Sciatic Nerve

Sciatic Nerve

Sciatica is one of the most loosly used terms when diagnosing symptoms.  I want to spend a little time providing some background to this diagnosis.

Sciatica is a very broad term given to any type of pain, numbness, weakness, or tingling sensations felt in the lower back, buttocks (usually only one-sided), or down into the leg and/or foot (usually only one-sided).  The term sciatica, itself, is not a diagnosis but a catch-all term for any of the symptoms listed above.

Pain, numbness, weakness and tingling arise from pressure or irritation on the sciatic nerve itself or from pressure on the nerve roots that make up the sciatic nerve (4th and 5th lumbar nerves and 1st, 2nd and 3rd sacral nerves).  Pressure or irritation on any of these nerves could arise from the following different conditions:

  • Spinal Disc Herniations/Protrusions: Disc herniations and protrusions can result from two common occurances.  The first is when the fluid that resides inside the discs of the vertebrae leak outside the disc into the nerve canal.  The second is when the outside cartilage of the disc bulges into the nerve canal.  Each of these places inflammation and pressure on the nerve roots of the low back, resulting in sciatic symptoms.
  • Spinal Disc Stenosis: The canals of the vertebrae in which the nerve roots (that form the sciatic nerve) exit sometimes begin to compress the nerve root that travels through this already tight space.  Bone spurs, inflammation and vertebral misalignment can cause this narrowing that results in friction of the nerve with different types of movement of the body.  Sciatic symptoms are the result.
  • Piriformis Syndrome: Around 15-20% of people’s sciatic nerve runs between their piriformis muscle deep to their glutes in their buttocks.  Overuse of this muscle can result in a tightening of the muscle around the nerve or an inflammation/pressure of the nerve that results in sciatic symptoms.
  • Trigger Points: Trigger points are knots that develop within muscles that are chronically overused or partially damaged from micro-tears.  The muscle becomes ischemic (lacks oxygen) and develops  these nodules that refer pain along the same nerves that are affected by sciatica. 
  • Personal Habits: There are many personal daily activities that can cause these symptoms.  For example, sitting on a wallet in your back pocket, crossing your legs while sitting, and wearing heavy tool belts and/or clothing that places pressure on the lower back.
  • Pregnancy: When the uterus presses on the sciatic nerve, these symptoms can sometimes arise.  Or sometimes the weight of the uterus can cause pressure or misalignment of the vertebrae that compresses the spinal nerve roots, resulting in symptoms.

Since sciatica is a broad term, the true causes of the symptoms need to be diagnosed.  I spend time with patients performing specific orthopedic tests that reveal the cause of the symptoms and then create a treatment plan based on the diagnosis.  Chiropractic adjustments of the low back and pelvis are extremely important in resolving the symptoms.  Soft tissue pressure/massage to select muscles (ART), traction, stretching, ergonomic advice, and lifestyle modifications are all common elements to the common treatment plan.

In the prevention of sciatica,

Dr. Phil Kotzan, DC

Lateral Epicondylitis (Tennis Elbow)

Welcome to Silicon Valley, land of the cubicle and all of the repetitive stress injuries that are associated with working behind the desks that reside within these cubicles.

One of the symptoms I am most commonly asked to examine and treat in the office is pain of the lateral elbow.  Lateral elbow pain that is most commonly aggravated with wrist flexion or resisted wrist extension is commonly called Tennis Elbow, or more appropriately called Lateral Epicondylitis.

The current explanation of the pain along the lateral elbow involves a process that results in angiofibroblastic hyperplasia of the extensor carpi radialis brevis muscle’s origin.  Quick, repetitive extension of the wrist with rotation outward can cause micro-tears of this muscle that results in damage to the tissue.  This damage is repaired with scar tissue that limits the muscle’s ability to contract and elongate properly, elliciting sensations of pain.

This condition can be diagnosed with a few simple tests.  Resisted wrist extension, while the elbow is extended, that triggers lateral elbow pain is one test.  Resisted middle finger extension that causes lateral elbow pain is another indicative diagnostic test.  And a third simple test is to pick up a chair by its back with an extended elbow and an inward rotation of the hand.  Pain of the lateral elbow upon lifting the chair is also indicative.

Treating Lateral Epicondylitis is different for every provider, usually resulting in mediocre results at best.  I have been using a very unique approach that has been extremely successful at reducing, even usually fully alleviating, patients’ lateral elbow symptoms.  My approach to treating these symptoms is four fold:

  1. Icing the lateral elbow during it’s most inflamed acute phase and decreasing the use of the elbow in the activity that causes the pain is an important start at tackling the symptoms.
  2. As the inflamation decreases, using Active Release Technique (ART) (see blog entries on this technique) to selectively target the problematic muscles and  repair the micro-torn muscle fibers so that they contract/elongate to perform correctly.
  3. I then adjust (see blow entries on this procedure) the bone of the elbow called the radius so that the elbow moves through its proper range of motion.
  4. And finally, other lifestyle patterns might need to be examined.  Wearing a brace that limits wrist and/or elbow motion might be beneficial.  I always provide a very specific wrist and elbow stretching protocol to prevent the symptoms from returning.  And if tennis is actually the cause, adjusting the patient’s serve, swing, or raquet is important.

