If you’re a runner (and we’re guessing you are), it is likely you have been confronted with the term ‘sciatica’ at some point – either through a quick Google search to try and identify that nagging back/leg pain or just a running mates' attempt at diagnosing you.
What everyone's reading
Contrary to popular belief, sciatica is not a medical diagnosis. It is actually a very old term that encompasses quite a few different and often overlapping conditions that can impact people in a range of ways.
So, let's run through the different types of sciatic nerve pain and how runners can potentially be affected.
So, let's run through the different types of sciatic nerve pain and how runners can potentially be affected.
What is sciatica?
‘Sciatica’ is named after 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), which runs 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.
Referred pain, radicular pain and radiculopathy can all be present at the same time or separately. This means that while a popular term, sciatica is not always a helpful 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
If you’re a beginner runner, it is a good idea to start slowly and build up distance/duration/intensity gradually. This is because we tend to have better tolerance of movements we are accustomed to, and so increasing your training slowly will help protect your muscles against injury.
Poor recovery
Injuries can also occur at the other end of the spectrum if a runner is under-recovered. This could be due to a heavy block of training or having returned too quickly 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 if you have an episode of pain, it is better to just rest rather than trying something new.
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.
Tendon pain generally manifests as less severe - at the start of a run it can ‘warm up’ but then becomes sore afterwards. But as tendon pain progresses, it can become more painful and tolerate less - ie, it comes on earlier in the run and doesn't warm up as much – 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 severity of your injury – muscle and ligament injuries are graded and can last a couple of weeks or longer, whereas most episodes of back pain tend to clear up in around six weeks. Nerve pain, however, will take longer to heal.
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 complete bed rest, but it is likely you will not be able to do what you normally do for a few days. Hot and cold compresses may both help in the short term. 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, try building back up activity slowly – 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-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 actions. Your body will still need to recover and rest, but you are likely to be able to continue your normal activities. Based on the severity of the pain, you can decide whether you should be running 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?
Every month, 4,0oo people Google if they can ‘cure sciatica in 8 mins’, so we are clearly desperate to find a quick fix... if only it were that simple! The real answer to this is that there are no ‘best’ exercises.
If the pain is severe, as it can be with radicular pain, you need to let your body recover and find positions that are comfortable when your pain is at its worst. These are often:
- Lying on your side 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 test 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 scan for any tension.
- Gently curl and move as far as feels comfortable.
- Repeat in the opposite direction.
- Repeat 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 be increasing your pain, and should only be continued if you feel they are helping.
My advice would be to get an assessment from a medical professional, like a physiotherapist, if you are concerned.
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 tomjesson.com
Rebecca is a physiotherapist with over 20 years' of experience working with recreational and elite athletes, including Olympic runners. She also lectures physiotherapy at MSc level.
