay, Michael. Yeah, unfortunately, I've had experiences with patients where you, a good example, if someone had neck pain or something, and I treated them and they did really well, and they said, oh, by the way, I've had this achy brachy sciatica for about 10 years. It's only achy brachy. It's not really severe. It doesn't really stop me, but I do notice that when I do something extensive of this occasionally, can you fix it? So we did a history and he had a disc hernia and stuff like that. And, and I said, well, we'll try, well, unfortunately with him, every time I treated him, it was provoked and it didn't improve in the long term. And he may have had some adhesions or some other pathology or some other pain mechanism going on in his back or his nerves. Michael Shacklock (16:39): And a, we, after several visits, we just agreed that it's probably safer for him not not to push it. And that was partly based on him not needing much function, high function. But for an athlete whose income, particularly a livelihood is dependent on, on, on their performance, then I would be more willing to take it further. But with closer controls, such as different types, examination neurological, make sure their nerves are okay and so forth. So I think the decision is based on the person's needs, and that's close communication with the, with the, the sufferer. And, and what they're willing to tolerate and what is safe. Because remember, we help practitioners, our requirement is to be safe, even though the patient might say, just try it. We still have to say, we think it's dangerous that we shouldn't do it. And, and so the situation is really important and requirements. Sebastian Gonzales (17:36): Mm-Hmm. Michael Shacklock (17:38): So for me, I don't mind, I don't mind bent over and getting an extra stretch down the back of my leg. , I, I don't care because I'm not gonna push my side. Yeah. Can't be bothered. Yeah. Return on investment is low. , Sebastian Gonzales (17:49): I, I, yeah, I remember there was somebody I, I, I was managing that. They were a really hard case for me anyways for the most part, things got better. And then, you know, we talked for every month or two and stuff would come back, and the amount of volume that they were doing with their sport was pretty high. They were not paid athletes. They're recreational, and that's really just what they want. It keeps them sane. And so I, you know, in so many words says it's assumed risk, you know, like, Mm-Hmm. Like, you, you don't, this isn't your day job. I know you love it, but like, you're gonna have to choose how much you wanna deal with, because it was just more highly provoked with what she was doing. But, so, but I've had some people too. Michael Shacklock (18:32): Yeah. Yeah, exactly. And I, I, and for the, for the listener who's not a health practitioner here unfortunately, licensed health practitioners are bound by law. And that's to protect the public from, from danger. And even though someone might say, don't worry, I'll take the consequences of something extreme and risky, we're still not allowed to do it if we know that it could place them at significant risk. And again, it's a cost benefit risk analysis, and that's between you and the patient, . So even though someone might say, oh, stretch the heck outta my nerve, I don't mind if it wrecks it. Well, we do. Mm-Hmm. . And so there's that very, particularly a high performance level that's where that 2%, 5% puts 'em into a window of risk in some people, not all, but some. And that's where, where, you know, the cost benefit analysis comes through and ethics. Sebastian Gonzales (19:24): Mm-Hmm. . Mm-Hmm. . Now you've mentioned the disc quite a few times here and I know that there's gonna be a lot of people who have been told they have disc injuries creating their leg pain or their sciatica. I know there's other types that you alluded to that there's what are the other causes? Can you talk a little bit more about a disc injury and how that affects it versus maybe another type of problem? Michael Shacklock (19:50) Yes, exactly. It's a really good question because even though the disc injury, a disc problem pressing on the nerve root is the most common cause of sciatica. It's not the only one. And if we jump to the assumption that it is Disc hernia, when it's something else, then things might go, not go well as you want. Disc hernia presses on the nerve root, it's a bulge in the disc, or specific terms, we're gonna call it a herniation, which is the kind of more official term. And it's like a bulge in your bicycle tire. And, it can press on the nerve root. Now that the nerve root needs blood flow it's a little bit like if I were to put a small tourniquet around my arm, the upper part of my arm might be okay for a while, but then finally the veins will start bulging. Michael Shacklock (20:35): It'll go blue, and it may start hurting. And so take the tourniquet off and it will relieve it. And that's kind of what's happening in some nerve root problems, particularly in the early stage. So if you get a lot of pressure, you can get pain, but you can also get loss of function like paralysis or numbness. And unfortunately, there's not a close relationship between the two. So if you get severe compression early, suddenly often you don't get much pain, and instead you get a weak limb, you, your foot might not be doing what it's supposed to or something like that. The other part, the other sort, is that it might not be so severe, but it's more irritating and it can be really painful. And, and so the really painful one doesn't always indicate that it is serious, which is a pain in the neck, not quite literally, but for the sufferer, I've got really severe pain. Michael Shacklock (21:24): The problem must be serious, but actually not always, we're actually, as a health practitioner, are actually more concerned about whether you're paralyzed. So if you're paralyzed from a pressure on the nerve root, then you, particularly early, you might end up, you, you might need to get a medical consultation or some sort of radiology or something. So for me, there are, again, there are different kinds. The more severe, more likely cause loss of feeling and loss of movement. But it's not a determinative pain. Pain is often related to irritation and inflammation and loss of blood flow. So it's, there are different, well, this is why I'm sort of impressing the audience here. That type of problem is important. Sebastian Gonzales (22:03): Some people decide to just wait it out. Michael Shacklock (22:05): Mm mm Yeah. Then wait it out. I personally find the wait out approach controversial. Now there are two for the listener. Michael Shacklock (22:16): There are different parts. We read research. We learn what the clinical trials show. We, you know, we, we learn what happens when you don't touch something for a long time, don't treat it. Mm-Hmm. , and a lot of problems are what we call self-limiting. So they, you heal naturally. But unfortunately, and, and that is common with sciatica, but unfortunately there's a, about 10 to 30% of people are still problematic after a year. And it's not very easy to predict who's gonna go in that direction and who won't. And so if someone has sciatica early, you could say, ah, don't worry, be happy. Just keep moving and it might work. Or you might need something quite specific from the health practitioner such as a chiropractor like yourself and, and so forth. And it might really help, but there's another group that if you leave alone, don't. Michael Shacklock (23:10): And my opinion is that that's, that's horrible because from, from a political perspective, we help practitioners that are not really doing very much. We, we are supposed to help people, and if we're told that we can't help you and it doesn't work, then that, that, that's a failure as far as I'm concerned. Mm-Hmm. . And so my opinion is that partly based on research, partly based on my experience, I would much rather see someone with acute severe or severe sciatica