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Sciatica

Old 01-15-18, 08:34 PM
  #1  
jskash
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Sciatica

I had to take my first day off my bike today since June. Seems I have developed a nasty case of sciatica. I have not been able to stand up straight since yesterday. Not much I can do except take the pain meds and wait for things to calm down. My doctor did give me some stretching exercises to do after I start to feel better.
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Old 01-15-18, 10:18 PM
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Now that you've seen a doctor, and nothing more was done for you, I will relate my sciatica story. Last Thanksgiving I wound up with severe lower back pain after skiing. I've had a history of infrequent lower back pain, kept in check with regular swimming. Well, no swimming for the past year, and while in bad pain, I did get into a pool the next day. At least I could walk, albeit slightly bent. Swimming helped to get me feeling better, but the condition progressed into sciatica. That's when I went to my doctor. He x-ray'd my spine, and sent me to a biker chiropractor. I kept swimming every day, and had a few chiropractic visits as well. After several weeks the sciatica improved, and became simple lower back pain again. This is called centralization, where the pain retreats back to the spine, and does not radiate into sciatica. I watch my posture, and read a good book that my brother sent me called 7 Steps to a pain Free Life by Robin Mckenzie. As long as your doctor sent you home with drugs and some exercises, you best get some education on this stuff, as it might not be your last go-round. I've read most sciatica simply goes away over time. I believe I need to be proactive, especially as I age. It is interesting to note that I'd had no problems on my pro-fitted road bike, but got into trouble riding my wife's upright MTN bike. Whatever the situation, swimming will be part of my life, all year long.
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Old 01-15-18, 11:52 PM
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I have a number of spine issues including sciatica and stretching worked well for me. I've done core strengthening and other calisthenics and swimming and inversion stuff and all that helped somewhat, but over many years I've figured out that for me, stretching had the biggest bang for the buck.
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Old 01-16-18, 12:07 AM
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Yea
time will help,
Hope yours is fixable with therapy.

For many ,a shot gives months of relief .
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Old 01-16-18, 12:31 AM
  #5  
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Sciatica is complex and encompasses multiple causes and symptoms. Mine rarely affects my back, but is murder on my right hip and leg.

In any case, the first and (hopefully) best defense is exercise to maintain flexibility and movement.

However, since this is a bike forum, some questions.

Do you have a history of Sciatica and this is just a flame up?
Do how long have you been riding, and what, if anything, is changed over the last 6 months?

These are important because if you have no history of sciatica, and changed anything since June, there's a possibility that the two are linked. For example, a saddle slightly too high can cause your hips to rock and lead to sciatica symptoms. On the flip side, long saddle time in a position that you're not really used to can also cause issues.

So, think about the questions, and as you recover, think about whether the sciatica and cycling may be related and how. Hopefully, with some detective work, you'll find an underlying issue, and by resolving it, prevent future issues.
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Old 01-16-18, 04:31 AM
  #6  
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I finally had to have surgery to end my episode of sciatica. I went from #9 and #10 pain to #0 pain when I left the hospital (out patient procedure). I later required 5 steroid shots within one year to stop the recurring post-operative pain episodes, but the surgery was the best thing to ever happen to my back (had a herniated disc). I went to the best surgeon around and he turned me down in the past as he thought I was not ready for surgery back then.

Sciatic nerve is the largest nerve in the body and the pain can be agonizing, but usually temporary. 'Temporary' becomes quite subjective when you are in agony! Hang in there, it will run it's course.

I wanted to add one more thing. After back pain agony all my life (I later re-injured my back when I was a primary caregiver), the best thing to prevent back pain has been riding my bicycle. I now literally have only 1-10% of the daily pain level I used to feel before I stared riding again. That is an amazing figure that is not exaggerated. One of the first questions I am asked from old acquaintances is "how's the back?"

