What are Sciatica and Piriformis Syndrome?
Unfortunately, sometimes running and sciatica go hand-in-hand. Sciatica is a nerve pain that is felt throughout the sciatic nerve. The sciatic nerve runs from the lower back, through the buttocks and hips, and down the legs. Sciatica is generally felt on one side of the body. It is usually a result of a bone spur or herniated disk that is compressing the nerve. This compression may cause hip pain, inflammation, and numbness in the leg. Conservative treatments for a few weeks usually help with sciatica. Surgery is rarely required. As a general rule, surgery should be considered a last option in most cases, and sciatic nerve pain is not an exception.1
With piriformis syndrome, the sciatic nerve is also affected, but this “uncommon neuromuscular disorder” is caused by the piriformis muscle compressing the nerve. The piriformis muscle is at the top of the hip joint, in the buttocks. This muscle is crucial for walking, it is a part of what allows a person to maintain balance. It is necessary for control over the rotation of the thighs and for lifting, as well. Pain, numbness, and tingling in the buttocks are not normal occurrences. They are recognized as being some of the early symptoms of piriformis syndrome, and it can be a trigger of sciatica. A variety of actions such as sitting in a car, climbing stairs, or running may cause piriformis syndrome. This syndrome, however, is not considered to be the typical cause of sciatica.2
Running and Sciatica
Runners and athletes may develop sciatica. Most of these more athletic cases are due to the spine, and “nerves in discs in the back compress the discs themselves, causing them to bulge out”. Runners experience a “constant pounding” and they do not have a lot of “padding in the (buttocks)”, leading to tight muscles that “squeeze in on the discs, affecting the sciatic nerve”. It is not that running is itself the direct cause of sciatica, but it does make the already existent problem worse. Improper form and posture when running will greatly increase the patient’s risk of injury, so they should keep this in mind when engaging in the activity.
Runners need to find the root cause of the problem and seek treatment before their condition is worsened by something that is supposed to be a normal part of their life: running. Foot dropping indicates damage in the lower back. Night pain also indicates nerve damage in the lower back. Lack of control of the bowel or bladder demonstrates nerve damage that is even more severe.3
Treatments and Exercises
Recent research has shown that steroid shots do not resolve sciatica. Any slight improvements in mobility and pain were insignificant and provided no long-term relief; therefore, conservative care is the recommended approach. It is more important to find effective, long-term treatment than it is to settle for relief, which is only effective in the short term.4
Runners may try a piriformis stretch to determine if their sciatica is related to piriformis syndrome. The patient performs this while lying on their back and pulling one knee toward the opposite shoulder, holding it for a half a minute. If there is tingling on the outside of the leg, that may indicate piriformis syndrome. “Poor running mechanics, improper footwear, or overuse” could cause the pain. That’s why patients may wish to “pull back on running” and “strengthen some muscles”. Patients who create diversity in their workout routines, mixing running with other exercises as an example, are less likely to experience injury as they give certain muscles a break while they perform an exercise that strengthens a different muscle.
Additionally, manual therapies that address trigger points can provide relief. Massage therapists and chiropractors are able to provide that body work.5 Piriformis syndrome can be alleviated by stretches and with strengthening the gluteal muscles by engaging in hip strengthening exercises. Runners may also wish to sleep on their sides, with a pillow between the knees, and “sit with their knees straight”. When running, they might consider a “midfoot strike pattern”.6
As previously mentioned, runners should add some variety to their workouts. There are many exercises that will improve endurance and strength, which will, in turn, contribute to performance in running. Stronger, more flexible muscles will help the patient resist injuries. Runners who are both new to the practice and well-seasoned will all benefit from adding to their routine some or all of these exercises: squats, lunges, bridge, plank, and mountain climbers. These exercises might be made into a series of sets in a workout, performed at least twice per week on easy run or rest days. Moderation and listening to one’s body is key, as runners who push themselves too hard too soon, even when working to prevent injury, will almost inevitably end up hurting themselves in the long run.7
Learn more about piriformis syndrome and chiropractic care.