early figure out as best we can with what's going on, and give them the best advice that we can and give them home treatment strategies and some physical diagnosis and treatment, sometimes with their hands, et cetera, and sometimes with exercise and so forth. And that is influenced by what the practitioner sees. Mm-Hmm. , are you moving properly? Is it, it doesn't look like there's too much pressure on your nerve root. So then we'll show you some positions that can, which can at least transiently reduce that pressure and give you some symptom relief, some pain relief. And then as you're improving your pain, we can then give you training and so forth exercises and some physical treatment maybe to help optimize your healing. Sebastian Gonzales (24:23): Okay. Yeah. Actually, one thing that I've had people ask me a bit is, well, the position you gave me, it does feel good when I'm in it. I don't really have the problem, but it just comes back. So it really doesn't work. So what do you, what do you think, you know Mm-Hmm. Michael Shacklock (24:39): Like what's the point? That's what that Yeah, that's exactly, that's where the balance between transient benefit or temporary benefit has to be married with long-term needs. My feeling is if, or if, we did a recent pilot study on putting people into this position to relieve pressure on their nerve root in hospital. They arrived at the emergency at the hospital with severe pain and they were assessed them and, and so forth. And, we found that people who got, they've got this position to open their frame in and, and prove their pressure on their nerve root transiently did much better at a week than the ones who didn't get it. Sebastian Gonzales (25:18): Mm-Hmm. . Michael Shacklock (25:19): But that's not, that's not long term as you say. And so my feeling is keep adding to it like a yo-yo going upstairs and inserting other treatments in the process to address all the problems that relate to that sciatica. Sebastian Gonzales (25:35): Okay. I, I, I can't help but talk about that. Yo-Yo going up the stairs. Is that something that you did as you did? Were you a yo-yo man? Michael Shacklock (25:43): Mm mm mm Yeah. Yeah. Yeah. I was, I mean, in real life. I remember when I was a young kid buying this yo-yo thought, whoa, fantastic. This is, my parents probably thought, great, this kid's occupied for hours. . Sebastian Gonzales (25:56): Yeah. So, you know, my dad, he I forgot, I totally forgot. We saw him a couple weeks ago. And so we watched Tommy Smothers, I guess Tommy Smothers died, I think re recently, but he was the yo-yo man. Oh, wow. We used to watch this yo-yo video when I was younger. So we weren't super, Michael Shacklock (26:15): It's amazing what you can do with the, with a ball on a string or a on a string Sebastian Gonzales (26:19): . You can say that, like in that step by step type of scenario, does everybody have to do all the steps like the relieving position and then the exercises, or can they skip steps or can they just, you know, not continue up the steps and they'll be okay? Is there Yeah, Michael Shacklock (26:39): Yeah, exactly. I, I, I, I personally think that there are, we say in Australia where there's a lot of horse racing and gambling, you gotta pick the right horse for the right horse. If you get the soft course and it's been raining, then you gotta pick a horse that can run on soft turf. Or if you've got one that is strong on hard surfaces, then you gotta pick a horse that runs well on hard surfaces. So what I'm, what I feel is that the practitioner has to assess the person, figure out what, what the dominant problems are, and work with those dominant problems. And you might even jump tracks at some point. So I actually, we got stronger in this area really well, better than I expected, but this is what's lacking. Forget that for now. Just maintain it with a few exercises and without gonna add something different because this is the other, the, the next part that's lacking. So I'm okay about changing things and jumping steps as long as it's, you know, appropriate for the patient. Mm-Hmm, . Sebastian Gonzales (27:35): So for some of these step-by-step or general, general things that you give people over time I don't think I've ever asked you how, how long do you usually see somebody from early onset to like, you know what, you don't really need me anymore. How long does that usually take? How frequent is that touchpoint? Michael Shacklock (27:55): Hmm. Okay. Let's just say someone who limps in with severe pain. Mm-Hmm. . I like to see them probably two or three times in about three times in that first week. Say we're in, you know, we're in, in a utopia where we can do what we want, which mm-Hmm. Is rare. But, you know, we'll say we can, I like to go to the top and then dial it back. If it can't be done then I would like to see 'em two or three times, at least two or three times that first week. So we can give them some pain management strategies, how to unload their nerve root, how, how to move better and so forth, how to sleep better and so forth. And then move it to a couple of times a week with rehab strategies, some manual, some manipulations or manual therapy, whatever. And then, and then develop their understanding of the problem and not be frightened of certain things. And then go from there. It could take, I like to see a big improvement in the first one week, first week in the first one to two weeks. So I like to see, it doesn't always happen, but I'm willing to spread it out after that. And you might manage someone intermittently over a year. Mm-Hmm. depending on, depending on how they go. Sebastian Gonzales (28:56): Yeah. And, and so that was a, I'm glad you mentioned some of those points in there. 'cause I think I've met a lot of people who have said, you know what? I know this is, I know this is rehab, it's gonna take some time. And so it's okay that I feel bad for months, you Michael Shacklock (29:09): Know? Mm. Ah, yes. That's, that's really important because we're in a, we're in a world of re of velocity these days. And people want stuff quick. They want particular improvements. That's fair enough. But there are times, well, for example, just say someone who bends over, they, oh, I've got a back pain. Oh, it's not too bad. Then by tomorrow they had sciatic. It's really bad that that's an incident now that might be managed differently from someone who's, who's been, been building up, might be a repetitive task that's been building up that their pain's been building up. And sometimes we have to explain to the, to the, the sufferer look, a process got you here. So a process has to get you outta here. Mm-Hmm. . And so you might say, well, you've been bending over a fair bit. You haven't been moving very well over the last five or 10 years. Michael Shacklock (30:01): It's been loading you back in a way that we don't think is balanced. And that might be why you've got this problem. So we're gonna have to show you how to move differently or load you back differently. And that takes time for a tissue to change. The disc itself does not generally have a very good blood supply, so it doesn't heal very quickly. We know muscles can heal more quickly because they have good blood supply. We know that in the right situation, nerves have good blood flow. So they can often change quite quickly sometimes, not always. And so, but the disc not having very good blood flow means it's gonna take time to adapt to new load heals and so forth. And so one of my favorite statements to people who've got this problem is, look, remember that a process got you here. So a process has to get you outta here. Mm-Hmm. and the process is about if you're building a house, one brick at a time, one step at a time, finally you have a house. But it is step by step and piece by piece. Sebastian Gonzales (30:59): Mm-Hmm. I like that. That's a good process. Got you. Here, the process got you out. I know. Did you ever meet Dan John, by chance? You never Yes, Michael Shacklock (31:07): I have