INJURIES: Sciatica: The Nerve!

Sciatic pain is not a diagnosis, but a symptom of another problem. With a little patience and understanding, runners can find the root cause and treat the condition.

Sciatica is a recurring problem for runners and many other athletes. What is it exactly, and why does it affect so many of us? The first thing to know, according to Dr. Mark Bayley of the Toronto Rehabilitation Institute, is that sciatica is not a diagnosis but a symptom of a larger problem. Characterized by burning pain down the lateral side of the leg and on the top side of the foot, sciatica is most commonly caused by pressure on the sciatic nerve.

“The nerves in L5, S1 and S4 [vertebrae] converge into one nerve-the sciatic nerve, which passes under the glutial muscle under the pelvis. The muscles swell, creating pressure on the nerve,” explains Dr. Bayley. “You have to ask yourself what you’ve done that has caused the nerve pain.” What he means is that sciatica is not linked to one specific set of circumstances. They can vary, and that is why Dr. Bayley prompts runners to take a close look at the events that led to the sciatic condition.

The most common cases of sciatica are located in the spine: nerves in discs in the back compress the discs themselves, causing them to bulge out. “The bulging of the discs is really a kind of lubricating gel around the discs that, once compressed, gets pushed back on the nerve and irritates the nerve path,” says Dr. Bayley. A case like this is typically brought on by lifting-and the result is often a classic herniated disc problem.

In runners, says Dr. Bayley, the constant pounding can cause this pain-though it’s not as common as being brought on by lifting. “Runners often get sciatica quickly and easily because typically they don’t have a lot of padding on the bum.” Muscles get tight from running and squeeze in on the discs, affecting the sciatic nerve. This tightening is often known as piriformis syndrome, which leads to sciatic pain. Dr. Bayley makes clear that runners are not likely to get sciatica from running alone-usually the nerve path gets damaged by something else, and running further exacerbates the problem.

But Dr. Bayley is certain about one thing: runners with the condition need to quickly determine how they got it, so they can make wise decisions about activity and treatment. “If it’s been caused by muscle pain, you can often alleviate the discomfort by stretching-and you can often run through the problem,” he says. Stretching the muscles to free the nerve from pressure is key. And combined with stretching, short runs can be tolerable.

If the sciatica has been caused by nerve damage in the lower back (a herniated disc) or in the gluteal muscles, it’s a little more complicated, Dr. Bayley warns. “If the nerves in your glutes are injured, it will be very difficult to run: since you have only one foot on the ground at a time, the glutes are what pull your leg through. So if the hip abductors or pelvic stabilizers are weakened through nerve damage, running will be very painful.”

Montreal-based massage therapist, reflexology teacher and yogi Wanjira Njenga contracted sciatica during the 2008 Albany Marathon in New York state. A hamstring flare-up during the race led to six months of a variety of therapeutic measures and customized exercise programs. Fortunate in her misfortune, Njenga sustained injury to the piriformis muscle, so while the healing process was long, a herniated disc would have been worse. She saw an osteopath, a physiotherapist and a host of other paramedical and medical professionals, and used a buoyancy belt for pool running and an elliptical trainer that kept her moving and in reasonable shape. “Because I used the pool so much, when I got back to running,” she says, “it was like I had never stopped. What I learned is that I can’t afford not to stretch.” A certified yoga instructor, Njenga also suggests the pigeon pose (see exercises) to relieve sciatic pressure, but emphasizes that a good warmup is necessary before taking it on.

While Njenga was not able to keep up her running program, she was certainly able to stay active. Dr. Bayley favours this approach but emphasizes that it is imperative to know the root of the pain. “Try running through it,” he says, “but be aware of three red flags.” If you have any of these issues, stop running and seek treatment:

1)      If your foot is dropping, it means the pain is associated with nerve damage in the lower back;

2)      If you have night pain, it suggests nerve damage in the lower back. If your pain is relieved by lying down, that’s a strong indicator that it’s a muscle issue and not a back or nerve issue; and

3)      If you have a lack of control of your bladder or bowel, it indicates severe nerve damage and means you must get to the hospital.

Though sciatica from a herniated disc in the lower back is much more serious, Dr. Bayley does not want to give the impression that healing is illusory and surgery likely. “That’s far from the truth. Discs can heal but you need to take it easy and build yourself up again.” He suggests doing McKenzie exercises to encourage the disc forward and relieve pressure on the nerve roots, as well as stretches for the piriformis muscle (see exercises).

“Runners with sciatica tend to do better because they are active and often lighter. It’s much harder to relieve pressure in the discs and nerves if you are heavy and inactive,” he adds. But of course, the best approach is a preventative one. Stretch after you run, says Dr. Bayley. Commit yourself to core strengthening exercises to take pressure off the back and keep it limber and strong. “You can be fit for running but not so fit in an all-over-body way,” he adds. “So strength-building is important, especially as you get older. You need to be stable when you run-if you are not running smoothly, there is more chance of injury. Core strengthening will give you that stability, and have myriad other benefits too.”

EXERCISES

McKenzie Exercises for Lower-Back Pain

1.  Flat prone position:  On a mat, lie on your stomach with your arms at your sides and head turned to one side. Hold for 5 to 10 minutes.

2.  Prone on elbows:  Lie on your stomach and put your weight on your elbows and forearms and your arms at a 90-degree angle. Keep the lower back relaxed and hold for 5 to 10 minutes.

3. Prone press-ups: Lie on your stomach with your arms straight and palms shoulder-width apart on the mat. Slowly raise your shoulders, keeping your hips on the mat and letting your back relax. Gently lower your shoulders. Repeat 10 times.

4.  Progressive extension using pillows: Lie on your stomach with your forearms out front and place a pillow under your chest. After a few minutes, add a second pillow. If you don’t feel any discomfort, add a third. Stay in this position up to 10 minutes. Remove pillows one at a time every few minutes.

5.  Standing extension: While standing, place your palms at either side of the small of your back and slowly lean backward. Hold for 20 seconds and repeat. You can do this exercise several times during the day, especially after long periods of sitting, heavy lifting or forward bending.

Piriformis stretches

1.      Sit upright with one leg straight out in front. Grab the angle of the other leg and pull gently toward your chest. Hold for 20-30 seconds and ease the leg back down. Repeat with the other leg.

2.      Lie face down on a mat with one leg bent under your chest and the other leg straight out behind. Slowly lean toward the ground and hold for 20-30 seconds. Repeat with the other leg.

Carolyne Van Der Meer’s knee injuries last year were followed by a case of sciatica caused by a skiing accident. She’ll be the first to tell you that stretching is imperative.