Advice re: Sciatica

[li10up]

I desperately need some advice on how to alleviate the severe discomfort that I have while riding.
Background: I fell from a horse about 8 years ago. It was the worst pain I have ever felt in my life…I fully expected to be paralyzed – that is until I realized I probably wouldn’t be hurting if I were paralyzed. An x-ray said there was nothing broken, bulging, etc. Shortly thereafter I developed a burning, painful tingling sensation that ran from the top of my buttocks, down the back of my left leg to the sole of my foot at the base of my toes. Sciatica. I had a MRI done about 7 years ago because of this constant pain. It didn’t show anything. I’ve taken nortriptyline from time to time when it gets to the point that I can’t sleep or even sit for more than 10 minutes at a time. The side effects of the nortriptyline prevent me from taking it on a regular basis…plus, I just don’t like taking drugs. Another x-ray about 6 months ago only shows “signs of early arthritis.”
Back to the present. It has flared up again to the nearly unbearable point and now the right leg is becoming involved from the calf down to my foot.
Hence the problem: About 5 minutes into my ride now I am experiencing severe discomfort in both soles of my feet at the base of my toes. Does anyone have any ideas what I can do to alleviate this? My shoe straps are not tight. My SPD cleats are attached to fixed holes in the sole of my shoe so I can’t adjust them. The soles of my shoes are stiff. I really need some help. My doc doesn’t have any solutions. Obviously something is wrong...why can't they find it!? Stretching helps some with the daily discomfort but not while riding. I’m hoping to clear this up before my first 100K attempt this Saturday. Advice please!

[SadieKate]

Could they determine where the nerve is being pinched? In your back or in your buttocks?

Arnie Baker, MD, covers sciatica in his book Bicycling Medicine. It is a fairly involved discussion based on where the nerve is being pinched so I'd recommend getting his book.

[li10up]

Could they determine where the nerve is being pinched? In your back or in your buttocks?

Arnie Baker, MD, covers sciatica in his book Bicycling Medicine. It is a fairly involved discussion based on where the nerve is being pinched so I'd recommend getting his book.
Unfortunately, all they say is "We can't SEE anything wrong." My doc doesn't doubt me though. It's just that they say the x-rays and MRI don't show anything abnormal. Is there a way to find out?

[SadieKate]

Get the book! I can't emphasize enough that you should use medical professionals that specialize in bicyling for advice first. It might help your doctor also. Photocopy the pages for your doc.

You could also read Andy Pruitt's Complete Medical Guide for Cyclists and get informed on the biomechanics of cycling. He also runs a clinic in Colorado which you may want to look into if you can't solve this.

I think these two books are critical for one's library. You've got a severe enough problem that you should buy these books and read them.

[li10up]

Get the book! I can't emphasize enough that you should use medical professionals that specialize in bicyling for advice first. It might help your doctor also. Photocopy the pages for your doc.

You could also read Andy Pruitt's Complete Medical Guide for Cyclists and get informed on the biomechanics of cycling. He also runs a clinic in Colorado which you may want to look into if you can't solve this.

I think these two books are critical for one's library. You've got a severe enough problem that you should buy these books and read them.
I will get the book but I was hoping for some advice that I can use now so I can complete my ride on Saturday. Is there anything you (or anyone else) can tell me that may help. I only rode 20 miles yesterday and I was in pain the whole way.

[SadieKate]

Sciatica is a very complex problem. Sure, others (like me) may have solutions to their sciactica, but it will be based on a statistic of one. The book covers multiple reasons why the nerve may be pinched and you need to know them all to make the best judgement about where to start to solve your own problem.