Studies have shown that cortisone injections, the most commonly recommended treatment by medical doctors, may be effective in the short-term.  But long-term studies show that the most effective treatment plan possible to permenantly alleviate lateral elbow pain is the four-step treatment plan that I’ve detailed above.  I stick to evidence-based research and deliver the most effective treatment plans possible.

If you believe you may have these symptoms and would like to consult with me, please give me a call.

Looking to reduce your elbow pain,

Dr. Phil Kotzan, DC

Healthy 2009!!!

The most important New Year’s Resolution of 2009 should be striving to improve one’s own health and the health of those around them!

  1. Visit your chiropractor to work on healthy goals for this new year (which daily stretches to incorporate, how to lose your low back pain, how to improve your shoulder’s range of motion, etc.).
  2. Incorporate more fruits, vegetables, and nutrients into your diet (Ask Dr. Kotzan about the fantastic Isagenix nutritional line of products).
  3. Incorporate laughter into your daily life.
  4. Create a daily or weekly exercise routine that fits your schedule and preferences/needs.
  5. De-stress your life with relaxation, meditation, and time with family/friends.
  6. Incorporate daylight into your daily routine by being active outside in some sort or another.  Most of us lack sufficient levels of Vitamin D.  15 minutes in the sun daily provides the amount we need.
  7. Pamper yourself weekly.  Take your pick: massages? chocolates? vacations? personal time?
  8. Give to charity/community. There are plenty of groups in our area that help others find the healthcare they personally need.
  9. Learn something new.  Keep your brain-function strong.  Make it a daily habit to be on a path of knowledge.  Through daily interactions or websites that provide new facts, there are plenty of ways to improve one’s knowlege.
  10. Be happy.  A positive attitude means everything.

Have a healthy 2009!

Dr. Phil Kotzan, DC

What Is Chiropractic?

Everyone has heard of a chiropractor and knows people that have been to a chiropractor.  But what exactly is chiropractic?  And how can a chiropractor use his or her skills to help you?

The answer to these questions rests in an understanding of the anatomy and physiology of the body. Our bodies are composed of just over 200 different bones and around 400 individual joints.  Each of these joints serves as a means to moving our bony skeletal frame that supports us.  With so much movement happening between the bones of a joint, lots of wear and tear occurs.  Many of our daily movements can lead to an increased amount of stress to the joint, often associated with repetitive actions (such as typing, bending at the waist, sleeping and reaching above the head).  Stress on a joint leads to the muscles of that joint being pulled unequivocally (muscle overuse and tension) and eventual restrictions of the joint that don’t allow it to move in its normal range of motion.  A lack of movement causes inflammation.  And inflammation around a joint has the potential to cause impingement of the local nerves.  Impingement of local nerves is the central cause to a tremendous amount of a person’s physical conditions.  These conditions include:

  • Neck, Back, and Extremity Pain, Tightness, and Numbness
  • Sciatica
  • Migraines
  • Carpal Tunnel
  • Shoulder pain
  • Tennis Elbow
  • Etc.

Chiropractors assist the body in reducing the inflammation around the nerves.  Chiropractors perform a procedure called an adjustment, which is a minor force that is applied with their hands or a tool into any of the body’s joints that are in need of increased movement.  Quick forces into the joint provide the movement the body needs in that joint to restore movement to a joint, therefore reducing the local inflammation and decreasing the spasm of the local muscles around the joint.

Many chiropractors, like myself, use a wide variety of techniques to perform the adjustment.  Personally, I use the following forms of adjusting styles:

  • Diversified
  • Activator
  • Flexion-Distraction Traction
  • SOT Blocks
  • Gonstead

I also use different techniques, such as Active Release Technique (ART), strain/counterstrain, trigger point therapy, myofascial release, and cross-friction massage to provide movement to the body’s muscles that have become restricted or injured.  This also allows the joints to which these muscles are attached to move more freely, therefore reducing the local inflammation.

Rehabilitation is a big part of my treatment plan as well.  I highly engage patients in stretching, posture-correcting, and balance routines that foster proper muscle function.  Cryotherapy (ice therapy), exercise promotion, disease prevention, dietary advice, and stress reduction are all incorporated into my treatment plans as well to attain superior levels of fitness that prevent muscle imbalances and poor joint function.

Please contact our office if you are in any need of an evaluation of your joints and the quality of their movement, especially in relation to your health.

Dr. Phil Kotzan, DC

Active Release Technique (ART)

Low back pain doesn’t seem to be resolving?  Migraines driving you nuts?  Annoying elbow pain?