a couple of times actually. Did you really? Yes, yes I did. Yeah. Sebastian Gonzales (31:10): He, he, I thought he said, you're the sum of your, your habits, you know, maybe a little bit more brash than yours, but I like it. Michael Shacklock (31:18): Hmm. Yes. Ha. Habits, I mean, really a lot of health practices about changing habits. Sebastian Gonzales (31:22): Mm-Hmm. . So we have a few minutes here. Is there anything that you think is important to take home that we have not hit yet about? Michael Shacklock (31:33): I, I think, well, what from the, the, the, there's the listener's perspective, there's a broad range of services for, for sciatica. Mm-Hmm. And in physical therapy, particularly in the British Commonwealth countries, and it's sort of partly through the US as well, but more, more in the British commonwealth countries, a lot of physical therapists are reducing their emphasis on physical function or not function, physical causes. And they're going into the psychosocial meaning, look, if you're worried about your pain, then it's gonna make your pain worse. Which is kind of true to some extent. But I think you gotta be careful about overdoing some of either end of the spectrum, physical or psychological. And so I, I really worry that some physical therapists, so I can't only speak for our profession, are telling people, your disc is not hurting when maybe it is and you should test it. Michael Shacklock (32:23): Mm-Hmm. . So you, you're entitled to a decent physical examination and a decent interview with, with your health practitioner. And I get worried when people go to a health practitioner, they get a short time, they don't get a good explanation. The statements given to them about their problems are not tested. Mm-Hmm. That they just read a, read some paper, read a research paper, and tell a patient what to do. To me, that's not enough. Because we are paid and we have obligations and responsibilities to the patient, to the sufferer to give them the best we can. And so I would, number one, be discerning about who you see. I'm not recommending anyone or not recommending anyone, but make sure that you feel that someone's communicated with you, well, listened, well tested the ideas with you, and negotiated an outcome or a plan with you. Michael Shacklock (33:10): And I just worry that a lot of physical therapists are not doing so much physically. And, and I personally think that the body is important, that we know that disc hernias can hurt. We know that the prevalence of disc hernias in people with back pain is higher than those without back pain. And, and, and, but because there are studies that show that some people without back pain have disc hernias, therefore disc hernias are not important. I, I don't think that's to some extent biased. It's, you've gotta balance all the information and hopefully you come out of the evaluation with your health practitioner that you've got a good balanced view and tested a bunch of ideas with the health practitioner. Yeah. Michael Shacklock (33:47): Nice. Thanks. Well said. Michael. I, I, God, I, I want to do this just again and again and again, Michael Shacklock (33:53): But Zoom's gonna cut us off. Yeah, sure. Thank you. It's been, it's a pleasure. It's an absolute pleasure. Thank you, Sebastian. Thank you. Michael Shacklock (34:00): Yeah. Well cool. Thank you for being on. Alright. I hope that was helpful to everybody. Unfortunately in the middle of the podcast we had an audio glitch and I, I don't, I don't pay for Zoom 'cause I don't really use it that much. So it cuts us off in 40 minutes and that's kinda how it goes. So we lost a little bit of time there, but I, I think I wanna recap just a couple things here that he said. And I hope I don't misquote, but I think the takeaway that I thought was interesting is that obviously there's different types of sciatica, you know, there's different variants if you will. But also too, in that utopia type of scenario, like how often would we see somebody with this type of problem? And I would, I would echo the same thing because people who have full-blown pain associated with sciatica or the disc, or radiculopathy, whatever you wanna call it, it really hurts, you know? Michael Shacklock (34:52): And so we can supply some treatment on day one and it's transient effects and ideally we get them to do some things at home. But I think if I were the patient in that scenario, I would just, all things considered equal, I don't have to pay it all. And I just come in and see me for 15, 20, 30 minutes and just make me feel better. You know, and, and I think Michael's right with that two to three days a week would be pretty appropriate. 'cause When I've had family members with the same type of thing there's a lot more more in it, you know, because they're, they live really close by. They're not paying me for help, you know, they contact me on my phone. And there's a lot of questions, there's a lot of concerns. And there's a lot of things that I can do for them in week one. Michael Shacklock (35:34): And so hopefully if you guys are looking for some help, you find somebody who practices in a similar methodology that Michael's talking about. Again, if you're looking for a provider, I don't think at this point he has a certification for the people who've gone to his workshop. It's just educational. They show techniques and methods and so on. But I'm hoping very soon because I was kind of poking Michael with that, that it's, it is very hard to find people who are vetted for this type of management style. We do it here at Performance Place and if you guys are looking for somebody, we can certainly look around and see if we know any around, around your area. But it'd be really nice to know. I'd love to connect with the people who have taken his workshop. Michael Shacklock (36:18): 'Cause there are some step-by-step. And to be fair, everybody may do a slightly different treatment as well. There, there may be someone who does more soft tissue work. There may be someone who does more exercise, there may be someone who does some adjusting. But it's all based upon your unique presentation as well as what is found in your physical examination, like what's found in the assessment. So I hope that recap was, at least, enough to highlight the things that I found, you know, interesting in there, amongst many other things. So if he'd been suffering for this for a long time and you're not finding any relief, hopefully you find someone who can do a good job with you. So if you guys are looking for help from Michael or someone who's been helped who's learned from him, again, neurodynamic solutions.com subscribe to the podcast for more to come take care.
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Discover why sciatica often returns and learn essential tips to prevent it with nerve expert Michael Shacklock. In this episode, we dive deep into the causes of recurring sciatica, exploring both common and overlooked factors that contribute to this persistent condition. Michael Shacklock, renowned for his expertise in nerve mobilization, shares effective treatment methods and discusses the latest advancements in sciatica management.
Listeners will gain valuable insights into preventative measures, including exercises, lifestyle changes, and ergonomic adjustments to keep sciatica at bay. Shacklock offers practical advice for both healthcare professionals and individuals suffering from sciatica, emphasizing the importance of understanding nerve health and the role it plays in chronic pain.
Learn about the science behind nerve pain, discover how to manage and reduce sciatica symptoms, and uncover strategies to maintain long-term relief. Whether you're seeking to enhance your professional knowledge or find personal relief from sciatica, this podcast provides a comprehensive guide to understanding and tackling this common yet challenging issue. Tune in for expert advice, actionable tips, and the latest research on keeping your nerves healthy and staying pain-free.
