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Sciatica Journey and questions for those with the experience
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Hey All,

I have been on a wild ride recently, and have used Slowtwitch to search my symptoms and study up on my potential injury, and I have come today to seek guidance. I will make this as concise as possible.

I was training for a half marathon that was March 1st. Mid-February I started experiencing classic IT band symptoms during my runs. Pain on lateral side of knee starting midway through my run. It would start as a nibble, then quickly escalate to solid pain. It would relieve post-run, and I went forward with my half marathon. I finished the race (pain came on about mile 7) and knew it was time to shut down running for a bit. After the race, I kept riding, but I just didn't feel all of that great while riding, so I shut that down too. My last S/B/R was on April 6th. I was doing the typical ITBS stuff (clams, monster walks, etc.) and not only was it not improving, but it seemed to be getting worse. I had a digital doc appointment followed by digital PT, and they both thought it was ITBS and thought I may have just been pushing too hard (I can only imagine how difficult it is for them to diagnose without actually being able to assess me). After pushing through a bit longer on my own, the ITB pain became constant, and I knew this wasn't going to go away on its own.

Clinics around me started opening up in mid-may, so I made an appointment with a PT and figured seeing them in person would help. I went in on day-1 with the tightness on the outside of my knee and some hip "junk" and tightness. After an assessment my PT informed me that she thought all of my issues were stemming from my lower back. I was demonstrating some minor weakness in my left foot (compared to my right), and she thought I had a pinched nerve. She is a Mckenzie method PT (that was by luck), and we started moving forward with her approach to addressing back pain. After day 1, my lower back was killing me. It was crazy to me, because I wasn't experiencing any back pain up until this point, but she explained the importance of centralization and how this was actually a great sign. This was then confirmed by reading all of the stories on slowtwitch.

I am now on week 4 of PT and things seem to be taking a turn for the worse. My back is sooo much looser than it was. I can do my extension exercises like a pro and while I didn't realize my back was tight before, I can tell now just based on how loose it feels. The problem is, a few weeks into this PT I started experiencing some pretty rough sciatica (pain in foot, pain in hamstring, pain in butt). It seems like the pain is shifting CONSTANTLY. The sciatica is new, and didn't start popping up until week 2 of PT. I am starting to get the feeling that she doesn't know what we need to do to address this, as my pressups and everything else can't seem to get this pain out of my foot and back into my back.

I am pretty lost. This whole journey started with me thinking "I can't wait to get back on my bike" and that has turned into "I can't wait until I start feeling normal again".

I have an MRI scheduled late next week. The back doc/neurosurgeon that I was recommended to through cycling friends won't see me until I have an MRI for them to review, so I am going to grab that MRI and get an appointment there.

Do any of you have thoughts or have gone through something similar? Any insight would be greatly appreciated. Thanks, Slowtwitch!


Nick
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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I'm not a doctor or any sort of expert but I've dealt with this for the last couple years. My guess is that the MRI will reveal that you have a bulging or herniated disc in your lower back that is causing the sciatic pain. The disc protrusion causes inflammation that puts pressure on nerves including the sciatic.

They'll probably recommend starting with a conservative approach (more PT) and possibly cortisone injections. You'll get lots of differing opinions here on cortisone but personally I'd push for it ASAP, for a couple reasons. First, the conservative approach can be very very slow, and the cortisone can give you quick relief by knocking down the inflammation. You'll still need to do the PT to strengthen your core and stay pain-free going forward, but at least you'll get some pain relief. Second, it can take multiple injections to be effective and it can end up taking a few weeks between shots depending on how your doctor works. At the very least in my experience they'll want to wait 7-10 days for an injection to have it's full effect before they do another one.

The good news its a very common injury so plenty of docs and PT's have experience treating it. The bad news is that recovery can be really slow and frustrating, and you may be prone to flare-ups in the future. I was good for a couple years after my first episode and it flared up a few months ago out of nowhere. At least I know what to expect this time!

Good luck!
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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sciatica is like that.. because it's the leg nerve getting pinched in the disk, the pain can show up in lots of different places.
A doctor friend mentioned he'd had endless calf muscle pulls and tears, all of which turned out to be related to his back problems and sciatica.
I've had calf muscle tears that seem to happen only after the sciatica has flared up.