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Old 01-16-18, 07:43 AM
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See a good physical therapist if the pain persists, and then see a surgeon as a last resort, if PT does not resolve it.
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Old 01-16-18, 08:52 AM
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Originally Posted by FBinNY View Post
Sciatica is complex and encompasses multiple causes and symptoms. Mine rarely affects my back, but is murder on my right hip and leg.

In any case, the first and (hopefully) best defense is exercise to maintain flexibility and movement.

However, since this is a bike forum, some questions.

Do you have a history of Sciatica and this is just a flame up?
Do how long have you been riding, and what, if anything, is changed over the last 6 months?

These are important because if you have no history of sciatica, and changed anything since June, there's a possibility that the two are linked. For example, a saddle slightly too high can cause your hips to rock and lead to sciatica symptoms. On the flip side, long saddle time in a position that you're not really used to can also cause issues.

So, think about the questions, and as you recover, think about whether the sciatica and cycling may be related and how. Hopefully, with some detective work, you'll find an underlying issue, and by resolving it, prevent future issues.
I've had sciatica before but nothing like this. I did have an episode with my back a couple of year ago that was very painful, but it was only a one-day thing. This has been going on for five days and I the meds are not helping. I have just emailed my doctor that.

Nothing has changed in my riding in the last six months. Same bike and set up.

I suspect that gardening caused the flareup to begin with. That was about a month ago. My back was tight, but didn't keep me from doing anything. This is ridiculous. I can't stand up more than 90 degrees without pain shooting down my back into my leg. I had to take the day off today, as there is no way I could walk from my car to my classroom.
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Old 01-16-18, 08:13 PM
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Like others, I keep it in check with daily stretching. If I slack up for a while, it will rear it's ugly head.
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Old 01-16-18, 10:02 PM
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I have degenerative lower discs and the result is often sciatic pain. Short term aid: put a pillow under one leg when you sit (you'll know which one, the relief is pretty immediate). When my sciatica is really bad, sitting is impossible without doing that. Bad flare ups, usually brought on by moving wrong or overuse, require meds for 7-10 days. But I went from taking Nsaids almost daily for well over a year to hardly needing them by taking Celadrin (Costco has it online). I had no idea if it was a "real" solution or another placebo type of alternative, but when you are hurting, you will try anything, period. It works for me, amazingly well. I stopped a couple times for a few weeks just to see if I was imagining it, and the difference was remarkable. My stomach has thanked me. YMMV.

Riding my bike seems to actually help my sciatica inflammation - because I have my bike set up to lean forward and stretch out my back just the right amount. Sitting more upright aggravates and inflames the nerve. It's the opposite of what I thought but after a bike fit, getting the amount of lean and stretch right, it was fantastic. A big part of it is getting the hip aligned properly so it's not over or under extended.

Also, there are two really good stretches, just go on youtube and look for piriformis stretches, they can make a huge difference. Good luck.
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Old 01-17-18, 08:06 AM
  #11  
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I have had sciatic pain from a genetic condition where my spine attaches to my sacrum with cartilage rather than bone. Cartilage can flex and when it did I had compression on nerves and intense pain. A Chiropractor got me right and the pain went away. He gave me an exercise called Williams Flexion which also helped. That was back in 1975. Since then my back seems to have calcified the joint and fused itself. In any event I recall being told that the bent forward position on a bike (a motorcycle for me at the time) helped stretch the spine. In recent years I've read a lot of good things about inversion tables and I just bought one this past week. Trying to forestall any issues. I would check out info on inversion tables. It might be something that works well. FWIW, I have lost 2" in height over time and my fear that compression would put stress on my spine and nerves was what motivated me to buy the inversion table.
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Old 01-17-18, 01:39 PM
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I developed severe back pain and sciatica years ago when I went skiing after not doing so for years. I was with a fast French guy and trying to keep up. Took a couple hard GS type turns and felt something give. Went to doctor, had MRI, diagnosis: I have old man spine. Arthritic facets, spinal stenosis, and thin discs. Like duh. The radiologist either missed the soft tissue injuries or maybe the MRI didn't show them, or maybe he was just looking for confirmation of Old Man Spine Disease.