Michael Shacklock's Contacts:
https://www.neurodynamicsolutions.com/
https://www.instagram.com/neurodynamics/
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FREE GROIN WEBINAR (LAYPUBLIC)
Sebastian Gonzales (00:41):
Hey, everyone, it's your host Sebastian, with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time at a show. Welcome. You've missed a lot of different shows in the past. I think we're around 200 and almost 90 right now. We've covered various things from sciatica to sports hernias to hip pain, to neck pain, nerves, and so on. Many, many, many different things. So I've had guests on, more guests on in the past, and as of the recent years I found it easier to just sit in my own little room here and just podcast with myself or some of my associate doctors. So I wanted to have Michael Shacklock about a year ago. I've had him on before, but we got lost in communication by email a little bit because he is on the other side of the world.
Sebastian Gonzales (01:24):
I've been to multiple of his workshops before. They're excellent. I've seen him speak multiple times. Every single person I know from chiropractor to PT to doctor or let's say medical doctor orthopedic that I've ever met, who's watched him speak the dang everything that he said was missing parts of the puzzle for treating people with sciatica. But I had no idea. I didn't know it. I remember one friend I've had on the show, Cody Dimak before. He said, you have to go to his workshop. Basically, if you know all the stuff that you know, this is a part that you cannot afford to miss if you're treating people with sciatica. So I thought we would call this podcast Why Sciatica Comes Back, tips from Michael Shacklock Nerve Expert. But gosh, I hope I don't change the name of the podcast, but I want it to be something really catchy and really precise for you guys.
Sebastian Gonzales (02:17):
Because here's the thing, I've met a lot of people who have had lower back pain before, just generalized lower back pain. And a lot of 'em heard of, have heard of the Mckenzie Method. Robin Mckenzie was a famous therapist who put together a methodology that really, really helped a lot of people. And then for other people who have been experiencing low back disc pain, a lot of you have heard of Stuart McGill. Stuart McGill is an excellent source of information. He's well researched. He's done a lot of research on his own in his lab, and he's written quite a few books. The books, I think both Robin McKenzie and or I don't know if Robin actually wrote it, but the McKenzie institute wrote it. And McGill wrote for the lay public, I think we're excellent. Mckenzie's is called Fix Your Own Back.
Sebastian Gonzales (03:04):
They have Fix your own neck, fix your own shoulder in various methods. Stuart McGill has The Back Mechanic, which I think is excellent as well. So there's these types of treatment methodologies that are synonymous with these problems. Even. I'm hoping one day to have Jill cook on for tendinopathies. And then you'd think that everybody who has these problems should probably know about these people and the information that they have come across in order to get themselves better, quicker. The sad reality is a lot of us end up having encounters as clinicians with people who have just not been doing the best things at the moment. You know, sadly and there's a lot of great information out there that we just have to become exposed to. So in this podcast, this is intended for lay public.
Sebastian Gonzales (03:54):
My intention is, I want to course Michael one day to write a book, almost like Fix Your Own Nerve. You know, like he doesn't just work with sciatica. He doesn't just talk about sciatica. He talked about the whole nervous system. And so I hope his information today is clean enough and informative enough to help you guys find that there is gonna be a solution, even if he tried other things before. And then I'm hoping one day that he actually puts together a provider list of people who have been through his workshops. I think we've talked on email a little bit, and he said that possibly over the next year, he will be a little busy. But I think from my struggle as a clinician, I've met people from different areas and they say, I have this sciatica.
Sebastian Gonzales (04:36):
Where should I go? You know, I wish I knew who took that workshop because I know everybody who's taken that workshop has the relevant information and can probably treat you really well with simple things and get you better faster. Now, if you're compelled in this podcast to think, you know what? I really need that type of care. I need help. I need to get better. I need to know all the things that I should be doing, should not be doing, and how to progress my care. What type of sciatica do I have? What are the causes? I need some education. You're thinking all that kind of stuff. You should find somebody who's been trained by Michael, if you can't see Michael himself, but certainly see someone who's been trained by Michael or his disciples. So you can go to neurodynamics solutions.com. Hopefully very soon he's gonna have a provider list up and find somebody who practices neurodynamics. If that listing's not up, you can certainly ask one of your local providers, Hey, do you, do you know anybody? You can even email us. There's a contact in the podcast as well. Just ask us if we know anyone around you, and we'll certainly do our best to find somebody. So without further ado, let's meet Michael. And here he has to say about all things sciatica. It's morning time, right?
Michael Shacklock (05:47):
Yeah, that's right. It's 9:30 AM
Sebastian Gonzales (05:49):
I thought we'd narrow the topic to sciatica more so than other types of nerve problems. And can you tell everybody why you're so qualified to talk about this topic?
Michael Shacklock (06:01):
Well, that's a really good question. I find it hard to answer because even though I've been studying the area for a long time Yeah. And treating patients the more you know, the more you realize you need to know. And so people say, you know, do you know a lot? Or you're an expert? Well, maybe, but certainly there's a lot more to know. And you know, even though we do know a lot, so I'm gonna say yes, I might be an expert, but let, let, let's talk about what we dunno as well. 'cause We need to learn, you know?
Sebastian Gonzales (06:31):
Okay. So, we're not gonna call you a guru or anything, right?
Michael Shacklock (06:35):
Oh, well, just Michael Shacklock. That's all I need. Michael .
Sebastian Gonzales (06:39):
Okay. So for everybody, just to give context again this is gonna be lay public based. So no big need to talk about clinical stuff. If there are clinicians listening, then they should know there's other podcasts. Taylor and Brett interviewed you very well recently too. So there's lots of other references and everybody should go to his course. So can you explain for the lay public, at least in regards to sciatic distribution, what's the difference between something like a neurodynamic problem and something more like, say a diabetes neuropathy? 'cause I think those are confused sometimes.
Michael Shacklock (07:15):
Yeah, yeah. First of all, what is sciatica? Sciatica is simply symptoms. And it could be pain or pins and needles or numbness itching. It could be all sorts of symptoms in the area that would cause it, it follows the course of the sciatic nerve. So usually it's the back of your, your buttock, right? It could be anywhere in the area, the back of your buttock, right down to the, to your foot on the back surface of your leg or your lower limb. That's generally where it is. It can vary a bit because people's anatomy is not completely uniform. And, and so that's the general description. The next step is what's it caused by, because as many possible causes, you could have a little swelling in your sciatic nerve that can produce sciatica to occur. But that's not the same as low back pain with a pinched nerve root by disc, for instance.