Both of these books are usually in stock at Borders. You have one nearby?
You can even check inventory on-line.
http://www.bordersstores.com/index.jsp

Here are the ISBN numbers so you can call any book store to check inventory

http://www.amazon.com/gp/product/0684844435/sr=8-1/qid=1149788446/ref=pd_bbs_1/104-8865199-3373520?%5Fencoding=UTF8

http://www.amazon.com/gp/product/1931382808/qid=1149788507/sr=2-1/ref=pd_bbs_b_2_1/104-8865199-3373520?s=books&v=glance&n=283155

[SalsaMTB]

I know zero about Scaitica (never even heard about it until now) but, you're desperate so I thought I would ask if anything has changed in your bike setup. There are some nerves in the balls of your feet that could be getting compressed that cause numbing or burning feeling. Have you changed your setup at all? Or maybe your route has changed and add more climbing causing more pressure? Typically people will move their cleats back a couple mm, but if you can't, maybe you can try different insoles in your shoes (either thicker or thinner, depending on how your shoes fit). Also, maybe try different socks or having someone stretch out that area of your shoe. Sorry I couldn't help too much. Good luck, hope you can find something soon!

[li10up]

SalsaMTB-no the bike setup is the same. This is only my 2nd year riding and I didn't ride much last year. I've had this problem for 8 years. Riding seems to make it worse though. On the easy ride I lead I almost never have problems...because I soft pedal or coast quite a bit. But on my solo rides it is extremely bothersome. Sitting at my desk today is quite a chore in itself.

[DrBadger]

I had back problems and severe sciatica about 5 years ago (when I was only 22!) due to a fall, so I have some idea of the amount of pain you are in. My first suggestion that has nothing to do with cycling is to see another dr. and GET ANOTHER MRI!!! there is obviously a nerve being pinched, and it is getting worse if it is involving the other leg now too. It is possible that when you had the first MRI they just didn't take it from a direction that allowed them to see the disk that is probably bulging and doing the damage. The other thing to watch out for is if at any point you seem to have to go to the bathroom more often than before (or at least feel like you do)... this is an indication that the nerve that controls bladder function is being compressed, and this is serious. When the doctors heard this, I had surgery the next day! And when I woke up there was no more pain down my leg for the first time in 6 months, it was amazing! I am not saying surgery is the answer for everyone, but for me it was, and given the length of time you have been in pain, there is a chance it will be for you too... just to warn you.

As for the 100k this weekend, my first recommendation is that with the amount of pain you are in, don't do it. You won't have fun, and there is a chance you are just going to do more damage. If you absolutely must do it, take the drugs, and see if you can get in to the Dr. and get a cortisone injection. I never had one, but other people I know who had back problems found they really helped temporarily. I didn't bike at the time I had problems, so I can't give any more on-bike suggestions, but off the bike, the thing that felt the best when I was in a lot of pain was to lay on the floor and have someone pull on my leg (I only had pain in one). This is similar to traction, and removes some of the pressure on the nerve.

Hope you feel better and they can get to the bottom of this! Since things are getting worse I would go back to the Dr. and try to see some one new and get a new set of MRIs with more than one view of the back.

Good Luck!

[slinkedog]

I began my foray into the wonderful world of sciatica during my 4th pregnancy. I still deal with bouts of it on occasion. I will just echo what PABadger has to say... don't do the ride this weekend. Wait until you've got the problem sorted before you go subjecting yourself to the rigors of a metric century.

Hope you're feeling better soon! Sciatica really bites.

[li10up]

Everything I've read online says that it usually goes away in a couple of weeks to a couple of months. How is it possible that mine has stuck around for 8 years?

PABadger-thanks for the info. How long did you have to deal with this? I really don't want anyone cutting on my back. But I've also sworn to myself that I won't allow this to keep me from doing the activities I want to do. It's almost too the point right now of doing just that though.

[bcipam]

The pain you are discribing does not appear to be sciatia but in fact a neuroma, a pain in the base of the toes. Index neuroma on this website. Thre has been lots of discussion. Generally a few ways to handle, make sure you ride with a cleat/pedal that has a wide platform, make sure the cleat is properly positioned, make sure your shoes are comfortable but not loose - you told want your foot rocking around inside the shoe, and wiggle your toes, alternate clipping right then left, rest your feet occasionally.

[SadieKate]

It sounded like Piriformis Syndrome to me and why I think getting the books will help. There are many, many causes for sciatica and she probably needs advice from a medical professional who deals with biomechanical issues for cyclists. The inflammation could be caused by jarring on the saddle and/or leg length discrepancy.

http://www.answers.com/topic/piriformis-syndrome

http://www.americanrunning.org/displayindustryarticle.cfm?articlenbr=2056

As Baker says, "Pinched nerves in the back are the most frequent, but not the only, cause of sciatica. Occasionally, the nerve is pinched in a buttock muscle, the piriformis, rather than in the spine." This is why you must find out where the nerve is being pinched.

