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2683 Views 8 Replies Latest reply: Feb 20, 2012 11:03 PM by lindsayleeb
kdarold Amateur 24 posts since
Sep 8, 2009
Currently Being Moderated

Dec 12, 2011 9:25 PM

I need some siatic advice, por favor

Maybe this question has been answered a hundred times over...but I'm having bouts with my siatic nerve flaring up and it is literally a pain in the butt,  pun intended.  My question is to train or lay off.   I'm getting conflicting advice from everyone I sob my story too!  Anyone with some experience with this, I'd gladly take your advise.  Thanks,

Pain in the butt, Katie 





Every step of the Journey is the Journey
  • SteveBikeRun Legend 455 posts since
    Aug 3, 2010
    Currently Being Moderated
    1. Dec 13, 2011 7:55 AM (in response to kdarold)
    I need some siatic advice, por favor

    Katie:   I am currently dealing with sciatica that began in mid-July.  I had severe pain in my right buttock area, right calf and numbness in the big toe area of my right foot for about 10 days.  I was unable to lie down for any period of time for several nights without walking around my house for 30-45 minutes until the pain subsided (Tylenol and Vicodin helped).  The discomfort is significantly less now, but still noticeable after five months.  A CT scan showed some disk degeneration and bulging in the lumbar area (L4-L5), causing the pressure on the sciatic nerve.  My initial treatment was several weeks of physical therapy and I am continuing to exercise to strengthen my core and glute areas. 

     

    Although there has been improvement, I am still feeling mild to moderate discomfort and soreness in my right leg and foot, especially after exercise.  Therefore, I am also now seeing a chiropractor to correct a posture problem (shoulder and hip higher on one side than the other) that may be a contributing factor to the pressure on the sciatic nerve.  I have just started this treatment, so I can't report progress yet, but I expect improvement over the next few weeks.

     

    I suggest that you see either an orthopedist or a chiropractor for X-rays and/or a scan to determine the cause of the problem.  It won't go away by itself.

     

    I am also posting regularly on the "50 and Over; 5K and Beyond; What Are Your Challenges?" thread in this forum.





    --Steve

    Completed in 2012:

    The Qualifier HM, Midland MI, May 2012, 2:58, 80+ degrees

    Dam to Dam 20K, Des Moines, IA, June 2012, 2:17, PR for this race

    Garry Bjorklund HM, Duluth, MN, June 2012, 2:20

    Fox Valley HM, St. Charles, IL, 9/16/12, 2:23

    Des Moines HM, 10/21/12, 2:19

    Tentative plans for 2013:

    Wisconsin (Half) Marathon, Kenosha, WI 5/4/2013 (registered)

    Dam To Dam 20K, Des Moines, 6/2/2013 (registration opens March 20th)

    Grandma's (Half) Marathon, Duluth, MN, 6/22/2013 (if I get picked again in the lottery)

    Des Moines HM, 10/20/2013 (registered)

  • SteveBikeRun Legend 455 posts since
    Aug 3, 2010
    Currently Being Moderated
    2. Dec 13, 2011 8:05 AM (in response to kdarold)
    I need some siatic advice, por favor

    Katie:  I should add that I could not run for two months, until mid-September.  However, my doctor and therapist encouraged me to walk as much as I could tolerate, so I was doing 30 minutes daily to keep some level of fitness and flexibility.  I am now up to running six miles.  There is some soreness afterwards, but it subsides, especially with the core and glute exercises I'm doing.  I will be gradually rebuilding my mileage so that I can be back in half-marathon shape by spring. 

     

    I know the frustration you are feeling. Recovery from this is a slow and gradual process, but if you have been exercising regularly, your recovery period may be shorter than for someone who is not in good condition (including being overweight).  Still, trying to do too much, too soon will only set you back.  Good luck and my wishes for a full recovery. 





