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

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

When Things Don’t Go As Planned

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

A lot of people think they have it but they really don’t.
Pain in the glute or down hamstring doesn’t automatically mean sciatica.
Sciatic nerve is really more from back of the knee down.
Sensory innervations of the sciatic nerve is really only beyond the knee (distally–knee to foot), according to some research.
- But this is debated and some disagree.
Common to misdiagnose sciatic pain (when it’s in fact something else).
- Sclerotogenous pain– this is a type of referred pain from lumbar spine/sacral area in the glute area or even hamstring that can get mixed up with sciatic pain.
- Whereas sciatic pain is more like numbness, tingling, sharp-stinging-type pain all the way down into calf and foot
- They both can come from lower back issues or piriformis, muscle imbalances, etc.
If you do have sciatica—the #1 muscle involved is the piriformis muscle, in which the sciatic nerve can be in different places even going through this muscle in some people.
Who is susceptible? What are contributing causes?
- Whether it is sciatic or something else, a lot of the causes and treatments are similar; don’t get too wrapped up in terminology if the roots to healing are all similar.
- Hormonal connection, i.e. sex hormones and stress hormones—muscles of pelvis can be affected when over-stressing the body in this way that leads to hormonal imbalances.
- Those with better hormonal status have better core strength and thus likely to have better performance.
- Or also an inflammatory condition or lack of offsetting inflammation in the body, including dietary stresses.
- The role of biomechanics and form in all of this.
Path to healing
- Steps to healing will depend on the patient you may not need to dive into in-depth testing right away, and maybe you start with the mechanics and then see if influence with hormones.
- Assess the person: some are more hormonal based and others more mechanic based.
- Correlation between sciatica with menstrual cycle? Not so clear compared to hip pain for example.
Trigger point therapy
- No static stretching, usually just irritates things more (despite temporary pain relief).
- Trigger point work in hip area: under the sacrum, piriformis muscle; this can even help balance things out for back pain relief.
- Beyond that, depends on level of pain.
Why is it sometimes we flare up and sometimes we’re not only fine but perform so well? Because there are a lot of things that go into this beyond the obvious, e.g. were we really stressed leading up to the issue/flare up?
Piriformis or sciatic pain could also be an issue on the OPPOSITE side of where the pain is being felt—work on that opposite to relieve and relax the side in pain.
Supplements
- Healthy fats, animal-based fats.
- Vitamin A & E—main precursors to reproductive hormones which inadvertently helps these issues.
  - Timestamp: starts at 28:00
  - Types and IU vs mcg of Vitamin A, conversions and confusion cleared!
  - Eg) 1,000 IU D is 25 mcg
  - Vitamin E is in milligrams, 400 IU of E is 268 mg
  - Vitamin A is RAE 2000 IU of A is 600 RAE (0.3 multiplication)
  - It’s also about building nutritional status over time
Usually with sciatica it’s something brewing for a while, such as pelvic floor dysfunction, poor breathing technique (mouth/shallow breathing).

Part 2: Healthy Perimenopause and Menopause

What is a normal age and timeframe for perimenopause/menopause?
- Is it normal for someone in their late 30s early/ 40s to be experiencing this transition? Not so much.
- 40-45 years old is too young to be starting to experience symptoms and changes in one’s menstruation.
- Late 40s to 50 years old is about the normal time.
Common and not-so-common symptoms & cycle changes
- The biggest thing is that you don’t ideally want to experience drastic changes in how you feel, e.g.
  - Hot flashes, mood swings, body aches, low libido, vaginal dryness.
- The problem is when one’s menstrual cycle changes ALONGSIDE these other symptoms, e.g. longer cycles or missed periods.
- Often, worse symptoms are seen in those women who start this transition at an earlier age.
- Possibly a stress correlation or some underlying
- If there are menstrual cycle changes without (perimenopause-type) symptoms that could be something else.
“Normal” perimenopause/menopause
- Late 40s to early 50s
- More often when self-care and overall health is present, this is when symptoms may be subtly present but not drastic, very manageable.
- This also is usually when women start this transition later in life rather than too early and things tend to progress more smoothly, in his experience.
Hormone levels (before and after)
- You still make these sex hormones just less of them.
- Health of adrenal glands through your cycling years can help determine how early or late you go through menopause and how you actually feel.
- If your adrenal glands are stressed out and you’re burnt out this could make perimenopause/menopause feel much worse.
- Progesterone/cortisol connection; relative estrogen dominance.
- Estrogen & receptor issues.
  - May need to detoxify estrogen, may need to supplement with progesterone, balance takes time.
Stalling or reversing perimenopause/menopause? Possible?
- If you’re young and experiencing this you may be able to do something if you catch it very early and ease symptoms.
- Hot flashes have to do with liver detox (1-3 AM timeframe).
- Sulfation, glucuronidation
- Estrobolome
  - Focus on gut health, nutrition, stress balance, supporting detox pathways, etc.
Supplements
- Vitex aka chaste tree berry for progesterone support and hormonal balancing.
- Black cohosh (but NOT when pregnant).
- Jerusalem Artichoke–break down estrogen, PMS, breast tenderness, prebiotics, no side effects, etc.
- Cruciferous veggies, broccoli sprouts
- But if you always have to take an herb, you’re not getting to root causes or via lifestyle and nutritional support.

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