[ascanales]

I have recently taken up road biking and I am having pain from Sciatica. Any ideas on what I can do to help this pain...or stop the pain?

[Lara]

Not a doctor here, but am someone who has had sciatica. Not so much any more since I stopped all the heavy labouring in the yard. The angle you're bent into when you're riding might have something to do with it. Maybe changing the angle or lowering the seat might help a little. Depends what type of bike you're using. I can imagine a lot of bike riders would have had this problem from time to time. I'm sure this is not an uncommon occurrance. You're maybe triggering some type of physical or mechanical issue that is pre-existing in your spine. Have you ever had back problems before this? No curvatures or major injuries?

Anyway, welcome to the forums here. I hope you get some answers and can get back to riding pain free. The main thing is to figure out what is actually causing the pain. Investigations might be needed for that.

Added: Here's the link to the Spinal Disorders Forum where you could ask your questions there...

http://neurotalk.psychcentral.com/forumdisplay.php?f=22

and here's a link to an older post from someone else

http://neurotalk.psychcentral.com/showthread.php?t=8890

take care,
Lara

[Ellie]

Sorry for the delay responding to this. I suffered from Sciatica after a tailbone injury around 1997. It wasn't until I think 2003 or so I finally got the courage to have a cortisone injection. I remember being sore for about 3 days and then one day I went to the mall and by nature, I sat down. It wasn't until then I realized I didn't need to sit because I had no pain.

My quality of life really increased after getting these shots, and I've heard they vary so much by person in terms of results. Some don't work at all, and some are like me - very lucky (and I wont ever take it for granted!) and have them last a full year.

I get an injection around once per year, sometimes a bit longer. I normally have one as soon as the other wears off (and boy does it bring back reality). I also had injections in my right hip for bursitis when I had my very first cortisone injection. This was because due to the sciatica pain, I would shift my weight and sit in this awkward type of indian style position, bearing a lot of pressure on my right hip resulting in bursitis. That was the first and only shot I needed once I started this treatment.

I've heard bad things, such as people get them too frequently. You can't expect 100% results, it will still flare up now and then. Getting too many shots can damage the area with scar tissue and such. So if/when you look into it, do your best to spread them out as far as you can.

The pain is not bad at all (the shot) they spray on this stuff to numb the area, then you get a numbing shot (sometimes, I had one doc who didn't do it) and do an injection of cortisone in the SI area, sometimes they do a shot of the anti-inflammatory stuff, I don't know what it is to be honest (which should apply to you as you're biking). Now, don't confuse this with a nerve block, that hurts. I've also had a shot directly into my joint which feels rather weird more than it hurts (it makes sound, too - which is gross).

I am not a fan of needles, but I will praise these shots. There's no words than can explain how much more I've been able to do now, and I'm thankful for being able to do them pain free.

Finally, don't get one of these shots from someone who doesn't do them basically daily. Look for someone in Physical Medicine, or even Sports Medicine. Remember you will have breakthrough pain, ice it or give it a day or two - don't rush back for a new shot. I think you can only get a max of 2-3 per year. Aim for only 1 per year.

Good luck finding some relief.

PS: Stand with your legs crossed if you stand for a long time, it takes some of the pressure off. You look kinda silly, but it works!

[Pwalla]

I know your pain. I had sciatica so bad two years ago I thought I was ready for a wheel chair and I was an athletic healthy person. When I see people go to a GP or PT for this now I cringe. I had only 3 sessions of acupuncture from an excellent licensed one trained in Chinese medicine as well. He wasn't Asian himself. The 3 sessions included using tens stimulation and heat as well as putting the needles into the skin deep. This was my first experience with acupuncture and the first two sessions hurt bad afterwards but now it's been completely gone two years later!! Voila!! Now I go to him first before other treatments. My guy charges $65 and also takes my insurance so ends up about $30 a visit. My insurance allows 20 visits a year. Goodluck!!