[li10up]

The pain you are discribing does not appear to be sciatia but in fact a neuroma, a pain in the base of the toes. Index neuroma on this website. Thre has been lots of discussion. Generally a few ways to handle, make sure you ride with a cleat/pedal that has a wide platform, make sure the cleat is properly positioned, make sure your shoes are comfortable but not loose - you told want your foot rocking around inside the shoe, and wiggle your toes, alternate clipping right then left, rest your feet occasionally.
The pain starts at the top of my butt, travels down the length of my leg and ends at the base of my toes. Cycling just makes it more prevalent in my feet. But I'll search on neuroma.

[DrBadger]

If the pain were just in her foot, I would agree that it isn't sciatica. But since it is radiating from her back, across her butt, and down the back of her leg before residing in her foot, that is exactly the same as when my sciatic nerve was pinched due to a herniated disk in my back. Most of my pain resided in my ankle on my left foot (on the outside right below the knobby bone).

Li10up, I fell right before Christmas (unplowed city streets on my way to a final exam... that was fun!), was sore for a couple of days, then on Christmas day had some pain in my butt that mimicked piriformis issues that I had had before (like was SadieKate mentioned), did some stretches for that and boom.... shooting pain down my leg. My dad had to put a board under my mattress so I could sleep and I cried myself to sleep that night. Spent the next 3 months going to Physical therapy trying to get things under control, had an MRI around Easter. When my doc called, he said the herniated disk was really obvious in my case (ruptured to the side) and that I must be in a ton of pain. He told me that at this point, since medication, rest, and physical therapy hadn't helped that surgery was really the only option left for relief. I was finishing college, so didn't go and see a surgeon until mid-May after I had graduated, but they took one look at my MRIs and my other symptoms and I was scheduled for surgery the next day. So, I was basically in constant pain for about 6 months. My pain was very similar to what you describe, hurt in my but in the piriformis region, down my leg and then resided in my ankle... I really never had much pain (or at least it was eclipsed by other pain) in my back, it was all in my butt, leg and ankle.

The things online that say it usually gets better in a couple of weeks or months is generally if the sciatica is due to muscle spasms and injuries, or very small herniations that can actually be pushed back in with physical therapy. Once you get to severe herniations there really isn't a lot of option for pain relief other than surgery. Like SadieKate said though, you do need to determine where the nerve compression is coming from, if you don't know that you don't know how to treat it. Just given that you fell in a way that was similar to mine (only you fell further) makes me think that there is a chance that it is a disk, and x-rays won't show this, only an MRI or CAT scan. If you look up piriformis stretches online you can see how doctors generally diagnose piriformis syndrome, but I have to warn you, doing these stretches is how I made my disk a lot worse than it was, so you probably shouldn't do these on your own given the amount and length of time you have been in pain.

While surgery is a last resort, it was the best thing I have ever done... I couldn't believe how much better I felt right after I woke up. If you want more details about the surgery, recovery etc., feel free to PM me. I was at the point of just wanting to bend over in the Drs office to have them take care of it immediately, but that still didn't quite prepare me for the reality of being told I was having surgery the next day.

Good Luck!
Ellen

[li10up]

What keeps bothering me is that I wouldn't really call what I'm experiencing painful...at least not compared to the fall I took. It is painful but in more of a severe discomfort type of way. Maybe my definition of pain or pain threshold is different. It's more like my leg and foot is really, REALLY deeply asleep...pins and needles type thing. Especially when pedaling. So is that pain? Wouldn't a bulging disc be more painful than what I'm describing? I can't recall if the dr. used the word sciatica or not. I think he just used the words like, pain of unknown etiology. So I'm not 100% sure of what the problem is. Also, when he moves my leg around I don't feel any pain in my back...if it was a disc problem wouldn't there be pain when he does this? If it's not a disc then what has been causing this for 8 years? My lower back is constantly tight, like a mini spasm. Putting on socks is a hugh chore, especially first thing in the morning. If it was a piriformis issue wouldn't doing those stretches hurt? They don't really hurt me. I know it is somehow related to that fall though. Maybe another MRI is called for. At least that's what I'm going to ask for. I see a different dr. tomorrow. Hopefully I'll find out something more. I just don't want to have to deal with this for another 8 years.

