Have you ever had a sensation of lightning shocks down the back of your leg and wondered “am I injured or just hurt?”
Maybe it’s not a lightning bolt, but perhaps it’s an ache, muscle weakness, or even numbness in one leg or the other.
Whichever sensation it is, you may have developed a temporary condition called sciatica.
In this article, MD Amy Whitson will look at:
- What is Sciatica?
- Symptoms of Sciatica,
- The Sciatic Nerve, and Causes of Sciatica,
- Diagnosing Sciatica: 2 Common Tests and similar syndromes,
- Running With Sciatica: Does It Cause It Or Make It Worse?
- How To Run With Sciatica,
- 5 Tips For Treating Your Sciatica.
Let’s jump in!
What is Sciatica?
The term “sciatica” refers to a radiating type of pain that is typically unilateral (one side of the body) and follows along the path of the sciatic nerve.
The nerve starts in the low back, courses through muscle and the pelvis, travels through the hips and buttocks, and down the back of each leg.
Sciatica shows up differently in each person, but the most common symptom is pain that starts in the low back and shoots down the back of one leg.
Symptoms can be variable, however, and they depend on each person’s own activity and medical history.
Symptoms of Sciatica
How do you know if you have sciatica? The most common symptoms are:
- Sharp or dull pain starting in the lower back
- Sharp or dull pain that radiates down the hip and buttock
- Sharp or dull pain, numbness or weakness in the back of the thigh
- Sharp or dull pain, numbness or weakness past the back of the knee
The symptoms can worsen during leg extension after prolonged sitting, which is when most people feel the pain.
What is the Sciatic Nerve?
The sciatic nerve is the largest nerve in the human body (up to 2cm!).
There are two sciatic nerves, one running down each leg.
There are ten paired nerve roots in the low back and pelvis (L1-S5). Five nerves in the L4-S3 lumbosacral region combine to eventually form the sciatic nerves.
The sciatic nerves exit the pelvis through a small hole called the sciatic foramen, through the deep piriformis muscle, and course down the back of the legs.
The sciatic nerves primarily provide motor function to the hamstring muscles in the back of the thigh and provide sensory information about the lower leg and foot.
What Causes Sciatica?
In the general, sciatica is most often caused by a bulging disc, bone spur, or narrowing of the spinal canal.
In runners, sciatica is often caused by a tight muscle called the piriformis muscle (see Piriformis Syndrome below).
The lumbosacral nerve roots we discussed above can become inflamed due to herniated lumbar discs.
The following types of herniated lumbar discs causing sciatic compression are:
- Direct compression
- Disc Inflammation
- Spinal Stenosis
- Spondylolisthesis (slipped vertebra)
These nerve roots, unlike nerves higher in the spinal column, are not well protected by surrounding stabilizing bone and soft muscle tissue.
This reduced support can lead to reduced blood flow which reduces oxygen and nutrient delivery to the nerve, other reasons that may explain sciatic nerve inflammation.
You may be asking “I’ve run through many different aches and pains so how will I know this is sciatica?”
The good news is that the cause of low back pain is usually made clinically, which means no expensive lab tests or x-rays are usually needed, just an office visit with your doctor.
During your visit, the doctor will take a thorough history of your symptoms such as the onset, duration and nature of the pain, trauma or injury to the area.
The doctor will also ask questions to determine if you have risk factors for developing sciatica such as cigarette smoking, obesity, job-related physical stress.
The next part of the visit will include the physical exam, during which the doctor will observe the curve of your spine, angulation of your hips, and any discrepancies between the length of your legs.
Physical Tests for Sciatica
The doctor may also examine your gait and perform a straight leg raise and slump test to see if either movement replicates the pain.
Straight Leg Raise Test (SLRT)
- The most common test to confirm the clinical diagnosis of sciatica
- Used to elicit the sciatic symptoms
- Patient lies on the exam table and the examiner passively raises your outstretched leg to or above the level of the hip.
If there is shooting pain down the leg beyond the level of the knee, then there is true sciatica and the likely cause is a herniated disc.