Anyway, I looked into it. Turns out that back in the bad old days, docs prescribed pain meds and rest. Now the good ones prescribe exercise and no pain meds, lots of exercise, gradually ramping up what you can do. I immediately bought Core Advantage and spent the first year gradually working my way through all the exercises in it. Then I started weight work in the gym. So that must have been about 7 years ago.

Today, I lift weights at the gym 2 days/week year 'round, except dropping to 1 day/week for high summer. I do whole body work including barbell squats with all the weight I can move, use a back machine, stiff legged deadlifts, all that stuff. I can also ski like a maniac again, no problems. Sure, my back hurts a little from time to time, but I can fix that at the gym. Pain goes away after a hard workout. So far so good.

My bike also really helped with the back pain. Ride 'til it hurts, rest it until it doesn't, repeat. Bike is the best and cheapest doctor I ever had. I also have a stretched out position, slammed stem, lots of reach, etc.

I also stretch every morning after I've been up for an hour or so.
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Old 01-17-18, 03:44 PM
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Those of us who can heal through exercise are lucky. I would guess there are many with more difficult cases. I now know I am better stretched over a drop bar bike. My back went out when I started putting more time in on my wife's MTN bike. I admit that I did my own fit, for the shorter rides. But...the upright position, and fit, may have done me in! As a dentist, I am at high risk for back problems. Swimming during biking season is a must from now on.
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Old 01-17-18, 03:55 PM
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Originally Posted by 355Mono View Post
Those of us who can heal through exercise are lucky. I would guess there are many with more difficult cases. .....
We're all different, both when well and ill. Likewise, our illnesses or injuries are different, and will respond to various treatments differently.

This is especially true with sciatica and it's effects, because we're describing a symptom, and not the cause. There are plenty of causes underlying sciatica, from disc injury, spinal stenosis, to simple a short term nerve flareup. Some people may have sciatica because a muscle spasm, ie. in piriformis, that affects spinal alignment, in others the sciatica causes the piriformis spasm.

The takeaway is to keep an open mind, find what works for you, be it stretching exercises, changing riding position, drugs or other medical intervention, etc. then stick with it until there's a reason to change.
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Old 01-17-18, 04:08 PM
  #15  
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Originally Posted by FBinNY View Post
The takeaway is to keep an open mind, find what works for you, be it stretching exercises, changing riding position, drugs or other medical intervention, etc. then stick with it until there's a reason to change.
Yeah it took me years (and multiple doctors and physical therapists) to home in on a regimen that works for me. It's an ongoing process of exploration.
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Old 01-17-18, 04:46 PM
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It's not uncommon for cyclists to experience sciatica like symptoms because of a tight piriformis muscle that compresses the sciatic nerve. Especially so in the 17% of patients in which the sciatic nerve runs through the piriformis muscle. It's called, obviously, the piriformis syndrome. The piriformis muscle's function is to turn the hip outward and to aid in the rotation of the foot. It's attached deep in the buttocks and goes to the lower back. It sits on top of the sciatic nerve in general and so if it's tight, it compresses the nerve and irritates it. And that (believe me) can be very painful.

I had this problem last year with almost debilitating pain that prevented me from riding and from cycling. No one could seem to figure it out so I bought a $40 iPad app that allows you to peel away the layers of muscle, tissue and nerves as you go down. I found the place where the pain was coming from and peeled away. My finger was smack dab on top of the piriformis muscle. I did the stretches, and immediately the pain ceased. Now, as I feel it tightening from overuse, I start stretching it.

Piriformis syndrome is relatively common in cycling but not so much in other sports. So if your MD or PT is unfamiliar with cycling in their sports medicine practice, they could easily miss this diagnosis.

There are a lot of good piriformis stretches if you google them. Find the ones that work best for you.

Literally, a magical solution to my problem. Serious problem for me that was gone in a matter of three days of stretching and largely in the first day.

