Dear Running Doc:
For the last 3 months, I’ve had pain and tingling going down my left leg. I can’t run without getting more pain. My family doctor told me it is “sciatica” and sent me to physical therapy, but I am no better. What should I do? Will I be able to run again?
Joey B., Manhasset, N.Y.
Joey, I hear this all the time!
Tell me if you’d settle for this: You hobble from the tennis court into your doctor’s office after a clumsy off kilter lunge that blew up your ankle like a puffy softball. Ow! Dr. What Have We Here looks thoughtful. He palpates it (medical for “feels carefully”), pulls and twists it to test ligament strength. Next, he taps on the bone to see if it’s tender. Grave looks, off you go to X-ray, and when the film comes back, Dr. throws it up on the light board and knits his brows. “Yes, Yes,” he concludes, rubbing his chin and straightening up “It’s quite apparent. What you have here is called a swollen ankle.” Nonsense? Maybe. But not much different from the answer you were given and what athletes run into time and again when they seek help with low back pain radiating down the leg. The most sophisticated medical consumers I know, runners are nevertheless still getting and buying one of the big, bogus diagnoses of all time: “sciatica.” Bogus because it somehow makes you feel good without actually revealing a thing about what’s wrong. A symptom, not a cause.
Everyone deserves better, as I say over and over in my book, A Healthy Back (Owl Books; available at BarnesandNoble.com and amazon.com). Too long have we thought of spines including the spines of athletes as stiff columns of bony structures from which radiate the most mysterious of pains. Spines are, instead, highly flexible, extremely graceful and eminently understandable. You just have to ask the right questions and pursue the search until you get the real answer.
Why, then, do some physicians simply stick “sciatica” onto so many athletes like a diagnostic Post It, then give them a couple of generic exercises and send them away? Why did “sciatica” become the catch all phrase the doctors give as a diagnosis, over and over? Because, frankly, a lot of back patients don’t get better. They return repeatedly with the same complaint, and the doctor eventually begins to wonder whether they even want to recover overlooking the fact that it could be the treatment that’s not hitting the target. A more refined answer takes additional time and effort, and this is a simple way of letting the patient walk out of the office happy with a diagnosis.
The sciatic nerve runs down your leg; it originates higher up as nerves feed into each other like so many streams and tributaries, and eventually emerges from between the vertebrae of the spinal column as a single nerve of many parts. The nerves weave themselves together somewhere around your butt, and the sciatic nerve goes down your leg and spreads out again to all parts of the leg.
Trouble is, that tingling or painful sensation going down, or in your leg, could be caused by any number of things happening to any number of nerves way “upstream.” Degenerative disk disease which we all get as the little padded disks between the vertebrae gradually dry out and lose their cushioning as we age can let a vertebra settle onto a nerve and irritate or pinch it. A facet joint at the back of a vertebra can get out of alignment. A strained back muscle might go into spasm and squeeze painfully a nearby nerve or nerve sheathe. Even running with a leg length discrepancy the most common back pain culprit of all among my patients can cause “sciatica.”
The list goes on and on, but fortunately these are not unfathomable mysteries. They can, and will be found by someone determined to get to the bottom of a patient’s back pain because we now have the diagnostic tools to do that, And each cause has a specific treatment. Your physical therapy is like taking a shotgun and trying to hit a barn; with an accurate diagnosis, the therapy can take aim at the bullseye and get you running again, pain-free!
To be fair, it wasn’t always possible to be this accurate. Just as we once had to settle for “internal derangement of the knee” as a diagnosis before arthrograms let us inject dye into joints and X-ray the results, before MRIs and other diagnostic tools let us pinpoint “anterior cruciate ligament tears” and “medial collateral ligament tears” and other knee joint problems that we can now treat specifically and effectively, “sciatica” was once the best we could do with the mysterious back.
But the mystery’s gone now. If “sciatica” is as far as you can get with your physician, consult someone else. You don’t want a Post It. You want a probe. Good luck.
Enjoy the ride!
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Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
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