Specialist musculoskeletal physiotherapist Rebecca Christenson on what runners need to know about sciatica – including what it is, how and why it may affect runners, treatment options and best exercises
By Rebecca Christenson MMACP, BSc (Hons), MCSP
Most runners have been confronted with the term ‘sciatica’ – whether it’s via a quick Google search to try and identify that nagging back/leg pain or just a running mates’ attempt at diagnosing you.
It may come as a surprise that sciatica is not actually a medical diagnosis. It is a very old term that encompasses quite a few different and sometimes overlapping conditions, and can mean different things to different people.
So, let’s run through the different types of sciatic nerve pain and how runners can potentially be affected.
What is sciatica?
‘Sciatica’ gets its name from the sciatic nerve. This nerve originates from the bottom of the back, known as the lumbar spine, and the sacrum. Specifically, it is formed from a plexus, which is a group of nerves, from L4-S3, and then comes out by the buttock. And, yes, very close to the piriformis (all runners seem to have heard of this muscle), going all the way down the back of the leg.
The term ‘sciatica’ is normally used when someone has leg and/or back pain. As medical professionals, however, we want to be more specific about what is causing the pain as this will give us our treatment options. We would tend to use these terms:
- Referred pain: as its name suggests, this is pain felt in an area other than where it originates. The back is made up of joints, ligaments, discs and muscles, and these are all capable of referring pain. This is often described as a ‘dull’ pain.
- Radicular pain: this is the word we use when we have pain in the nerve itself and is more commonly described as a ‘sharp’ or ‘burning’ pain. This can occur when a disc has prolapsed or ‘slipped’ and presses on a nerve.
- Radiculopathy: is when the nerve is not sending information in the way it should do. This can be picked up by clinical tests. When medics use this term they are talking about how the nerve is functioning rather than the pain itself.
The difficult thing is that all of these – referred pain, radicular pain and radiculopathy – can occur at the same time or separately. It is one of the reasons the term ‘sciatica’ continues to be popular, but also why it may not be that helpful as a diagnosis.
Can running cause sciatica?
There will certainly be instances when an episode of pain is triggered by running and there is evidence that the discs sustain considerable compression and rotational forces during running. However, there is also evidence that loading the discs in activities such as running can be helpful. Some surgeons are very cautious about running when it comes to back pain, but in my clinical practice I have not associated a strong link between running being the cause of a patients’ back/leg pain; in fact, in some patients running is something that makes them feel better.
New runners
People tend to have better tolerance of movements and activities they are trained for or accustomed to, so in the case of running, beginner runners can reduce their risk of this type of injury by starting slowly and building up their distance/duration/intensity gradually.
Poor recovery
At the other extreme, an injury can occur if a runner is under-recovered. It may be that you have had a heavy block of training or have returned too quickly to training after a race. These factors in themselves cannot be blamed for causing ‘sciatica’ but they can increase the risk of injury.
Strength training can be helpful to reduce injury risk and improve running economy. But it is obviously not something to start doing if you have a new episode of pain.
Combined factors
The reality is, there are often a combination of factors that cause the pain including:
- Relative inactivity (obviously less likely in runners), but a recent break in training may mean you are less accustomed to running than usual
- Social stress – things happening at work/home
- A past history of back pain
- Increase in training
- Genetics
- Poor sleep/recovery
- Biomechanics (how we move). This could be related to deficits or asymmetries in strength, balance and/or flexibility
This is where listening to the history of pain and issues helps us, as medics, understand the specific components that may lead up to an episode of pain. The more we understand the causes, the more specific we can be in directing treatment.
How do you know if the pain in your bum/leg is sciatica or another running injury?
If the pain feels like a burning or is sharp, it is likely that there is some nerve irritation. This can occur when the nerve is compressed, inflamed or overstretched at the root causing what we call radicular pain. This type of nerve pain is typically too severe to run through.
If you have tendon pain, it is generally less severe and in the beginning can ‘warm up’ during a run and then become sore afterwards. Though as tendon pain progresses it will become more painful and tolerate less – ie, it comes on earlier in the run and doesn’t warm up as much.
Runners who are suffering from hamstring tendinopathy will feel pain in the buttock and may wonder whether their pain is nerve-related or symptoms of the tendon. Confusingly, it can actually be both. But this type of nerve irritation is not the same as the radicular pain, which happens when the root of the nerve is irritated, and it tends to cause less severe symptoms.