    --Steve

    Completed in 2012:

    The Qualifier HM, Midland MI, May 2012, 2:58, 80+ degrees

    Dam to Dam 20K, Des Moines, IA, June 2012, 2:17, PR for this race

    Garry Bjorklund HM, Duluth, MN, June 2012, 2:20

    Fox Valley HM, St. Charles, IL, 9/16/12, 2:23

    Des Moines HM, 10/21/12, 2:19

    Tentative plans for 2013:

    Wisconsin (Half) Marathon, Kenosha, WI 5/4/2013 (registered)

    Dam To Dam 20K, Des Moines, 6/2/2013 (registration opens March 20th)

    Grandma's (Half) Marathon, Duluth, MN, 6/22/2013 (if I get picked again in the lottery)

    Des Moines HM, 10/20/2013 (registered)

  • Haselsmasher Legend 520 posts since
    May 25, 2009
    Currently Being Moderated
    3. Dec 15, 2011 4:15 PM (in response to kdarold)
    I need some siatic advice, por favor

    "Sciatica" (or - pain because the sciatic nerve is irritated) is more of a symptom than the actual problem.  What is done to improve it and how severe the problem is, IMHO, is dependdent on what is aggravating the nerve.  The two most common problems are 1) disk problems like Steve commented on above or 2) Piriformis Syndrome, where the Piriformis muscle in the hip aggravates the nerve.

     

    If you've got disk problems that is NOT something to mess with - so I'd lean toward resting.  If it's Piriformis related I'd see a PT.  Generally stretching, massage and strengthening other hip muscles to lighten the load on Piriformis helps.  You do have to be careful about stretching because sometimes it can hurt because things become over-stretched.  Check out some info by Damien Howell who hangs out around here if you're interested.

     

    Jim





    "Kick off your high heel sneakers, it's party time."

    -- From the song FM by Steely Dan

  • lenzlaw Community Moderator 10,431 posts since
    Jan 18, 2008
    Currently Being Moderated
    5. Dec 15, 2011 6:51 PM (in response to Haselsmasher)
    I need some siatic advice, por favor

    I agree with Jim, except that I know several runners with back/disc issues who have been able to resume running through PT and exercise and strengthening the core and back.  But your first step is to see a doctor to determine if it's your back or the piriformis.

     

    Len





    Len

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    6. Dec 16, 2011 5:29 PM (in response to kdarold)
    Re: I need some siatic advice, por favor

    With all due respect to posters here, I wish to enrich the thread with some professional experience, as well as a personal story. There are a few assumptions that need to be challenged as well.

     

    As Jim writes, Sciatica is a description of symptoms generally related to the Sciatic Nerve, and two of the most popular diagnoses, as well as some of the attempted solutions, have been discussed here. Namely, entrapment of the Sciatic Nerve root at the lumbar spine and/or entrapment between sections of the Piriformis muscle (possible causes among the differential diagnoses), and on the solution end, stretching, strengthening, massage, adjustments, etc.

     

    First, a personal account:

     

    Several years back, I injured myself in preparation for a 15k. Like the original poster, I had recently run a Half and was probably still feeling some of the results (rule of thumb: It is often said that it takes a day for each mile you race to recover, but this formula breaks down at the extremes). My injury was severe back pain, a twisted back (visible Scoliosis in the mirror), walking with a limp, and the inability to stand up straight. I thought I had really injured my back, as I had done a number of times, since a slip during college dishwashing job put me out of work for a few days. Almost every year, I would be unable to get up from bed or walk erect without pain for a week or so. This was one of those times.

     

    Since I had pre-registered for the 15k, I attended the expo the day before and dropped in on a lonely massage therapist working a booth with a single table. After describing my problem, she cautioned that she was not supposed to do therapeutic work, but only sports massages. I plunked down my 30 bucks and asked her to fix me. It was my first massage, ever. In just 20 minutes she paid cursory attention to my back and moved down onto the side of my Sacrum, just below the rim of the pelvis. The pain was so bad I craved a stick between my teeth, and literally cried. I limped away with grudging thanks, and ran a painless 15k the next day, the back pain and Scoliosis having been banned to memory.

     

    Since then, I interestingly do not have the yearly occurrences of back pain, despite a vigorous lifestyle that often includes heavy lifting and long runs that exceed marathon distance. It is important to note that I have aged considerably. I do no strengthening exercises, stretches, core building, never get adjustments, and hardly ever ever get a "massage." I do not take any pain meds of any kind. If I do hurt myself, and back pain symptoms return, I've learned how to perform the same therapy described above, on myself, and it works just as effectively.