As a chiropractor, I know there is nothing more important than maintaining proper joint movement (adjustments) for superior joint health and, therefore, overall health of the body.  But unlike many chiropractors, I have incorporated a technique along with my adjustments that takes healing to the next level…Active Release Technique (ART)

ART is a systematic approach to examining the body’s muscles, ligaments, tendons, fascia, and nerves.  When a muscle or any other soft tissue becomes overused, it suffers one of three different fates: it is deprived of oxygen, it is “pulled,” and/or it accumulates micro-tears.  These problems lead the soft tissue to develop a thick scar tissue that prevents the tissue from being fully stretched to it’s normal levels.  This results in a lack of range of motion, a decrease in strength, increase in pain and possible nerve involvement if the nerve becomes impinged as well.  And many people can relate to the consequential types of symptoms one suffers (of which ART can treat):

  • Low Back Pain 
  • Neck Pain
  • Migraines
  • Rotator Cuff Injuries
  • Carpal Tunnel
  • Whiplash Injuries
  • Tennis Elbow
  • Shin Splints
  • Plantarfascitis
  • Ankle Injuries
  • IT-Band Tightness

Upon the initial examination of the patient and each subsequent visit after, Dr. Kotzan uses his hands to feel the texture, the tightness, and the movement of the soft tissues causing the symptoms.  A very specific application of tension at a very specific depth and direction is then applied to the tissues that need to be addressed while the patient is directed to perform very specific movements.  There are over 500 patented ART moves for treating various soft tissue symptoms. 

A typical treatment lasts about 15 minutes.  Most commonly, results are seen after the first treatment.  Results that are accomplished with ART are permanent and non-invasive.  Sure beats surgery, doesn’t it?

Please call with any questions: (650)593-3500

Let the joints and tissues keep moving,

Dr. Phil Kotzan, DC


Vitamin and Mineral supplement sales have skyrocketed in the last few years.  More and more lay people are beginning to explore more ways to improve their symptoms with conservative health care options, especially through nutrition.  These people that have caught on to the nutrition wave are discovering that we truly are what we eat.

The Council For Responsible Nutrition has come out with a report that 150 million Americans are now taking dietary supplements.  This is surprising when the last few months have painted a bleak picture of the benefits of supplements.  Vitamin C and E were not recently found to have any effect on lowering heart disease, vitamin E was shown to possibly raise bleading strokes, and vitamin D and calcium were not shown to improve the risks of breast cancer.  So where does that leave one to look for help when trying to follow what so many people suggest, incorporating nutritional supplements into a daily diet?  Read some expert opinions below:

Dr. Andrew Weil, health guru/coach, Arizona Center for Integrative Medicine, www.drweil.com:  Dr. Weil suggests taking a daily dose of multivitamins, vitamin D3, magnesium, a product called Juvenon, Coenzyme-Q-10, and warns men against taking calcium and iron supplements.

Dr. Walter Willett, chairman for the Department of Nutrition at Harvard School of Public Health: Dr. Willett also recommends a daily multivitamin and vitamin D.  Like Dr. Weil, Dr. Willet warns against men taking supplemental calcium to avoid possible risks to prostate cancer.

Dr. Christiane Northrup, author of “The Secret Pleasures of Menopause”: Dr. Christiane states that she recommends a daily antioxidant supplement, fish oil with omega-3 fatty acids, calcium, magnesium, vitamin D, coenzyme-Q-10, and warns post-menopausal women not to take iron–to prevent heart disease.

As with most supplements, the product never has the same effect on every single person.  It is important to work with your doctor to come up with a proper nutritional path that works for you.  I personally recommend a product line put out by a company called Isagenix.  Most people’s symptomology can be addressed with these products.  I’d be happy to consult with you about how we could incorporate Isagenix or any other supplements into your treatment program. 

In Great Health, Dr. Phil Kotzan, DC


With only a couple of weeks left before Thanksgiving, I begin to think about the thanks so many of my patients give to better health through chiropractic care. 

Some patients rely on the healing science of chiropractic to help them handle their daily symptoms.  The pain, numbness, and tingling sensations they experience are enough to prevent them from living their daily lives with full function.  Certain movements cause them agony that is unbearable.

Other patients rely on chiropractic treatments to maintain their high level of fitness.  Although these patients don’t have any debilitating symptoms, they rely on my care for minor areas of concern they have over how to stay at their peak level of health.  They want to relieve every trace of muscle tightness and possible nerve impingement to keep them at the top of their game. 

Although two very different groups of patients, they are thankful for services that cover each of their needs. Their health is restored to an optimal level.  I’m able to look back and be satisfied with the type of treatment that I can provide for such a large array of wants and needs in terms of health care.  Seeing so many of my patients thankful makes me thankful for chiropractic health care, a model health care approach to so many of today’s healthy-lifestyle barriers. 

Happy Thanksgiving,   Dr. Phil Kotzan, DC


Welcome to the Kotzan Chiropractic blog.  Expect many exciting and informative blog postings to follow.