Sciatic Nerve Issues: A (Literal) Pain in the Ass

I know I am getting older and all, but I certainly didn’t expect to be complaining to my co-workers about my sciatica for at least another 40 years. Sciatica was one of those ambiguous old people medical issues your great aunt Mildred used to complain about when you were a kid. So when my PT told me the achiness in my ass and the “tightness” in my hamstrings was in fact not a pulled muscle but rather an unhappy sciatic nerve, I was a bit surprised. I kind of love my PT because she never actually put a name to my condition but based on what she described I have piriformis syndrome which is surprisingly common among runners. Your great aunt Mildred’s sciatica has similar symptoms but is caused by issues in the lumbar spine, not the butt. A good description of the difference for you biology nerds can be found here. The reason proper diagnosis matters is that proper treatment is different for the two different underlying causes. You can read all about it on Web MD but I figured I would share my experience with this  injury. I am not a doctor or a physical therapist, but I have seen a bunch of health care professionals and can at least share what is working for me.

Symptoms


I went on a trail run in early November as part of the training for a trail race in December. I kind of pushed myself because I was still coming back from post surgery time off and at the end of the run noticed a tightness right where my butt meets the top of my leg. “No big deal” I thought” “just a little tight. I will stretch it out and it will be better in a few days”. Well 3 months later and I was still managing the discomfort but it won’t really go away until I take some time off (which we all know won’t happen until after April 20).   Some days are worse than others. It never really feels like a sharp pain but rather achiness and stiffness deep in where the butt meets the leg. Sometimes, the tightness in my butt extends down the back of my leg and I feel tight on the outside back of my knee. It usually feels worse after sitting for a long period of time so I have found that alternating between sitting and standing at my desk at work has helped. It also gives me the chance to do single leg balances and calf raises! Overall, it has been feeling a lot better with all the treatment and strengthening I’ve been doing but now I have a slightly different, but related, issue.

My glute strength has greatly increased since starting therapy, but my hamstring tightness has increased pretty drastically as my training volume has also increased. My new PT identified that in my left leg I am firing my hamstring at the same time as my glute (that’s not how it is supposed to be), thus putting too much strain on my hamstring.

Causes


Perhaps unsurprisingly, the discomfort is in my left leg, which is also the leg I had surgery on. I had been doing my physical therapy exercises post surgery and thought I had gotten my strength back. Turns out it takes a lot of work and way more time to get that last 5-10% of strength back which is crucial to healthy running. The butt muscles in my left were clearly still weaker than those in the right and when the butt muscles get fatigued they collapse on the nerve causing the discomfort. This issue is sometimes called piriformis syndrome although my PT explained that there are a bunch of muscles in the butt (which is why its the powerhouse for runners) and the issue is caused by a combination of them not working properly.  Another PT added that lower back issues such as bulging discs or weakness can cause the vertebra to put pressure on the nerve.

OK.. So How Do I get Rid of It?


Well, the only real way to get rid of it for good is to A) stop doing things that aggravate the nerve.. ie running (especially hill running and speed workouts) and B) Strengthen the butt, lower back and core to prevent it coming back (see below).  If you are unwilling to stop running altogether for a couple weeks, say if you are training for something, reducing running days to 4 a week and adding in cross training will help manage the discomfort while still getting in the hard work you need. Bodywork and acupuncture can also help reduce the discomfort to get you through your training regimen if you catch it early.

Bodywork:

I have been getting active release therapy from my PT at Presidio Sports and Medicine which I find helps a lot. The basic premise is that by combining massage and movement, the therapist is able to break up scar tissue caused by overuse. I have been supplementing my visits to her with self- myofascial release, basically rolling with a baseball on the glute and piriformis.

Acupuncture:

I have had many treatments with Dr. Jennifer Ross at Remedy acupuncture clinic now and I am loving it. She assess how I am feeling that day and chooses the course of therapy based on the progress from the previous session. The first session I was treated with cupping on the affected hip and butt to get things moving a little bit before starting with the needles. I have also had work done for my Achilles and calves, both of which had immediate effect.

In Chinese Medicine, any type of pain is seen as stagnation of qi and blood, regardless of what body structure is injured or in pain. Cupping and acupuncture returns movement, and thus, function. Cupping acts to draw stagnant blood from muscle tissue by creating a vacuum effect. The darker the cupping marks, the more stagnation there was. This dark, un-oxygenated blood is then removed through the lymphatic system. Clean and healthy bright red blood can now move through the injured area, bringing nutrients and healing factors. Cupping is also called myofascial decompression. I felt immediate release from the tightness and aching I was experiencing 2 days after the half marathon a couple of weeks ago.
Inserting acupuncture needles works to move qi. Qi can also be called energy, or even oxygen. Once qi is moving, blood can follow, and the body’s natural healing processes can occur, unimpeded. These two modalities together are a real powerhouse in returning an athlete’s pre-injury function and movement. Sometimes you will feel immediate effects. For example, during my second treatment Dr. Ross had me squeeze my butt to initiate the discomfort and added needles until the discomfort went away. The real benefit though comes from repeated treatment
Strengthening Exercises: 
 I will post about these in more depth later but strengthening the glutes and core are essential to preventing it from coming back after you get it calmed down.
1. The gold old fashioned clam
2. 2 leg then single leg bridge

Main Takeaways


Some things that feel good can actually make the discomfort worse in the long run: IE Pigeon and half pigeon poses.

In order to really get rid of these issues, you have to fix the root problem, which is almost always running form.

Professionals actually can help and are essential for diagnosis early on before the problem becomes too serious.

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