     

    The other day I fell asleep in my car after a long day, waking up after hours with a sore back. Over the next few days it was so bad I was waking up in the middle of the night, unable to go back to sleep from the pain. Even I thought I had really messed something up, it felt so much like a severe spinal injury. Even though I find it much easier to work on others for a living than to work on myself, I performed an experiment. I laid on my fingers and knuckles to work the parts of my back that seemed to hurt. I thought I had felt relief, but still found myself waking up at 3 or 5 in pain. Last night, at about 5am, I was unable to sleep through the pain and was starting to look very unrested. This time, I cupped my fingers under my Sacrum, and worked the same area that had miraculous results in that original treatment. Within minutes, I was sleeping like a baby. It appears I nailed it this time.

     

    These stories are to illustrate a few important points. (1) All massages are not the same. Unless it is focused on exactly the right spot, it will often have little effect, even if delivered by a professional. (2) Muscular injuries can feel very structural, enough to fool somebody who works with them all the time like I do. (3) If scans had been taken of my back during these times, they would have shown marked Scoliosis, uneven disk compression, and probable bulging. In the same way, photos of celebrities often show them with their mouths open or eyes shut, and when they are unlucky, with both their mouths open and eyes shut as if they were caught snoring. This example is to demonstrate how misleading these snapshots in time can be. Since many of these medical views are taken with the patient lying down, it is important to ask why irregular disk images are seen at this time. Exactly what force is compressing the disks? The same force that twisted mine: muscle spasms. Could they, and the bad images they cause, be quite temporary too?

     

    Popular theory holds that disks fall like a bad souffle and the vertebrae collapse and pinch the nerve in between. While this theory can be convincing in light of one of these photos, and is sometimes true when a disk herniates and its components surround the nearby nerve, it's actually pretty difficult for this to happen as a result of running. Not only does the neural foramen (a hole in the side of each spinal segment) protect the exiting nerve from said compression, even when the vertebrae are fused together with no disks, but the actual problem is often seen in reverse. While a spinal dislocation or "subluxation" can in rare cases lead to muscle spasms, it is usually the other way around. That's why the xrays often show an ominous twist while lying down, when gravity is no longer a factor.

     

    Professionally, I have mended many an ailing back, neck, shoulder, or hip, simply by removing the spasms that prevent each of these elaborate systems of joints, tendons, and muscles from working properly. Some of my clients are so well trained, that I simply rest my hand on their backs, and the vertebrae spontaneously pop into place, no movement on my part required. There is obviously a strong mental component. Balanced muscular tension allows the brain to adjust the joints without further assistance, by moving the muscles that control them, without further restriction by spasm. Think of what happens to a marionette when the strings are kinked or tangled. There is no control. Remove the kinks, and things will work the way they are supposed to.

     

    In your case, you report an uneven hip. One of the functions of the upper gluteal muscles is to "hike" the hip, and gluteal muscles that will not release, keep the hip in that dysfunctional position. Another function of these muscles is to keep the pelvis level as you walk or run. A half marathon, for many people, will repeat this action with a few G-forces, more than 10, 000 times on each hip during a Half Marathon. That's enough overuse to wear them out and force them into spasm. As I found, so can a nap in a car seat, or standing on one foot in a long line at the store. Release these contorted muscles, like I did - as the therapist did years ago - and the hip can return to its normal function.

     

    But that's not the only thing that happens when you release these muscles. (1) Sympathetic contractions in the muscles along the spine, that react to hip dysfunction and cause aching in the area, are no longer required, and many of the irregularities observed in the posture and imaging begin to disappear soon after. In some cases, work needs to be done to release these muscles too, if they've been contracted too long. (2) Swelling and "knots" that occur between the stressed gluteal muscles eventually goes away, and the symptoms of "false Sciatica" that occur when lower branches from the Sciatic nerve are squeezed between them, go away as well. Train and irritate them back to spasm, and the symptoms will probably return as well.

