Advice re: Sciatica

[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/displ...rticlenbr=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]

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/displ...rticlenbr=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?

[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/displ...rticlenbr=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.

[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.