Michael Shacklock (08:08):
That can produce symptoms in the same area 'cause it's a pathway. And if you, if you think of a garden hose and you block, you block the garden hose, you can affect all the flow all the way down that hose. And so part of our, the issue from defining it for the layperson is what's, what's the cause it's a symptom in sciatic is just a symptom. The next thing is what's the cause? And that's where the health practitioner enters the picture and tries to establish that so they can plan a treatment. And so really it's symptoms in the area where the sci nerve goes. Yeah.
Sebastian Gonzales (08:42):
But can I, can I ask a couple questions on those two?
Michael Shacklock (08:44):
Yeah, of course. Is
Sebastian Gonzales (08:45):
Is it allowed to jump, does it need to travel all the way down your leg in
Michael Shacklock (08:48):
Continuity? No, it doesn't. No. No, it doesn't. You could have a buttock pain and a pain in your calf down the bottom of your leg, two areas, but it's coming from, could come from a similar general area. So that's technically a variation on sciatica. But people don't usually call it that because they're not so aware if the, if the, if someone's not, hasn't looked into the area in detail, they might say, I've got a buttock pain and calf pain. So what's the cause? Is it two things or is it one or so forth? So it doesn't have to be in continuity? No.
Sebastian Gonzales (09:18):
Do they have to, does it have to feel like electricity? Are there other different qualities?
Michael Shacklock (09:23):
No, no. That's a subcategory of sciatica. So if you imagine you have pain and aching down your leg, that could be sciatica. But if you had burning pins and needles or something like that, itching even, that could be a nerve called neuropathic, which means something that's related to definitely abnormal function of the axons. The little, the little, the nerves inside your nerve. But nerves have connective tissues around them as well, and they can cause aching. So different parts of the nerve can produce different types of responses from, and from a science or health perspective, we can define them differently. But for the umbrella statement, it's still sciatica. Different components of it though are different types.
Sebastian Gonzales (10:06):
Okay. And so I know there's a phenomenon with sciatica that comes on with movement. You know, when you lay down, it goes away or bends forward or you kick, you know. Mm.
Michael Shacklock (10:19):
And that's what I call neurodynamic pain. 'cause It's dynamic in the nerve. And a, a sort of more umbrella, or a superficial way of describing it would be movement-related nerve pain.
Michael Shacklock (10:32):
Mm-Hmm. . Okay.
Michael Shacklock (10:33):
And, and that's, that's reliant on the nerve being center to force, such as movement, stretch pressure and so forth.
Sebastian Gonzales (10:39):
So there I know that with some of the patients that I've seen, we've talked about what I described as tolerances. So some of the tests that you perform to identify how sciatica or not is, or what's causing sciatica and so on. And we talked about the tension. And like, I know a lot of people who have been down the rabbit hole of looking at things, they think about pinched nerves, and where's the pressure? Can I do nerve flossing? Is that right? Should I stretch my leg?
Michael Shacklock (11:08):
Mm-Hmm. ,
Sebastian Gonzales (11:10):
You know, how do you identify which things are good for them?
Michael Shacklock (11:12):
You know, I, I sort of, I feel like I'm on thin ice here because I watch, you know, you really watch social media. It's a way of life now. And unfortunately there's a lot of junk. And unfortunately the lay person is not aware of what is junk and what is accurate. And unfortunately, junk can be just low quality, good stuff, or it can be downright false. And, and so unfortunately the lay person is vulnerable to misinformation. And so if we go to flossing or nerve mobilization or stretching as you call it, there's a lot of stuff outside there saying, Hey, do this for society, do this. It might work and it might not. But the key is finding out why it's there and changing the why. And so nerve flossing is a possibility, but it's not always useful.
Michael Shacklock (12:05):
Nerve tensioning or slight and so forth, or stretching is also a possibility. But a lot depends on what kind of problem you have. For example, if you are limping into your pal practitioner's clinic because you have severe sciatica, my opinion is give the person pain relief. It's pretty simple. And 'cause that's what they want. The reason they have loss function is their pain. And so why are we applying force to a nerve that's already forced on from a, we know that from a most common diagnosis, disc hernia. So we're, we are applying force to that's already forced on, and we're supposed to help. Now over time that might be true, but today I can't sleep, I can't walk and I need help. And for me, unloading or taking force off the nerve root for pain relief to me is really important for, particularly in the early stage of saying, okay, I'm not saying that, the approach is generally wrong.
Michael Shacklock (13:08):
What I, but what I am saying is different stages require different needs to have different needs. So we can do different treatments along a spectrum of different mechanisms, of different ways of treating. And I, and I, it's like you, Sebastian, you know, this stuff, you'll be familiar with, okay, this person needs this type of treatment, even though it's still sciatica at, at different stages, the same medical, same classification, if you will, or label actually needs different treatments. And so that's why I really recommend that people see a health practitioner skilled in the area. Unfortunately, it's not always easy to know who is.
Sebastian Gonzales (13:42):
Yeah. Well, that's why I want you to make that directory
Michael Shacklock (13:45):
. Oh yes. That's, I take your point. I take your point. Yes.
Sebastian Gonzales (13:49):
So, but yeah, you're right. And, and I like the, the, since I am on social media and, and you know, we try to provide context to everything that we talk about, but the hard thing is, and, and it's like a common question that we always get is, so I have side, I guess what do I do? I don't know. What do you mean you treat sciatica? Yeah.
Michael Shacklock (14:06):
So yeah, I'm not saying we shouldn't put that stuff on the internet. I'm not saying that I'm just saying that, that, that the certain aspects are important and you are Right. Situation, context.
Sebastian Gonzales (14:15):
Yeah. So they're all, they're all situational, I feel like, and what you mentioned to that person that limps in is maybe different than someone who's fully functional, but they can't do, you know, just a few things, right?
Michael Shacklock (14:27):
Yes. The athletic sciatica can be treated differently from the severe pain sciatica. And one is a, the top one, the athletic one is just, just lost a bit, lost a bit of performance. And, and for example, a hurdler or a hundred meter sprinter or a performing artist, a dancer, a football player who's a peak performance, that a small problem for them is a big problem for them because, because their top 2% of their performance can be the difference between winning a competition and losing in the finals. And so for them, what I would see, I'm not, I'm no athlete. I'm healthy and reasonably fit, but I'm not an athlete. And so my top 2% isn't tested. So I would never know if I've got a 98% sciatic nerve, but an athlete would. And that's why they had to be treated differently. And that's why we have to go into performance strategies that are often more complex and more intricate for the athlete.