I started with back pain due maybe to the herniated L5-S1 disk, got that under control with lots of PT and maintained with those exercises, since 2004 or so.
The sciatica showed up a couple years later, triggered by a hard and unforgiving bike saddle.
More PT and more ongoing maintenance exercises keep it down to a mostly dull pain, though it flares up sometimes.
Last time I tried the Sacro Wedgy in desperation, either that or the daily foam rolling helped.

The back doc/neurosurgeon will probably want to operate, which is more expensive than PT but no more effective.

https://www.ncbi.nlm.nih.gov/...articles/PMC2948294/
and
https://www.mayoclinic.org/...surgery/art-20048274
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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When the pain started was there something stressful going on in your life? Don't laugh as it is not your typical response, but it could be TMS or Tension Myositis Syndrome. Dr. Sarno was a huge pioneer in the whole TMS- pain issue. It is actually really fascinating. Sciatica is also one of the symptoms that Dr. Sarno says is TMS. The pain moving around also makes me think it is TMS as that is called the symptom imperative, once you fix one thing, the mind moves the pain to another area. TMS is also ripe in triathletes as most of us are Type A perfectionists.

Something to consider.

https://proactivemindfulness.com/stress/back-pain.htm

https://www.tmswiki.org/ppd/Sciatica
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Re: Sciatica Journey and questions for those with the experience [SwimBikeRun35] [ In reply to ]
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I appreciate the response, thank you! I actually have a book of his that I haven't read yet and I will start it this afternoon.
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Re: Sciatica Journey and questions for those with the experience [Dgconner154] [ In reply to ]
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I appreciate the response and hope you recover from this flare up quickly. Man, it can be a frustrating process and I haven't been dealing with it too long. It is funny how quickly things change, because I ran on the treadmill at PT today and felt good for that half mile. Just a few days ago I was wondering if I will ever feel decent again. I have been seeing how quickly this can change and will just await the MRI results and continue to take the advice of my doc/pt. My GP did just prescribe me oral steroids per the PT's suggestion and I started those yesterday. I am assuming it is no coincidence that I feel pretty good today, but who knows. What a roller coaster. At the end of the day, I know this is on me. I have had horrible posture my whole life and unfortunately it is taking something like this for me to finally address it.
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Re: Sciatica Journey and questions for those with the experience [doug in co] [ In reply to ]
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I really appreciate you sharing your experience and the resources. I have a very hard saddle and I never considered the fact that may be contributing to this. I also have always had a George Costanza wallet in my back left pocket (side of the symptoms) and have recently been told that it most certainly contributes to this. I appreciate the response.
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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I have had a few bouts of Sciatica and have been treated by a very good Chiropractor who sorted me out very quickly, however your symptoms do not sound like sciatica to me. I more recently had Piriformis syndrome, Sciatica for me only effected my buttocks, the tightness and soreness in my back was the cause of the Sciatica not the effect. Piriformis Syndrome on the other hand my back and buttocks were OK but I had pain in my ITband outside of my knee and down into outside of my calf.
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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McKenzie is way more than just press ups/back bends. It's a diagnostic and treatment method used to assist a clinician to classify a patient in order to better treat them. Clearly something changed since week two if you're having more symptoms down your leg. You currently present with the opposite of centralization as your symptoms are peripheralizing. Despite how good/loose your back may feel now, having increased distal symptoms is not ideal and should be the focus.
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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Hey Nick,

Sorry to hear about your sciatica issues. As a fellow on-off sufferer, thought I'd give my perspective (standard caveats apply - not a doctor etc... Smile)

As another poster said, it's likely important to determine whether the prob is coming from the piriformis or the back. The sciatic nerve passes close to the piriformis muscle (& through it in some cases) so, if that muscle gets fired up, it can irritate the nerve. In my case, the piriformis has been the root of the problem. When it gets locked up, everything around it on that side becomes problematic.

What works for me, when this happens, is a focus on extending that whole side - Adductor, QL, Psoas, Rectus femoris, ITB coupled with internal rotation. Everything down that side feels short & tight to me in the midst of an episode so I focus the foam rolling on releasing those areas. Lots of foam roll time working through the high medial adductor (seated), upper quad - ilium - lower gut region (prone) along with some very focused work on any point tender spots on the piriformis.