[li10up]

PABadger-you sound like you had it worse off than me. I couldn't move without muscle relaxants for about a week. I had two hugh bruises at the top of my butt - where it meets the back. Your ordeal sounds terrible but at least you knew what was causing the pain and they could fix it. I'm glad you are ok now. No lingering after affects I hope?

[li10up]

It sounded like Piriformis Syndrome to me and why I think getting the books will help. There are many, many causes for sciatica and she probably needs advice from a medical professional who deals with biomechanical issues for cyclists. The inflammation could be caused by jarring on the saddle and/or leg length discrepancy.

http://www.answers.com/topic/piriformis-syndrome

http://www.americanrunning.org/displayindustryarticle.cfm?articlenbr=2056

As Baker says, "Pinched nerves in the back are the most frequent, but not the only, cause of sciatica. Occasionally, the nerve is pinched in a buttock muscle, the piriformis, rather than in the spine." This is why you must find out where the nerve is being pinched.
I would LOVE to know the source!! I've seen 3 different drs and not one of them has told me the source. Like I mentioned somewhere, "Pain of unknown etiology." How can I get them to figure out the source? It seems like I can't really do anything about it until that is nailed down. I'm I right? Also, if it was periformis would that last for 8 years? I'm so confused.

[KnottedYet]

Please ask a PT or OMT to check your psoas and iliacus. What you describe is pretty classic for iliopsoas spasm/tightness/structural shortening secondary to sciatica or back injury. This can start unilateral, and later become bilateral. Ask them if myofascial release (through the abdomen, a kind of deep massage) or strain-counterstrain would help. If they would help, the PT or OMT (or DO if you have access to one) will be able to teach you how to do both techniques on yourself.

[DrBadger]

li10up, how did the dr go today? any movement on getting another MRI? Hope all went well.
E.

[li10up]

li10up, how did the dr go today? any movement on getting another MRI? Hope all went well.
E.Thanks for your concern. I appreciate everyone's advice.

The Dr. appt went well, I thought. He seemed genuinely concerned that this has been going on 8 years. He stopped the meds that I was on and started me on Predisone 60mg for 3 days, 40mg for 3 days, then 20mg for 3 days, then stop. He is hoping this will clear up the inflammation and relieve the nerve. I took my first dose Fri night. Had a bit of a problem sleeping - awoke with pain around 2am. but was able to get back to sleep around 4am. Had to get up at 5 to leave for the tour. I was so happy on this ride. I had no real pain in my legs or feet. A couple of times I could feel it coming on so I just quit putting so much pressure on my pedals. The pain down the back of my left leg was practically non-existant! However about 3 hrs after the ride the pain was back with a vengeance!

He also scheduled me for another MRI. They should be calling me within 10 days to set that up. He said something interesting to me which could explain my problem. He said that I could have a disc that slips out of place and then returns back to place after awhile and that could be why I'm barely noticing anything for awhile and then bam! it flares up on me and I'm hurting. Does this sound possible to you ladies? He said that could also account for the disc problem not showing up on the first MRI. I do remember not being in much pain by the time they got me scheduled for the 1st one. Anyone know if this is possible - for a disc to move in and out of place?

Anyhow I felt encouraged that maybe I'm getting somewhere on this.

[li10up]

I'm feeling a little out of sorts today. I went for a walk and when I got back I didn't feel quite right. I took my HR and it was 58. A few minutes later I took it again and it was 48. My HR is normally around 70. Is this anything to be concerned about?

[KnottedYet]

A disc is like a jelly bean with a gooey center. If the "shell" of the jelly bean is cracked, the jelly and the goo can ooze out. It can also ooze back in. Kinda like those kid's toys of the chicken with the gooey egg-blob that comes out when you sqeeze it, and goes back into the chicken when you let go. when your disc is under pressure it can squeeze out the goo, when the pressure is off the goo can go back into the disc's "shell".