Sebastian Gonzales (15:28):
Okay. So that actually brings up a i'll, I'll tangent around. I know I have a bunch of questions written down here, but let's just say since you haven't tested your, you know, your upper limit of your, your, if you have that 5% sciatica, should you just never try athletic endeavors again and just you'll be okay? Or is it
Michael Shacklock (15:49):
You mean for, you mean for an athlete?
Sebastian Gonzales (15:52):
Let's just say for you because like, oh,
Michael Shacklock (15:54):
For me, yeah. Okay, Michael. Yeah, unfortunately, I've had experiences with patients where you, a good example, if someone had neck pain or something, and I treated them and they did really well, and they said, oh, by the way, I've had this achy brachy sciatica for about 10 years. It's only achy brachy. It's not really severe. It doesn't really stop me, but I do notice that when I do something extensive of this occasionally, can you fix it? So we did a history and he had a disc hernia and stuff like that. And, and I said, well, we'll try, well, unfortunately with him, every time I treated him, it was provoked and it didn't improve in the long term. And he may have had some adhesions or some other pathology or some other pain mechanism going on in his back or his nerves.
Michael Shacklock (16:39):
And a, we, after several visits, we just agreed that it's probably safer for him not not to push it. And that was partly based on him not needing much function, high function. But for an athlete whose income, particularly a livelihood is dependent on, on, on their performance, then I would be more willing to take it further. But with closer controls, such as different types, examination neurological, make sure their nerves are okay and so forth. So I think the decision is based on the person's needs, and that's close communication with the, with the, the sufferer. And, and what they're willing to tolerate and what is safe. Because remember, we help practitioners, our requirement is to be safe, even though the patient might say, just try it. We still have to say, we think it's dangerous that we shouldn't do it. And, and so the situation is really important and requirements.
Sebastian Gonzales (17:36):
Mm-Hmm.
Michael Shacklock (17:38):
So for me, I don't mind, I don't mind bent over and getting an extra stretch down the back of my leg. , I, I don't care because I'm not gonna push my side. Yeah. Can't be bothered. Yeah. Return on investment is low. ,
Sebastian Gonzales (17:49):
I, I, yeah, I remember there was somebody I, I, I was managing that. They were a really hard case for me anyways for the most part, things got better. And then, you know, we talked for every month or two and stuff would come back, and the amount of volume that they were doing with their sport was pretty high. They were not paid athletes. They're recreational, and that's really just what they want. It keeps them sane. And so I, you know, in so many words says it's assumed risk, you know, like, Mm-Hmm. Like, you, you don't, this isn't your day job. I know you love it, but like, you're gonna have to choose how much you wanna deal with, because it was just more highly provoked with what she was doing. But, so, but I've had some people too.
Michael Shacklock (18:32):
Yeah. Yeah, exactly. And I, I, and for the, for the listener who's not a health practitioner here unfortunately, licensed health practitioners are bound by law. And that's to protect the public from, from danger. And even though someone might say, don't worry, I'll take the consequences of something extreme and risky, we're still not allowed to do it if we know that it could place them at significant risk. And again, it's a cost benefit risk analysis, and that's between you and the patient, . So even though someone might say, oh, stretch the heck outta my nerve, I don't mind if it wrecks it. Well, we do. Mm-Hmm. . And so there's that very, particularly a high performance level that's where that 2%, 5% puts 'em into a window of risk in some people, not all, but some. And that's where, where, you know, the cost benefit analysis comes through and ethics.
Sebastian Gonzales (19:24):
Mm-Hmm. . Mm-Hmm. . Now you've mentioned the disc quite a few times here and I know that there's gonna be a lot of people who have been told they have disc injuries creating their leg pain or their sciatica. I know there's other types that you alluded to that there's what are the other causes? Can you talk a little bit more about a disc injury and how that affects it versus maybe another type of problem?
Michael Shacklock (19:50)
Yes, exactly. It's a really good question because even though the disc injury, a disc problem pressing on the nerve root is the most common cause of sciatica. It's not the only one. And if we jump to the assumption that it is Disc hernia, when it's something else, then things might go, not go well as you want. Disc hernia presses on the nerve root, it's a bulge in the disc, or specific terms, we're gonna call it a herniation, which is the kind of more official term. And it's like a bulge in your bicycle tire. And, it can press on the nerve root. Now that the nerve root needs blood flow it's a little bit like if I were to put a small tourniquet around my arm, the upper part of my arm might be okay for a while, but then finally the veins will start bulging.
Michael Shacklock (20:35):
It'll go blue, and it may start hurting. And so take the tourniquet off and it will relieve it. And that's kind of what's happening in some nerve root problems, particularly in the early stage. So if you get a lot of pressure, you can get pain, but you can also get loss of function like paralysis or numbness. And unfortunately, there's not a close relationship between the two. So if you get severe compression early, suddenly often you don't get much pain, and instead you get a weak limb, you, your foot might not be doing what it's supposed to or something like that. The other part, the other sort, is that it might not be so severe, but it's more irritating and it can be really painful. And, and so the really painful one doesn't always indicate that it is serious, which is a pain in the neck, not quite literally, but for the sufferer, I've got really severe pain.
Michael Shacklock (21:24):
The problem must be serious, but actually not always, we're actually, as a health practitioner, are actually more concerned about whether you're paralyzed. So if you're paralyzed from a pressure on the nerve root, then you, particularly early, you might end up, you, you might need to get a medical consultation or some sort of radiology or something. So for me, there are, again, there are different kinds. The more severe, more likely cause loss of feeling and loss of movement. But it's not a determinative pain. Pain is often related to irritation and inflammation and loss of blood flow. So it's, there are different, well, this is why I'm sort of impressing the audience here. That type of problem is important.
Sebastian Gonzales (22:03):
Some people decide to just wait it out.
Michael Shacklock (22:05):
Mm mm Yeah. Then wait it out. I personally find the wait out approach controversial. Now there are two for the listener.