[GaryA]

Originally Posted by Pwalla

I know your pain. I had sciatica so bad two years ago I thought I was ready for a wheel chair and I was an athletic healthy person. When I see people go to a GP or PT for this now I cringe. I had only 3 sessions of acupuncture from an excellent licensed one trained in Chinese medicine as well. He wasn't Asian himself. The 3 sessions included using tens stimulation and heat as well as putting the needles into the skin deep. This was my first experience with acupuncture and the first two sessions hurt bad afterwards but now it's been completely gone two years later!! Voila!! Now I go to him first before other treatments. My guy charges $65 and also takes my insurance so ends up about $30 a visit. My insurance allows 20 visits a year. Goodluck!!

Not knocking acupuncture. Acupuncture and trigger point therapy are similar, but not the same. Acupuncture (and acupressure which is acupuncture without the needles) is applied to energy meridians. Trigger point therapy is ischemic compression (a la acupressure) applied to small hypertense nodules that refer pain to other areas. One of the site's moderators provided an excellent detailed explanation of trigger points in another thread

If vertebral compression and damage to the sciatic nerve sheath by any one of several nerve disorders has been ruled out, by the process of elimination, the cause of your sciatic pain will have to be muscular compression of the sciatic nerve that enervates the legs.

The usual culprit is the piriformis muscle deep in the posterior hip. The nerve passes directly beneath this tiny but very powerful muscle--in about 25% of people, the sciatic nerve passes through the middle of the muscle. When it becomes hypertonic, it applies considerable pressure on the nerve, causing numbness, weakness and or tingling down the leg. Look it up on an anatomy chart.

One trigger point will be located an inch or so off the sacrum; two more can be found near the muscle's insertion on the femur. Contributing trigger points can be found in the gluteus medius on the thigh between the greater trochanter of the femur and the crest of the ilium; a couple more really active trigger points are in the quadratus lumborum which binds the ribs of the low back to the hip. With determination, a trigger point chart and a tennis ball, you can release these trigger points yourself. Better yet, get a friend to do it for you. Appropriate pressure applied to a trigger point will be mildly painful but for only a few seconds. Less painful than an acupuncture needle pinprick.

[GaryA]

Originally Posted by Ellie

Sorry for the delay responding to this. I suffered from Sciatica after a tailbone injury around 1997. It wasn't until I think 2003 or so I finally got the courage to have a cortisone injection. I remember being sore for about 3 days and then one day I went to the mall and by nature, I sat down. It wasn't until then I realized I didn't need to sit because I had no pain.

My quality of life really increased after getting these shots, and I've heard they vary so much by person in terms of results. Some don't work at all, and some are like me - very lucky (and I wont ever take it for granted!) and have them last a full year.

I get an injection around once per year, sometimes a bit longer. I normally have one as soon as the other wears off (and boy does it bring back reality). I also had injections in my right hip for bursitis when I had my very first cortisone injection. This was because due to the sciatica pain, I would shift my weight and sit in this awkward type of indian style position, bearing a lot of pressure on my right hip resulting in bursitis. That was the first and only shot I needed once I started this treatment.

I've heard bad things, such as people get them too frequently. You can't expect 100% results, it will still flare up now and then. Getting too many shots can damage the area with scar tissue and such. So if/when you look into it, do your best to spread them out as far as you can.

The pain is not bad at all (the shot) they spray on this stuff to numb the area, then you get a numbing shot (sometimes, I had one doc who didn't do it) and do an injection of cortisone in the SI area, sometimes they do a shot of the anti-inflammatory stuff, I don't know what it is to be honest (which should apply to you as you're biking). Now, don't confuse this with a nerve block, that hurts. I've also had a shot directly into my joint which feels rather weird more than it hurts (it makes sound, too - which is gross).

I am not a fan of needles, but I will praise these shots. There's no words than can explain how much more I've been able to do now, and I'm thankful for being able to do them pain free.

Finally, don't get one of these shots from someone who doesn't do them basically daily. Look for someone in Physical Medicine, or even Sports Medicine. Remember you will have breakthrough pain, ice it or give it a day or two - don't rush back for a new shot. I think you can only get a max of 2-3 per year. Aim for only 1 per year.

Good luck finding some relief.

PS: Stand with your legs crossed if you stand for a long time, it takes some of the pressure off. You look kinda silly, but it works!