Piriformis syndrome – which also presents as pain deep in the buttock – is a controversial diagnosis for patients with ‘sciatica’. Pain in the buttock can come from many sources, and it is rare as a primary cause of pain.
Sciatica treatment
Sciatica treatment depends on what the source of the pain is (referred, radicular, radiculopathy or something else). Nerve pain and tendon pain tend to take longer to recover from than muscle pain. How quickly you get better will depend on the degree of your injury – muscle and ligament injuries are graded and can last a couple of weeks or longer, and most episodes of back pain tend to clear up in around six weeks. If there is a component of nerve pain, however, it will take longer.
If you think you have radicular pain (burning/sharp and typically feels quite severe), you will normally need to modify your activity and rest. We don’t advise bed rest but mostly you are not be able to do what you normally do for a few days. Heat and ice may help so it is reasonable to try both. You should also speak to your GP/pharmacist about using medication if your sleep is affected or you are not coping despite reducing your activity. Once the pain settles, it is helpful to build up to your activity, and walking is a good place to start. As a guide, you should not return to running until you are back to your normal day-to-to day activities and off medication.
If you have referred pain, it is typically duller and a bit more mechanical – so it hurts when you do specific things. Your body will still need to recover but are you are likely to be able to continue doing your normal day-to-day activities. You can decide whether you should be running based on the severity and if the pain has a trend of improving or not.
Another thing to remember is that you may also have radiculopathy – this is not pain but when the messages the nerve normally sends are not being picked up. It can occur by itself but more commonly with pain in the nerve itself (radicular pain). It is something that can cause muscle weakness, numbness and/or changes in reflexes and needs to be assessed by a professional.
Should you keep running if you have sciatica/sciatic nerve pain?
If the pain is low level and is not getting worse during the run or afterwards, it is fine to continue to run. But if there is a trend of it getting worse with the passage of time or you have to change how you run to tolerate the pain, you should not be running.
What are the best exercises for sciatica/sciatic nerve pain?
The real answer to this is that there are no ‘best’ exercises. Every month, 4,0oo people Google search if they can ‘cure sciatica in 8 mins’, so we are clearly desperate to find a quick fix… if only it were that simple!
If the pain is severe, as it can be with radicular pain, you need to let your body recover and want to find positions that are comfortable in the beginning. These are often:
- Side lying with the painful side on the top and a pillow between your knees.
- Lying on your back with a support underneath your knees so that your back can relax.
There is no evidence that a particular type or set of exercises are right if you are recovering from radicular pain or have had referred pain from your back. But it is reasonable to see if your body can tolerate more movements as the pain improves. These are not stretches but a relaxed way to explore whether your body is ready to do more.
The repetitions are a guide and should be dictated by how you feel.
Cat/camel
- In a table-top position on the floor, come onto your hands and knees.
- Relax your breathing and monitor for any tension.
- Gently curl and move as far as feels comfortable.
- Repeat in the opposite direction.
- Repeat this 6 times.
Knee rolls
- Lie on a mat on the floor, with your hands placed comfortably across your stomach.
- Draw up your knees to form a bend in your legs and roll your knees from side to side.
- Do this 6 times.
If these are well tolerated, you can try the following movements with more range.
Prone extension
- Lie on your stomach with your legs fully extended and arms out into a push-up position.
- Gently push up as far as feels comfortable
- Pause for 2 seconds, then return to the starting position.
- Repeat 6 times.
Child’s pose
- Start on all fours.
- Send hips back so your glutes rest on your heels.
- Lower your chest to the floor and stretch your arms out in front of you.
- Hold for 6 and repeat 6 times.
SLR mobilisation
- Lie on your back and link your arms through one thigh with the knee bent.
- Gently straighten out the leg as far as comfortable and lower – you should only feel something in the back of the thigh.
- Repeat 6 times.
Any exercises you do should not increase pain so they should only be continued if you feel they are helping.
My best advice, if you are concerned, would be to get an assessment from a medical professional, like a physiotherapist. You will get a thorough assessment and a specific diagnosis. This is both reassuring and will help tailor advice and treatment to ensure you improve at the quickest possible rate and do not miss something more serious.
For more information on ‘sciatia’ please refer to https://tomjesson.com/.
Content from Runner’s World UK