Michael Shacklock (22:16):
There are different parts. We read research. We learn what the clinical trials show. We, you know, we, we learn what happens when you don't touch something for a long time, don't treat it. Mm-Hmm. , and a lot of problems are what we call self-limiting. So they, you heal naturally. But unfortunately, and, and that is common with sciatica, but unfortunately there's a, about 10 to 30% of people are still problematic after a year. And it's not very easy to predict who's gonna go in that direction and who won't. And so if someone has sciatica early, you could say, ah, don't worry, be happy. Just keep moving and it might work. Or you might need something quite specific from the health practitioner such as a chiropractor like yourself and, and so forth. And it might really help, but there's another group that if you leave alone, don't.
Michael Shacklock (23:10):
And my opinion is that that's, that's horrible because from, from a political perspective, we help practitioners that are not really doing very much. We, we are supposed to help people, and if we're told that we can't help you and it doesn't work, then that, that, that's a failure as far as I'm concerned. Mm-Hmm. . And so my opinion is that partly based on research, partly based on my experience, I would much rather see someone with acute severe or severe sciatica early figure out as best we can with what's going on, and give them the best advice that we can and give them home treatment strategies and some physical diagnosis and treatment, sometimes with their hands, et cetera, and sometimes with exercise and so forth. And that is influenced by what the practitioner sees. Mm-Hmm. , are you moving properly? Is it, it doesn't look like there's too much pressure on your nerve root. So then we'll show you some positions that can, which can at least transiently reduce that pressure and give you some symptom relief, some pain relief. And then as you're improving your pain, we can then give you training and so forth exercises and some physical treatment maybe to help optimize your healing.
Sebastian Gonzales (24:23):
Okay. Yeah. Actually, one thing that I've had people ask me a bit is, well, the position you gave me, it does feel good when I'm in it. I don't really have the problem, but it just comes back. So it really doesn't work. So what do you, what do you think, you know Mm-Hmm.
Michael Shacklock (24:39):
Like what's the point? That's what that Yeah, that's exactly, that's where the balance between transient benefit or temporary benefit has to be married with long-term needs. My feeling is if, or if, we did a recent pilot study on putting people into this position to relieve pressure on their nerve root in hospital. They arrived at the emergency at the hospital with severe pain and they were assessed them and, and so forth. And, we found that people who got, they've got this position to open their frame in and, and prove their pressure on their nerve root transiently did much better at a week than the ones who didn't get it.
Sebastian Gonzales (25:18):
Mm-Hmm. .
Michael Shacklock (25:19):
But that's not, that's not long term as you say. And so my feeling is keep adding to it like a yo-yo going upstairs and inserting other treatments in the process to address all the problems that relate to that sciatica.
Sebastian Gonzales (25:35):
Okay. I, I, I can't help but talk about that. Yo-Yo going up the stairs. Is that something that you did as you did? Were you a yo-yo man?
Michael Shacklock (25:43):
Mm mm mm Yeah. Yeah. Yeah. I was, I mean, in real life. I remember when I was a young kid buying this yo-yo thought, whoa, fantastic. This is, my parents probably thought, great, this kid's occupied for hours. .
Sebastian Gonzales (25:56):
Yeah. So, you know, my dad, he I forgot, I totally forgot. We saw him a couple weeks ago. And so we watched Tommy Smothers, I guess Tommy Smothers died, I think re recently, but he was the yo-yo man. Oh, wow. We used to watch this yo-yo video when I was younger. So we weren't super,
Michael Shacklock (26:15):
It's amazing what you can do with the, with a ball on a string or a on a string
Sebastian Gonzales (26:19):
. You can say that, like in that step by step type of scenario, does everybody have to do all the steps like the relieving position and then the exercises, or can they skip steps or can they just, you know, not continue up the steps and they'll be okay? Is there Yeah,
Michael Shacklock (26:39):
Yeah, exactly. I, I, I, I personally think that there are, we say in Australia where there's a lot of horse racing and gambling, you gotta pick the right horse for the right horse. If you get the soft course and it's been raining, then you gotta pick a horse that can run on soft turf. Or if you've got one that is strong on hard surfaces, then you gotta pick a horse that runs well on hard surfaces. So what I'm, what I feel is that the practitioner has to assess the person, figure out what, what the dominant problems are, and work with those dominant problems. And you might even jump tracks at some point. So I actually, we got stronger in this area really well, better than I expected, but this is what's lacking. Forget that for now. Just maintain it with a few exercises and without gonna add something different because this is the other, the, the next part that's lacking. So I'm okay about changing things and jumping steps as long as it's, you know, appropriate for the patient. Mm-Hmm, .
Sebastian Gonzales (27:35):
So for some of these step-by-step or general, general things that you give people over time I don't think I've ever asked you how, how long do you usually see somebody from early onset to like, you know what, you don't really need me anymore. How long does that usually take? How frequent is that touchpoint?
Michael Shacklock (27:55):
Hmm. Okay. Let's just say someone who limps in with severe pain. Mm-Hmm. . I like to see them probably two or three times in about three times in that first week. Say we're in, you know, we're in, in a utopia where we can do what we want, which mm-Hmm. Is rare. But, you know, we'll say we can, I like to go to the top and then dial it back. If it can't be done then I would like to see 'em two or three times, at least two or three times that first week. So we can give them some pain management strategies, how to unload their nerve root, how, how to move better and so forth, how to sleep better and so forth. And then move it to a couple of times a week with rehab strategies, some manual, some manipulations or manual therapy, whatever. And then, and then develop their understanding of the problem and not be frightened of certain things. And then go from there. It could take, I like to see a big improvement in the first one week, first week in the first one to two weeks. So I like to see, it doesn't always happen, but I'm willing to spread it out after that. And you might manage someone intermittently over a year. Mm-Hmm. depending on, depending on how they go.
Sebastian Gonzales (28:56):
Yeah. And, and so that was a, I'm glad you mentioned some of those points in there. 'cause I think I've met a lot of people who have said, you know what? I know this is, I know this is rehab, it's gonna take some time. And so it's okay that I feel bad for months, you
Michael Shacklock (29:09):
Know? Mm. Ah, yes. That's, that's really important because we're in a, we're in a world of re of velocity these days. And people want stuff quick. They want particular improvements. That's fair enough. But there are times, well, for example, just say someone who bends over, they, oh, I've got a back pain. Oh, it's not too bad. Then by tomorrow they had sciatic. It's really bad that that's an incident now that might be managed differently from someone who's, who's been, been building up, might be a repetitive task that's been building up that their pain's been building up. And sometimes we have to explain to the, to the, the sufferer look, a process got you here. So a process has to get you outta here. Mm-Hmm. . And so you might say, well, you've been bending over a fair bit. You haven't been moving very well over the last five or 10 years.