For the piriformis area, I've found regular foam rolling doesn't work as well and actually seems to worsen things for me, so I try to get more precision on the area I'm targeting by hooking a body-back (https://www.bodyback.com/products/body-back-buddy-original-trigger-point-therapy-self-massage-tool-body-back-company) around the stair banister and dig into any point tender spots on the piriformis. As I'm doing that I work on internally rotating the femur and trying to extend that whole side (picturing the leg feeling longer). I try to keep this focus of 'keeping that leg long', keeping even weight on the other side, and making sure I'm not externally rotated whenever standing, walking etc. This protocol works really well for me and generally clears up a bout fairly quickly.

Again, if back/disc related, the above may not apply but figured I would share my experience. Hope it is helpful.

Alan Couzens, M.Sc. (Sports Science)
Exercise Physiologist/Coach
Twitter: https://twitter.com/Alan_Couzens
Web: https://alancouzens.com
Last edited by: Alan Couzens: Jun 12, 20 13:06
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Re: Sciatica Journey and questions for those with the experience [ballisticpb] [ In reply to ]
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Yea that was my fear as well. My symptoms are moving away from my back and getting worse since starting PT. I’m not sure if this just means a change in PT is in order, or just hold tight until my MRI.
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Re: Sciatica Journey and questions for those with the experience [mikemelbrooks] [ In reply to ]
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I thought that may be the case and talked to my PT about it, but she said the assessment suggested lumbar issues. I’m going to try rolling out a few spots per the other recommendation and see how that goes. I appreciate the response.
Last edited by: NickJO: Jun 12, 20 15:45
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Re: Sciatica Journey and questions for those with the experience [Alan Couzens] [ In reply to ]
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Thank you so much for taking the time to share. I am extremely tight down the majority of my left leg and am going to try this out. My piriformis is extremely tender, but it’s very tender on both sides
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Re: Sciatica Journey and questions for those with the experience [Alan Couzens] [ In reply to ]
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I’m not sure if it’s my issue, but i have that hook and I did what you recommend and man does it feel painfully good. Great tip.
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Re: Sciatica Journey and questions for those with the experience [SwimBikeRun35] [ In reply to ]
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Huge Sarno person here. Seconded, thirded. All the recommends. Ten years of back pain/ sciatica/ shoulder pain/ knee pain. Gone.
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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It sounds like your pain is peripheralizing as opposed to centralizing. If your PT is pushing extension too hard she is likely missing the lateral component or aggravating it. Ask her about sidelying flexion-rotation or side glides in standing. There's no way you should be worse unless extending on a lateral component and ignoring worsening symptoms further from your spine.
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Re: Sciatica Journey and questions for those with the experience [AndrewL] [ In reply to ]
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Sounds good I’ll bring this up. Honestly, if nothing else this may just encourage me to find a new PT.

Extension really has been the name of the game. She has been having me kick my hips out to the right during the extensions, but I don’t feel like the extensions are doing much recently
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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Hips offset like you describe probably isn't far enough lateral if it increases pain in your lower leg or foot. It may be time for you to try out a new position.
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Re: Sciatica Journey and questions for those with the experience [AndrewL] [ In reply to ]
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3 herniated discs and numb legs for decade it sucks
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Re: Sciatica Journey and questions for those with the experience [AndrewL] [ In reply to ]
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Ok. Thank you, Andrew. I tried rolling out some things a bit ago and to make sure I am not trying too many new things at once, I am going to try that side flexion rotation tomorrow very lightly to see if it centralizes anything.
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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i had sciatic pain that started in my left glute and went all the way leg and made my foot numb, but my lower back itself didn't really hurt. i tried everything - pt, chiro, decompression therapy - and while some provided temporary relief, none helped long term. my quality of life was crap - couldn't train, couldn't sleep and work was miserable. i ultimately had a lumber laminectomy to repair a herniated disc - L5/S1 - that provided major relief. that was 2001 and i've been relatively pain free since then.

for me, it was a quality of life issue and surgery was an absolute last resort. i was scared shitless from all the horror stories i had heard but thankfully it worked out. hopefully your mri will answer some questions and you can plot a course of action that's best for you. good luck
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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Lots of good responses on here. I'll just throw in my N=1 because it seems it may apply to you. For starters, sciatica sucks. Big time. So I'm sorry you're going through that.

