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/068...Fencoding=UTF8

http://www.amazon.com/gp/product/193...lance&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/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]

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