- Less commonly performed, and less sensitive than the SLRT.
- It’s performed in a chair, with the patient sitting on hands and bending forward
- The patient extends the knee (extends the lower leg)
- If there is pain radiating down the leg with leg extension, the test is positive for sciatica
Unless the pain is persistent (beyond 6 weeks), you don’t need expensive imaging or lab tests to confirm your sciatica.
There are other syndromes that mimic sciatic pain and also present as low back, buttock, or leg pain, such as:
- Piriformis Syndrome
- Sacroiliac Joint Dysfunction
Piriformis Syndrome is inflammation of the piriformis muscle, deep in the buttock. The sciatic nerve courses through the piriformis, and as the muscle tightens it can compress the nerve that causes sciatica-symptoms.
The piriformis is a stabilizing muscle, that activates with every step. Many runners have tight piriformis muscles, and the key to ease the pain is regular stretching and massage.
The piriformis muscle can spasm, too, which causes sensations similar to sciatica.
Piriformis syndrome is treated with deep tissue massage, heat and regular stretching of the piriformis muscle.
Sacroiliac joint dysfunction is another less common cause of low back and buttock pain. This joint can irritate the L5 nerve root, which can cause sciatica-type pain.
The way you can tell the difference is that the pain from these conditions does not radiate down the leg. The hallmark of sciatica is the way that sciatic nerve pain travels down the back of one leg.
Can Running Cause (or worsen) Symptoms of Sciatica?
If you wonder whether it is safe to run with sciatica, the good news is that it is not only safe, but necessary to help relieve the symptoms!
A repetitive activity such as running with impact on the legs and hips can exacerbate the symptoms until the tight muscles are addressed, but inactivity is worse.
It is well accepted that inactivity such as prolonged sitting can exacerbate the symptoms of sciatica, and physical activity is one of the key treatments.
How To Run With Sciatica: Tips
The key to running with sciatica is developing a consistent stretching routine before and after the run.
Stretching should target the hamstrings, gluteus, and hip flexors on both sides of the body, not just the affected side.
Pre-run stretching is important to help loosen the muscles before exercise.
Post-run stretching increases blood flow and allows oxygen and nutrients to help heal your muscles after the run.
The following stretches are great to help keep you moving and improve sciatica symptoms:
Sit on the ground with both legs outstretched. Reach for your toes and hold for 10-20 seconds, then release. Repeat 3-4 times.
If both legs are too tight, sit on the ground with one leg outstretched and the other bent so that the sole of your foot touches the inner thigh of the outstretched leg.
Reach for your toes and hold for 10-20 seconds, then release. Repeat 3-4 times, alternate legs and watch your reach increase!
Active stretch: Hamstring sweeps.
As you walk, bend one leg and raise the toes of the other foot. Reach your hands down to “sweep” the hands under the sole of the foot, and switch legs.
Gluteus maximus and minimus stretch
Lie on your back and bend one knee in the air at a 90-degree angle. Place the ankle of the other leg across the knee and pull your leg in toward your chest. Hold for 30 seconds, and switch legs.
Hip flexor stretch
In a runner’s forward lunge position, place your hands on your hips, rotate the hip of your back leg forward and press the knee down to the floor.
Hold for 30 seconds, and alternate legs.
Hydration is also one of the keys to help heal inflamed and irritated muscle groups. If our tank runs dry, our muscles tighten and the symptoms will get worse.
Regular massages can also help loosen the muscles involved.
Five Tips for Treating Your Sciatica
The good news is that most cases can be treated non-operatively with resolution of symptoms in 3-4 weeks.
You’ve probably noticed the consistent theme to alleviate your sciatica is stretching.
Here are five tips for treating your sciatica:
- Stretch often, pre and post-run with a focus on hamstrings, glutes and hip flexors.
- Apply heating pads to the low back and glutes, as needed.
- Do not become sedentary, and avoid periods of inactivity.
- Keep moving!
- And finally…..seek medical attention if you still have pain after 4-6 weeks