by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Sciatica is a very common problem... and jogging is a common exercise program for many people. This page will discuss the relationship between jogging and sciatica.
The sciatic nerve runs from the low back through the buttocks area and down each leg. It divides into the tibial and peroneal nerves at the level of the knees.
The sciatic nerve controls a number of muscles in the lower legs and provides feeling to the thighs, legs and feet.
The term sciatica refers to pain that radiates along the path of this nerve — from the back into the buttock and leg.
Sciatic pain usually goes away on its own in six weeks or so. In the meantime, hot and cold packs, over-the-counter pain relievers, and exercise or physical therapy can help ease discomfort and speed recovery.
The primary symptom of sciatica is pain. The pain radiates from the lower (lumbar) spine to the buttock and down the back of the leg. The most likely routes of pain are:
• From the lower back to the knee
• From the midbuttock to the outside of the calf, the top of the foot and into the space between the last two toes
• From the inside of the calf to the inner ankle and sole
The pain can vary from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts gradually and intensifies over time. It's likely to be worse with sitting, coughing or sneezing. Usually only one lower extremity is affected.
In addition to pain, other symptoms that may develop are:
• Numbness or muscle weakness along the nerve pathway in the leg or foot. In some cases, a person may have pain in one part of the leg and numbness in another.
• Tingling or a pins-and-needles feeling. This occurs most commonly in the toes or part of the foot.
• A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a rare but serious condition that requires emergency care.
• Back pain
• Urinary incontinence
• Fecal incontinence
Besides bulging or herniated discs, other conditions that may put pressure on the sciatic nerve include:
Lumbar spinal stenosis. The spinal cord is housed inside the spinal canal which runs the entire length of the spinal column. Thirty-one pairs of nerves branch off from the spinal cord. In spinal stenosis, one or more areas in the spinal canal narrow, putting pressure on the spinal cord or on the roots of these nerves.
Spondylolisthesis. This condition, often the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced vertebra may pinch the sciatic nerve where it leaves the spine.
Piriformis syndrome. The piriformis muscle originates in the sacrum and connects to the greater trochanter of the femur. Piriformis syndrome occurs when the muscle becomes tight or goes into spasms, putting pressure on the adjacent sciatic nerve. Active women — runners and serious walkers, for example — are especially likely to develop the condition. Prolonged sitting, car accidents and falls also may contribute to piriformis syndrome.
Tendonitis or bursitis affecting the insertion of the oburator internus and pyriformis muscles at the greater trochanter of the hip. This condition can go unrecognized by even experienced clinicians.
Rarer causes include malignancy.
Age-related changes in the spine are the most common cause of sciatica. Most people are likely to have some deterioration in the disks in the back by the time they reach age 30, and most people who develop herniated disks are in their 30s and 40s.
Occupation. A job that requires twisting the back, carrying heavy loads or driving a motor vehicle for long periods makes a person more prone to develop sciatica.
Physical activity. Although walking and jogging have been associated with an increased risk of sciatica, exercise in general has not. In fact, people who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
Genetic factors. Researchers have identified two genes that may predispose some people to disk problems.
Diabetes mellitus. Having this condition, which affects the way the body utilizes blood sugar, makes a person more likely to develop nerve damage.
Mild sciatica usually goes away given some time and patience. A physician should be consulted if pain lasts longer than six weeks, is severe or becomes progressively worse. During the acute phase of sciatica, a runner should not run.
If the pain lasts longer than six weeks or is very severe, they may have one or more imaging tests to help identity why the sciatic nerve is compressed and to rule out other causes of their symptoms.
Magnetic resonance imaging (MRI). This is probably the most sensitive test for assessing sciatic nerve pain. Instead of X-rays, MRI uses a powerful magnet to produce cross-sectional images of the back. The test can detect damage to the disks and ligaments as well as the presence of tumors. MRI is noninvasive and has no harmful side effects. During the test, a patient will lie on a movable table inside the MRI machine, which is essentially a large magnet.
In some cases, sciatica can result in permanent nerve damage, although this is uncommon. Depending on what's causing the nerve to be compressed, other complications may occur, including loss of feeling or movement in the affected leg and loss of bowel or bladder function.
For most people, sciatica responds well to self-care measures. Although resting for a day or so may provide some relief, prolonged bed rest isn't a good idea. In the long run, inactivity will make symptoms worse.
Here are conservative measures that may help:
Cold packs. Initially, the doctor may suggest using cold packs to reduce inflammation and relieve discomfort. Wrap an ice pack or a package of frozen peas in a clean towel and apply to the painful areas for 15 to 20 minutes at least four times a day.
Hot packs. After 48 hours, apply heat to the areas that hurt. Use warm packs, a heat lamp or a heating pad on the lowest setting. If the pain continues, a patient can try alternating warm and cold packs.
Stretching. Initially, passive stretching exercises can help a patient feel better and may relieve compression, but one needs to avoid jerking, bouncing or twisting.
Over-the-counter medications. Pain relievers (analgesics) fall into two categories — those that reduce pain and inflammation and those that only treat pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Motrin, Advil, others) which help alleviate both discomfort and inflammation, can be helpful for sciatica.
In some cases, the doctor may prescribe an anti-inflammatory medication along with a muscle relaxant. Tricyclic antidepressants, such as nortriptyline or amitriptyline and anticonvulsant drugs, such as gabapentin, also may be prescribed for chronic pain.
Physical therapy. With a herniated disk, physical therapy can play a role in recovery. Once acute pain improves, the doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries. Rehabilitation typically includes exercises to help correct posture, strengthen the muscles supporting the back and improve flexibility.
During the acute sciatic episode, a patient needs to rest and avoid impact causing exercise such as running and walking.
Once the acute symptoms have passed, it's important for a patient to engage in regular exercise. Exercise makes the body to release endorphins — chemicals that prevent pain signals from reaching the brain. Combining low impact aerobics with strength training and exercises that maintain or improve flexibility can help prevent degenerative changes in the spine. If a patient has not exercised before, they need to start out slowly and progress.
When conservative measures don't alleviate the pain within a few months, one of the following may be an option:
Epidural steroid injections. In some cases, the doctor may inject a corticosteroid medication into the affected area. They seem most effective when used in conjunction with a rehabilitation program.
Surgery. This is usually reserved for times when the neurologic deficits progress or pain becomes intractable.
Exercise is the most important thing a person can do for their back. One should pay special attention to the core muscles — the muscles in the abdomen and lower back that are essential for proper posture and alignment. Yoga and Pilates — an exercise technique for total body conditioning and rehabilitation — may be particularly helpful in keeping these muscles strong. For cardiovascular benefits, one can try using a stationary bike, treadmill, elliptical trainer or cross-country ski machine. Cycling outdoors is also recommended, but be sure the seat and handlebars are adjusted properly.
Clin Orthop Relat Res. 1996 Jul;(328):102-7.
Alternating sciatica while jogging: an early symptom of cauda equina tumor.
Inoue K, Hukuda S, Katsuura A, Saruhashi Y.
Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan.
Three athletic patients with cauda equina or lumbosacral cord tumor noticed, as an early symptom of the disease, alternating bilateral sciatica synchronized with each stride while jogging. Comparison with athletic patients who developed lumbar disc hernia suggested that this symptom was significant. The authors speculated that the mechanism producing this symptom is the inertial force induced while jogging, which acts on the tumor in its early stage, when it is still quite mobile in the intradural space. The diagnostic role of this symptom in cauda equina and lumbosacral cord tumor should be recognized.
• Case Reports
PMID: 8653942 [PubMed - indexed for MEDLINE]
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