J.
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Old 01-17-18, 05:42 PM
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I ride with a couple of cyclists with piriformis syndrome. Yes, stretched out is good. Until just a few years ago, I could still remember the taste of toe from when I was very young. So one of my stretches is to attempt to get that taste again. I'm only about 6" away, but I doubt I'll ever quite get there.

My morning stretches: https://www.bikeforums.net/road-cycl...l#post15372967
They're also good after 100k or so on a hard ride.

Stack.com is a fascinating source of workout and stretching ideas. My guess is that deep barbell squats are good for piriformis. They make me sore in that area anyway, so that's good. Good squat tutorial:
A familiar chant around the squat rack: "elbows, elbows, elbows."
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Old 01-17-18, 05:55 PM
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I had sciatica years ago and it was indistinguishable from piriformis syndrome. So, if you do have sciatica like pain, I'd guess doing the stretches is probably without a downside. If it works, pain goes away and if it doesn't, you're not doing any additional harm.

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Old 01-18-18, 08:00 PM
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I went to a physical therapist today and her opinion was that I don't have sciatica but I do have spinal stenosis. I also got X-rays done which hopefully will determine what my problem is. Back to for PT on Monday and a visit with my doctor. Hopefully it can be figured out what is wrong with my back and what can be done about it. I sure don't like not being able to go out for my morning ride.
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Old 01-18-18, 09:00 PM
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Originally Posted by jskash View Post
I went to a physical therapist today and her opinion was that I don't have sciatica but I do have spinal stenosis. I also got X-rays done which hopefully will determine what my problem is.

That's a pretty bold Diagnosis from a PT eval. Holds no water and shame on her for telling you that. These are tough threads to respond in/to because of so many variables. Low back pain in itself can have many origins and several solutions depending on what/where the specific problem is. You will hear many suggestions on what to do and how to treat your pain. Be careful. If the pain persists, worsens, you have increasing numbness/tingling, or start having any weakness in the leg, see a Neurosurgeon* right way. More urgent for the weakness as there never is a guarantee that you will get that back. Nerves are a fickle beast and do not heal like other parts of the body, so haste with weakness is important. To truly "see" what is going on you will need an MRI. Again, only if it persists. Obviously if it is transient, no worries. In any case, a Plain Film (X-Ray) or CT is basically useless. An MRI will show the tissue and bone proper and will specifically pick up the cause. Whether it be a Spinal Stenosis, Lumbar Radiculopathy, Degeneration, Spondylolisthesis, etc. it will be crystal clear once reviewed. From there, you will now have a proper working diagnosis and can confidently implement a plan of care. Since there are so many back problems out there, there are a few things that all of us can do to help out that long hanger.

1) Lose weight. One of the most common irritants of the low back
2) Stretch after warming up and do it every day.
3) Strengthen your core. Another common problem that throws our low back out of alignment are weak abdominals.
4) When you are ready, start exercises to strengthen your low back progressively
5) Use proper body mechanics.................always. Bend at the knees and not at the back.
6) If lifting heavy objects for a long period of time, consider a back brace or abd binder

There are more, but you get the idea.


As a note: I began working as a Nurse in Neurosurgery back in 1987, from there to the MICU, Cardiac ICU and now have been back in the Neuro ICU for the last 20 years. Our Hospital does some of the most complicated and largest multi level back surgeries** in the State.




*do not go to an Ortho guy and most definitely do not go to a Chiropractor
**in all areas Cervical, Thoracic (not as common) and Lumbar/Sacral