Sorry, not a good description. But really, it's not the disc that moves, its the gooey inside stuff.

What you want to figure out is what is causing the pressure that moves the goo in the first place.

As far as not feeling normal and the decreasing heart rate: please call your doc or the on-call doc for his practice. If you can't reach him, call your pharmacist.

[li10up]

KnottedYet - thanks for the info. I did call later that day and spoke to a nurse. She didn't seem to be concerned and told me to continue with the med. I took my resting HR this morning before I got out of bed. It was 46. I guess the cycling has made my heart stronger...hence a lower HR.? I was just surprised to see it that low. I'm feeling fine this morning.

[tulip]

I would suggest getting to the source of the pain and addressing that rather than treating the symptoms.

I'm not a doctor, but I can speak to my experience. I had similar pain from a fall, although it did not go all the way to my foot, just to my knee. It got to the point where I could barely sit down and walking was difficult. My hamstring muscle was very tight, too. The doctors wanted to give me medications and send me on my way without getting to the cause of the pain.

I started going to a chiropractor and it has helped tremendously. I also started doing pilates to strengthen my core and improve my posture. That, also, seems to have helped. I can sit, ride my bike, and walk without pain. The only thing that is still uncomfortable is lying down on my back flat. If I put a pillow under my knee, I am comfortable.

I took prednisone for an eye problem years ago. It has some serious side effects. For me, it was dizziness, weight gain and very dry skin. Just keep that in mind.

Best of luck.

[pikato]

I've been talking about sciatica on my blog this week. There is something up with our work chairs, because another coworker & I have the same issue. We've been trying everything for it, but yesterday I got so bad, I couldn't even sit down without having tears in my eyes. So I scheduled a full body massage. I must say, possibly one of the most painful things in the world when that woman was massaging the sciatic area. BUT, I'm happily sitting at my desk, pretty much pain free.

[plantluvver]

I have sciatica exactly like you describe it, but mine started mysteriously. I went to a chiropractor, because of a recommmendation from a freind. (previously I thought the were quacks.) They diagnosed piriformis syndrome, and adjustments gave me IMMEDIATE relief. At its very worst, my entire leg went numb (before seeing her.) I still have a small area of numbness about two inches in diameter, right under my little toe. My sciatica can recur if I get stressed or travel , or just sit too much. but I haven't had a real recurrance for several years. My hamstrings are incredibly tight, which also contributes. And when not in pain, I have better things to do than stretch.:o

Since you had an injury, I don't know if yours could be the same cause.

I have also heard strange things about some Chiropractors, such as requiring payments in advance for two years of treatments, requiring lengthy periods of treatments. ( I had six or eight twice a week, while the pain kept recurring and I was taught stretches) Mine was done at a school clinic, so they weren't making money off of me. The one time I saw a private chiropractor, I only saw her twice, sadly, she is too far to go by bus.

After one thing I read about neck adjustments, I will never allow those! I don't know what risks if any come from lumbar manipulations.

I have seen acupuncture work extremely well for various things, but I have not used it for this.

But just my personal, anecdotal experience, for what its worth. And I think I will also take a look at that book sounds right on the money.

Mary

[li10up]

Well, I got the results back of my MRI. Nothing for them to report other than some signs of arthritis. So it's looking more and more like Piriformis Syndrome.


It sounded like Piriformis Syndrome to me and why I think getting the books will help. There are many, many causes for sciatica and she probably needs advice from a medical professional who deals with biomechanical issues for cyclists. The inflammation could be caused by jarring on the saddle and/or leg length discrepancy.

http://www.answers.com/topic/piriformis-syndrome

http://www.americanrunning.org/displayindustryarticle.cfm?articlenbr=2056

As Baker says, "Pinched nerves in the back are the most frequent, but not the only, cause of sciatica. Occasionally, the nerve is pinched in a buttock muscle, the piriformis, rather than in the spine." This is why you must find out where the nerve is being pinched.

SadieKate, thanks for the links. I re-read the article at answers.com and it says, "Treatment for piriformis syndrome includes avoiding activities that aggravate the condition, such as running and bicycling." That's not too encouraging. My doc hasn't called me back for a follow-up so I guess he's done with me. Looks like this is just something I'm going to have to live with.

