© 2003 By Dr. Tim Maggs
I recently spoke with a runner who’s suffering with a severe case of sciatica. The pain got so bad she couldn’t sleep at night. I asked my usual question, “So what’s causing it and what are you doing for it?”, but her response was one I hadn’t heard yet. “I looked up a bunch of info on the internet, and evidently there is no cure for it”.
What is Sciatica
This misunderstood condition is proven by her finding that there is no cure. To understand sciatica, it’s important to understand some simple anatomy. The sciatic nerve exits the low back and travels down through the butt and down the back of the thigh. It continues down to the lower leg, but for the most part, all symptoms remain in the butt and back of the thigh. It is the largest nerve of the body, approximately the size of one’s little finger.
When that nerve gets pinched or becomes inflamed, it hurts. And, although I’ve never had the condition myself, I can only tell you it’s one of the more painful conditions that patients come in with. The first goal for anyone suffering with this condition is to locate the sight of irritation on the nerve. So, to ever say there is no cure for the condition borders on lunacy, since there are so many different causes.
The most common cause of inflammation of the sciatic nerve is due to injuries, restricted motion in the lumbar spine or abnormal weight-bearing, or weight distribution, in the low back (detected on standing, low back x-ray). This will produce an added stress on the sciatic nerve causing the pain. The second most obvious cause of the condition is tightening of the piriformis muscle, which is a muscle that runs straight across the butt. All of us have 2 piriformis muscles, and usually only one will go into a spastic state at a time. If you think of your muscles in the low back and butt as wires holding up a flag pole, when the pole leans one way, the wire on the opposite side tightens, and that’s what happens to us.
Now, there are other causes for this condition, but none are as common as the two causes above. Despite that fact, I had a patient come in about 15 years ago with sciatic pain, and on x-raying the low back, we found an abdominal aortic aneurysm that put him into surgery within 2 days. Whether the aneurysm was in any way directly or indirectly causing the sciatic pain is unknown, but doing a thorough work-up saved this patient’s life.
Determining the Cause
Most sciatic conditions are due to long term conditions. Structural imbalances place too much stress for too long a time on one or more areas of the low back, and the sciatic nerve gets pinched. The easiest way to find out what’s causing it is to have a structural, or biomechanical exam done. This consists of a foot exam, leg lengths, low back range of motion and a variety of other structural tests. The most conclusive test is the standing low back x-ray (front and side-view), because that shows the unique structural positioning and condition of the vertebrae and disc spaces. The most important findings are the sacral base angle, the weight bearing gravity line and the quality of the disc spaces. (For more information on any of these, feel free to e mail me).
In most cases, once the exact cause is learned, proper treatment, home recommendations and exercises can be determined. Since most of us stand or walk or run a lot of the time, symptoms may take longer than normal unless we eliminate the majority of these from our schedule.
In the case of a degenerative joint, the condition may take a little longer, since the inflammation is due to a lack of motion within the joint as well as a compromise of the amount of space for the nerve to exit the joint. But, with proper treatment and home recommendations, symptoms and the condition can be improved greatly.
A good approach to treating all conditions would start with ice treatments to the low back, since the majority of sciatic problems originate there. Secondly, the tennis ball technique on the hip muscles will greatly help to relax the piriformis muscle, thus reducing the stress on the sciatic nerve. Stretching this area could also help to take pressure off the nerve.
If custom orthotics are needed, they almost become a must, since the imbalance in the feet will continue the stress on the low back until corrected. And, as written about in prior articles, the orthotic should be flexible for the foot and fitted in a standing position.
Finally, with regard to training, running should only resume once all symptoms are gone. This may sound harsh, but sciatic problems can last a lifetime, and the only way to get rid of them and keep them gone is to “get rid of them” before you run. So, ice, treatment if needed, orthotics if needed and patience will get most runners back the soonest and keep them back the longest.