Last edited by fixedweasel; 01-18-18 at 09:37 PM.
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Old 01-18-18, 09:06 PM
  #21  
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Thank you for your very thoughtful reply. At this point, there is nothing to do except wait until Monday when I see the doctor again. I will be out of work at least through Monday, as there is no way I could walk from the parking lot to the main office and then my classroom. My wife ordered me walker from Amazon that will be delivered on Monday. That would make it easier to get around if the pain does not subside.
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Old 01-20-18, 05:32 AM
  #22  
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Originally Posted by fixedweasel View Post
That's a pretty bold Diagnosis from a PT eval. Holds no water and shame on her for telling you that. These are tough threads to respond in/to because of so many variables. Low back pain in itself can have many origins and several solutions depending on what/where the specific problem is. You will hear many suggestions on what to do and how to treat your pain. Be careful. If the pain persists, worsens, you have increasing numbness/tingling, or start having any weakness in the leg, see a Neurosurgeon* right way. More urgent for the weakness as there never is a guarantee that you will get that back. Nerves are a fickle beast and do not heal like other parts of the body, so haste with weakness is important. To truly "see" what is going on you will need an MRI. Again, only if it persists. Obviously if it is transient, no worries. In any case, a Plain Film (X-Ray) or CT is basically useless. An MRI will show the tissue and bone proper and will specifically pick up the cause. Whether it be a Spinal Stenosis, Lumbar Radiculopathy, Degeneration, Spondylolisthesis, etc. it will be crystal clear once reviewed. From there, you will now have a proper working diagnosis and can confidently implement a plan of care. Since there are so many back problems out there, there are a few things that all of us can do to help out that long hanger.

1) Lose weight. One of the most common irritants of the low back
2) Stretch after warming up and do it every day.
3) Strengthen your core. Another common problem that throws our low back out of alignment are weak abdominals.
4) When you are ready, start exercises to strengthen your low back progressively
5) Use proper body mechanics.................always. Bend at the knees and not at the back.
6) If lifting heavy objects for a long period of time, consider a back brace or abd binder

There are more, but you get the idea.


As a note: I began working as a Nurse in Neurosurgery back in 1987, from there to the MICU, Cardiac ICU and now have been back in the Neuro ICU for the last 20 years. Our Hospital does some of the most complicated and largest multi level back surgeries** in the State.




*do not go to an Ortho guy and most definitely do not go to a Chiropractor
**in all areas Cervical, Thoracic (not as common) and Lumbar/Sacral
why do you say do not go to a chiropractor?
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Old 01-20-18, 03:42 PM
  #23  
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^ IME that was a perfect post by @fixedweasel. Do that.
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Old 01-20-18, 06:13 PM
  #24  
Garfield Cat
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Originally Posted by jskash View Post
I had to take my first day off my bike today since June. Seems I have developed a nasty case of sciatica. I have not been able to stand up straight since yesterday. Not much I can do except take the pain meds and wait for things to calm down. My doctor did give me some stretching exercises to do after I start to feel better.
Two things: Doing one yoga type stretch. Not even a stretch because I think its more of a "holding position" while lying flat on the ground with right leg bent, knee up, and foot planted just to the left of the left knee. Arms outstretched and flat on the ground as if you were Jesus being crucified on the cross.

Once in that position, tilt that right leg to the left and you will begin to feel the muscle react. The muscle is like the glutes area.

Second thing: I am going this Monday, Jan 22, 2018 to see a MD, but not a traditional, more holistic. Will let you know what happens. This was a referral. I called him and he asked a few questions; he seemed to know what's the problem.
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Old 01-21-18, 08:59 PM
  #25  
JohnJ80
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Originally Posted by Garfield Cat View Post
Two things: Doing one yoga type stretch. Not even a stretch because I think its more of a "holding position" while lying flat on the ground with right leg bent, knee up, and foot planted just to the left of the left knee. Arms outstretched and flat on the ground as if you were Jesus being crucified on the cross.

Once in that position, tilt that right leg to the left and you will begin to feel the muscle react. The muscle is like the glutes area.

Second thing: I am going this Monday, Jan 22, 2018 to see a MD, but not a traditional, more holistic. Will let you know what happens. This was a referral. I called him and he asked a few questions; he seemed to know what's the problem.
If I'm understanding you correctly, this is just a mild piriformis stretch. See post above about piriformis syndrome that masquerades as sciatica. To stretch more, reach up behind the knee and pull it towards your chest. Pay attention to the the piriformis as it releases.

J.
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