[Rai Sue]

Wow, I hope you figure out what is causing your problem.

I really recommend finding a physical therapist who has experience with athletes, and who maybe does some chiropracter moves. Mine really got my back into alignment, and made me see how out of shape my torso was in, compared to my legs (which bike a lot). In addition to the readjustment, she made me realize how important it is to keep my stomach and back muscles strong. If I don't do my pilates-type exercises a few times a week, my back starts to hurt again. But with strong-core muscles, and stretched out hip & leg ligaments, I really feel normal most of the time. Maybe see if doing pilates helps?

I injured my lower back (not sure exactly how) about a year and a half ago. It actually took me a while to figure out it was my back, b/c i was mainly (at first) only feeling pain in my hamstring. After I realized that it was probably my back, though, i started trying to figure out who to see for something like that. Once i finally got x-rays and an MRI, they told me i had a bulging/herniated disk. I was bummed, but compared to you I now feel lucky to get such an easy diagnosis!

Of course, they said that with a bulge like mine, probably the only solution was surgery. They also said that if such injury didn't go away w/in 6 weeks, it would likely not go away on its own. I was willing to do surgery if nothing else worked, but luckily the PT had an affect on my case.

I do notice that around my period, i get a lot more lower back pain, and I think i'm relapsing until I realize what's going on.

The whole diagnosis took about 3 months, what with all of the appointments, during which time all of the pain really made my ability to deal with stress (usually i'm pretty laid back) much more difficult. It really affected my tolerance for everything, probably because I was never comfortable--sitting, lying down, standing, etc, and it was hard to focus entirely without the pain in the background. It was mentally and emotionally draining, so if you're having trouble, realize that that is pretty normal when you're in pain a lot.

I also figured out that I had switched bikes, and the one i was riding was slightly too big and was exacerbating everything. So I switched back to my old trusty steed. Another friend with a similar injury (and my PT, who is a mountain-bike fanatic) told me that more upright bike, like a hybrid or cruiser, would be better for lower back pain. (that's for transport, not sport))

Everyone's different, so I hope this helps you (or someone)

ANd, if anyone wants a physical therapist who's great with backs in San francisco, let me know and I'll give up my recommendation!

Rai Sue

[Dogmama]

What kind of doctor are you seeing? Your need a SPINE SPECIALIST.

I had a slipped disc in my neck causing numbness & pain in my arm. Saw an ortho who took an x-ray and immediately referred me to an ortho who specializes in spinal surgery. The MRI showed disc problems, but DID NOT show the disc impaled in the spinal column OR the massive amounts of arthritis in my neck. MRI's are NOT foolproof. The doc operated primarily because my symptoms were so bad. He was aghast to find the mess in my neck (surgery took a lot longer) because THE MRI DID NOT SHOW THESE PROBLEMS.

If you can't ride without pred, it needs to be fixed. Period. You can't take steroids forever. And you should not have to compromise the quality of your life.

[li10up]

What kind of doctor are you seeing? Your need a SPINE SPECIALIST. If you can't ride without pred, it needs to be fixed. Period. You can't take steroids forever. And you should not have to compromise the quality of your life.
Just seeing my G.P. Maybe I should have you talk to my doc. ;) Quality of life doesn't seem to sway him much.

[tulip]

A second opinion might be in order.

[esther231]

I had sciatica. Painful. I couldn't believe the pain. What worked for me in the end was a chiropractor. A friend had recommended I try it. Went out of desperation and didn't for a second believe it would work. Gratefully, the relief started with my first visit.

From what the chiropractor told me, they can't help all forms of sciatica. But the ones they can help, they are wonderful at relieving when nothing else works.

For me, it turned out I had spasm in my lower back - that I was unaware of - I had no pain there - and it had caused spasms elsewhere that eventually lead to the compression of the sciatica nerve.

Felt like he was doing nothing to me during the visit. I left, feeling just a tad better. The next day, I felt like I had been hit by a car. lol But the scaitica pain begin to ease so I really didn't care. It took several visits to get the spasm out of my back but I haven't sciatica since.

I hope you find the answer for yours. Hang in there.