Here's my biggest piece of advice: if your PT is making it worse or not listening to you, please please leave. I really wish I had left mine earlier. I was in therapy for a hip labral tear + FAI. Like you, I never had sciatica before and then boom, electric shocks running down my leg in PT one day. MRI showed a herniated disc. Now, it was probably a combo of my hip issue plus the overzealous therapist that created this perfect storm. I don't blame her, I just wish I had stopped when I felt that she was causing more harm than good. Back then I was new to all of this injury crap and I trusted the medical system over how I was actually feeling. After that I realized you really are your own advocate and you have to do what's best for you, not what one textbook/doctor/PT/etc says is best for you.

Sometimes McKenzie style is not for everyone. Find whatever works for you...if that requires seeing multiple therapists or doctors, so be it! I'd rather have more info and perspectives than less. I think getting an MRI should be your next move, just so you know what you're working with and then you can address that specific thing with PT. If it is a disc issue, just be prepared for a long road ahead. Discs take a while to heal, so don't get discouraged.

Regardless of what is found / what you decided to do next, the book 'Back Mechanic' by Stuart McGill is a great resource. It's all about "spinal hygiene" throughout the day. He also has some core exercises, too, but the big takeaway for me was finding and eliminating the daily movements that worsen back/sciatic pain. At first I thought it was a load of sh*t (I'm 30...this book looks like it should be for someone 3x my age) but it's actually really helpful. I wish I had read it earlier. I feel like a posture/proper movement class should be mandatory in elementary curriculum. Definitely would have benefited from that over dodgeball...

Also, mental health is a really important part of this, too. Pain can reallllly wear you down. So don't be afraid to seek that out, too.

Best of luck to you! Happy (and hopefully fast) healing!
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Re: Sciatica Journey and questions for those with the experience [michco] [ In reply to ]
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Thank you so much for your response and suggestions. I’m glad you shared your experience, because these are decisions that I just had to make as well. I scheduled an appointment with a new physical therapist after hearing some of the thoughts from others on this post. I also have my MRI scheduled for Saturday. I have been putting a lot of blind faith in the process, and figured the sciatica moving further down my leg was just part of the process. I’m realizing that’s not the case and it’s time for a different approach. I read one of McKenzie’s books and will order the one you suggested today.

I also read one of Dr. Sarno’s books and really appreciated it. I’m not sure that I’m all in on the “this is all in my head” notion, but I absolutely realize how important my outlook is on this and making sure I’m in the right place mentality so i can heal physically. Yesterday I scheduled an appointment with my old therapist to talk through some of this. Triathlon has become not only my physical outlet, but also my emotional one. Without being able to train, I lose both and I think the loss of my emotional outlet is contributing to my pain. I’ve become obsessed with this pain and it’s just not healthy for me.

Thanks, again. I’m prepared for a long road back to doing what I love, and that’s ok. I just need to become my own advocate and start asking more questions and taking care of myself along the way.
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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I'm glad you're moving forward with an MRI + a new PT! And yes, pain going further down the leg is definitely not a good thing. Glad you're listening to your body and getting the help you need. You sound like you're in the right mind space with all of this.
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Re: Sciatica Journey and questions for those with the experience [NickJO] [ In reply to ]
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Hey Nick,

After going through something similar i’d thought i’d write..
I’m have been having back issues on and off for a few years now.
Backpain, spasms, the works.
Recently the pain going down the leg was new.
Some time ago I’ve had an MRI and the results were not bad but maybe also not great.
Wear and tear and a precursor to disc herniation.
What also has been an issue is my posture and sitting profession (short hip flexor, and pelvic tilt)

A few months ago i was putting our baby down on our bed and took the weight on my left knee, i almost collapsed as my back spasmed again. (Off course i put the kid down gently and took the pain)
Now I had sciatic pain going down the left leg as well.

Managing the pain has been difficult as I don’t want surgery and too many meds.

I knew I had to change something, so I went to a physical therapy company that specialises in back problems.
They work with Medx machines and have a back extension machine that helped me so much.
The Medx back machine is a tool that has been mentioned here on the forum as well.
Now after a range of sessions im incorporating a deadlift

I’ve had the same “loose” feeling which, as I understand it now is a lack of tension.
Building up that tension in your lower back is not easy I found out.
No amount of Bodyweight exercise has helped me much in the past.

So after training for a few months the pain is gone at the moment.
I also have a “solid” feeling in my back. (Nice when carrying a kid)
My posture is better though not optimal (pelvic tilt still work in progress)

I have been reading a lot and trying out many different things.
Nobody is the same and I don't think there is a simple fix.
But I encourage you to keep looking and work on it and hope you get better soon.

Greetings from Germany,

Daniel
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