Michael Shacklock (30:01):
It's been loading you back in a way that we don't think is balanced. And that might be why you've got this problem. So we're gonna have to show you how to move differently or load you back differently. And that takes time for a tissue to change. The disc itself does not generally have a very good blood supply, so it doesn't heal very quickly. We know muscles can heal more quickly because they have good blood supply. We know that in the right situation, nerves have good blood flow. So they can often change quite quickly sometimes, not always. And so, but the disc not having very good blood flow means it's gonna take time to adapt to new load heals and so forth. And so one of my favorite statements to people who've got this problem is, look, remember that a process got you here. So a process has to get you outta here. Mm-Hmm. and the process is about if you're building a house, one brick at a time, one step at a time, finally you have a house. But it is step by step and piece by piece.
Sebastian Gonzales (30:59):
Mm-Hmm. I like that. That's a good process. Got you. Here, the process got you out. I know. Did you ever meet Dan John, by chance? You never Yes,
Michael Shacklock (31:07):
I have a couple of times actually. Did you really? Yes, yes I did. Yeah.
Sebastian Gonzales (31:10):
He, he, I thought he said, you're the sum of your, your habits, you know, maybe a little bit more brash than yours, but I like it.
Michael Shacklock (31:18):
Hmm. Yes. Ha. Habits, I mean, really a lot of health practices about changing habits.
Sebastian Gonzales (31:22):
Mm-Hmm. . So we have a few minutes here. Is there anything that you think is important to take home that we have not hit yet about?
Michael Shacklock (31:33):
I, I think, well, what from the, the, the, there's the listener's perspective, there's a broad range of services for, for sciatica. Mm-Hmm. And in physical therapy, particularly in the British Commonwealth countries, and it's sort of partly through the US as well, but more, more in the British commonwealth countries, a lot of physical therapists are reducing their emphasis on physical function or not function, physical causes. And they're going into the psychosocial meaning, look, if you're worried about your pain, then it's gonna make your pain worse. Which is kind of true to some extent. But I think you gotta be careful about overdoing some of either end of the spectrum, physical or psychological. And so I, I really worry that some physical therapists, so I can't only speak for our profession, are telling people, your disc is not hurting when maybe it is and you should test it.
Michael Shacklock (32:23):
Mm-Hmm. . So you, you're entitled to a decent physical examination and a decent interview with, with your health practitioner. And I get worried when people go to a health practitioner, they get a short time, they don't get a good explanation. The statements given to them about their problems are not tested. Mm-Hmm. That they just read a, read some paper, read a research paper, and tell a patient what to do. To me, that's not enough. Because we are paid and we have obligations and responsibilities to the patient, to the sufferer to give them the best we can. And so I would, number one, be discerning about who you see. I'm not recommending anyone or not recommending anyone, but make sure that you feel that someone's communicated with you, well, listened, well tested the ideas with you, and negotiated an outcome or a plan with you.
Michael Shacklock (33:10):
And I just worry that a lot of physical therapists are not doing so much physically. And, and I personally think that the body is important, that we know that disc hernias can hurt. We know that the prevalence of disc hernias in people with back pain is higher than those without back pain. And, and, and, but because there are studies that show that some people without back pain have disc hernias, therefore disc hernias are not important. I, I don't think that's to some extent biased. It's, you've gotta balance all the information and hopefully you come out of the evaluation with your health practitioner that you've got a good balanced view and tested a bunch of ideas with the health practitioner. Yeah.
Michael Shacklock (33:47):
Nice. Thanks. Well said. Michael. I, I, God, I, I want to do this just again and again and again,
Michael Shacklock (33:53):
But Zoom's gonna cut us off. Yeah, sure. Thank you. It's been, it's a pleasure. It's an absolute pleasure. Thank you, Sebastian. Thank you.
Michael Shacklock (34:00):
Yeah. Well cool. Thank you for being on. Alright. I hope that was helpful to everybody. Unfortunately in the middle of the podcast we had an audio glitch and I, I don't, I don't pay for Zoom 'cause I don't really use it that much. So it cuts us off in 40 minutes and that's kinda how it goes. So we lost a little bit of time there, but I, I think I wanna recap just a couple things here that he said. And I hope I don't misquote, but I think the takeaway that I thought was interesting is that obviously there's different types of sciatica, you know, there's different variants if you will. But also too, in that utopia type of scenario, like how often would we see somebody with this type of problem? And I would, I would echo the same thing because people who have full-blown pain associated with sciatica or the disc, or radiculopathy, whatever you wanna call it, it really hurts, you know?
Michael Shacklock (34:52):
And so we can supply some treatment on day one and it's transient effects and ideally we get them to do some things at home. But I think if I were the patient in that scenario, I would just, all things considered equal, I don't have to pay it all. And I just come in and see me for 15, 20, 30 minutes and just make me feel better. You know, and, and I think Michael's right with that two to three days a week would be pretty appropriate. 'cause When I've had family members with the same type of thing there's a lot more more in it, you know, because they're, they live really close by. They're not paying me for help, you know, they contact me on my phone. And there's a lot of questions, there's a lot of concerns. And there's a lot of things that I can do for them in week one.
Michael Shacklock (35:34):
And so hopefully if you guys are looking for some help, you find somebody who practices in a similar methodology that Michael's talking about. Again, if you're looking for a provider, I don't think at this point he has a certification for the people who've gone to his workshop. It's just educational. They show techniques and methods and so on. But I'm hoping very soon because I was kind of poking Michael with that, that it's, it is very hard to find people who are vetted for this type of management style. We do it here at Performance Place and if you guys are looking for somebody, we can certainly look around and see if we know any around, around your area. But it'd be really nice to know. I'd love to connect with the people who have taken his workshop.
Michael Shacklock (36:18):
'Cause there are some step-by-step. And to be fair, everybody may do a slightly different treatment as well. There, there may be someone who does more soft tissue work. There may be someone who does more exercise, there may be someone who does some adjusting. But it's all based upon your unique presentation as well as what is found in your physical examination, like what's found in the assessment. So I hope that recap was, at least, enough to highlight the things that I found, you know, interesting in there, amongst many other things. So if he'd been suffering for this for a long time and you're not finding any relief, hopefully you find someone who can do a good job with you. So if you guys are looking for help from Michael or someone who's been helped who's learned from him, again, neurodynamic solutions.com subscribe to the podcast for more to come take care.