Ellie, according to research I've found through google, cortisone can have some very nasty side effects, including degeneration of muscle tendons and some suggest that it can "eat" into bursa, causing leakage. But if it works for you, good!

According to several studies I've read, almost all cases of intermittent sciatica is caused by soft tissue--muscle tissue trigger points which cause hypertonicity that can compress the sciatic nerve. One or more muscles deep within the posterior hip are likely to be the cause of your recurring pain.
The piriformis is the most troublesome; it originates low on the sacrum and attaches on the greater trochanter of the femur. The sciatic nerve passes right below it, and in 25% of the population, the nerve passed through the heart of the muscle!
A single trigger point therapy session with a licensed massage therapist may just resolve your sciatica issue. Problems within the spine don't come and go with activity, so it probably is nerve compression by muscles within the posterior hip.

But sometimes a little stretching of muscles not used too much since you were a kid is all that's needed.

[Leesa]

Hi ~ Sciatica USUALLY takes care of itself. That is, if it's simple sciatica! If the problem is piriformis syndrome, it might take longer -- or even surgery to correct.

Try icing the area for 20 minutes every 2 hours. That will decrease the swelling plus numb the pain. At first it hurts worse, but after a minute or two, it really feels good! Don't use heat -- heat draws blood to the heated area causing more swelling & inflammation & pain.

If this doesn't lessen in a reasonable length of time, you may need an MRI with and without contrast material to see what the problem is, i.e. disc pushing on nerve, etc.

I wish you the very best. I've had "sciatica" for over 25 years - so I know what you're going thru. The injections rarely work -- and they're only temporary anyway. Take care & God bless. Hugs, Lee

[GaryA]

Originally Posted by Leesa

Hi ~ Sciatica USUALLY takes care of itself. That is, if it's simple sciatica! If the problem is piriformis syndrome, it might take longer -- or even surgery to correct.

Try icing the area for 20 minutes every 2 hours. That will decrease the swelling plus numb the pain. At first it hurts worse, but after a minute or two, it really feels good! Don't use heat -- heat draws blood to the heated area causing more swelling & inflammation & pain.

If this doesn't lessen in a reasonable length of time, you may need an MRI with and without contrast material to see what the problem is, i.e. disc pushing on nerve, etc.

I wish you the very best. I've had "sciatica" for over 25 years - so I know what you're going thru. The injections rarely work -- and they're only temporary anyway. Take care & God bless. Hugs, Lee

I can't imagine ever needing surgery on the piriformis-- it is deep, and therefore well protected. Since it doesn't act alone, even serious weight training is unlikely to cause it to grow enough to cause a compression problem. But, yeah, ain't no part of the body that isn't vulnerable to all kinds of things. However, surgery and/or drugs should be the last resort.

There's plenty of youtube and other video online that demonstrates piriformis trigger point release. That's fine: it isn't rocket science, it's just a few moments of ischemic pressure. But you shouldn't allow anyone to apply deep pressure directly to the center of the muscle, which might (rarely, but possibly) cause even more compression on the sciatic nerve that is either directly beneath the muscle or running thru the heart of the muscle. But the TrPs in the piriformis will usually be found very close to the sacrum and a few centimeters off its insertion on the greater trochanter of the femur--no danger of putting pressure on the nerve.

Five lateral rotators in the butt can be causing/contributing to the problem. In fact, the entire length of the nerve is vulnerable to impingement by covering muscle...in the buttocks, in the posterior thigh.

[momto5]

Try watching this video. Tasso is a trigger point therapist, but he give stretches that will help with various pains. This video is about sciatic pain.

http://www.youtube.com/watch?v=lW0NRqqzld8

[pinehurstcharlie]

I've suffered with sciatica off and on for years now i'm trying to figure out if the burning in my feet and lower legs is from sciatica . It seems to be almost gone from now my new water exercises . I had been diagnosed with small fiber neuropathy this summer from a normal emg test and with all the other tests it would have to be idoipathic as no source . Anyone have similar burning ? I have a few discs that are not too good in lower back but not bulging or herniated.