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    7. Dec 16, 2011 6:16 PM (in response to JamesJohnsonLMT)
    Re: I need some siatic advice, por favor

    The worst aspect of pain-killer use among athletes, even when prescriptions and dosages are followed to the letter, has nothing to do with their chemical properties or assayed safety record. It has to do with the fact that when you run on injured tissue, it doesn't matter if you have numbed the pain, interrupted the inflammation, or relaxed the muscles. What matters is that you are using injured tissue that is not, and will never be, healed by any of these medications, until a new generation of them is invented that works by more natural means. By self-medicating, even when allowed by your doctor, you are risking further injury to your tissue, perpetuation of the original complaint, and fostering a host of new ones as your other muscles begin to compensate for what may feel better, but still isn't working right. If you are using the meds for these reasons, as many athletes do, I can't make you stop, but I am begging you to stop. Start reading up on the side effects, even when dosage instructions are followed, and especially about what happens when they are exceeded, even by a little bit. Most recommend use for no more than a few days, even if symptoms persist. That protects the manufacturer from lawsuits, even when the use of their product results in further injury. To wit, you were warned, and not by some internet crank, but by the drug manufacturers themselves.. despite their expensive hype. Just listen to the diclaimers and read the fine print, always.

     

    Regarding the usual therapeutic approaches to rehabbing injuries of this kind, I often ask why people expect an injury that has been caused by exercise to be cured by it. There is a very good chance that the strained muscles involved were plenty strong, well exercised, and probably already used too much. The fact that injured tissue often appears to be weak, doesn't mean it was not plenty strong before it was injured. The strongest runners in the world injure themselves, and most of us can never hope to be that strong. When tissue is overworked or overused, it does not follow that it will positively respond to further work and use. Sometimes it stiffens and becomes resistant to movement. Circulation breaks down.

     

    When tissue becomes too strong for the joints and tendons it moves, unexpected injuries can result from this excess pressure. Damage can spread to joints, tendons, and bursa, as well as to other muscle. In all things, moderation. Recovery is always more important than strength. In fact, it is the only way these things will eventually strengthen and become more resistant to injury. A strong core results in more power and speed, but also more compression of the spine and stress on the hips. What you really need, is a relaxed and flexible core.

     

    It is often repeated here, that stretching muscles is expected to lengthen and relax them, but as Jim also pointed out, damaged tissue may not respond any better to a stretch than it does to relentless exercise.

     

    On the other hand, there is data to suggest that the stretching (challenging) of healthy tissue, changes the chemistry that determines tissue flexibility. The operative word here is "healthy." More important than that, is to train your brain to recognize the range of motion by simply moving it through that range. Do this before a race or workout, rather than simply stretching something, and you are more likely to perform better than by trying to pull stuff apart. It often looks the same, but it is not. After running, these same movements can help prevent the stiffness and postural changes that can come from too much exercise. Think more along the lines of Tai Chi than an actual stretch. Save the hard stuff for when you are feeling really strong, but never overdo it, or you may be back where you started.

     

    Unfortunately, we are not issued a User's Manual for the most important thing we will ever possess, our human body. There are widely divergent opinions about how it should be maintained, and many of these methods can only be applied in a finite context, such as a workout schedule for a collegiate athlete, which should never be followed by folks in other age groups. Some of these strategies are promoted by specialists with advanced degrees and considerable experience, which unfortunately has misdirected their efforts to help. As your body changes with time and effort, the wisdom of each of these methods will apply variably. As we have discussed, some suggestions should never be followed by anyone, until the exercise and rehab business becomes more current, and ups its game. One tip that should be followed, is to learn how your muscles respond to overuse, and how to relax them so they can recover. The only thing left to do then, is to train sensibly, and the rest will usually take care of itself. En todas las cosas, tenga cuidado. De nada!

  • lindsayleeb Rookie 3 posts since
    Feb 20, 2012
    Currently Being Moderated
    8. Feb 20, 2012 11:03 PM (in response to JamesJohnsonLMT)
    I need some siatic advice, por favor

    only thing that helped me for extreme sciatic, hip, butt pain was the chiropractor. Started feeling better after a few months

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