Exercises for Sciatica in Runners
…and other common neural symptoms
The final injury that called time on my pro-rugby career wasn’t the ACL (knee) reconstruction, various broken bones, or dislocated shoulders, but lumbar disc degeneration at two levels of my lower back (L4-5 & L5-S1).
The disc degeneration in itself isn’t necessarily the big issue, as there are lots of people out there with the same level of wear-and-tear with no particular symptoms. However, mine came with significant neural irritation and pain locally in my lower back, and more painfully referred symptoms into my right leg, from buttock and hamstring, right down to the heel – Ouch!
Does this sound familiar? So many runners suffer from the pain of neural irritation / tension (sometimes referred to as Adverse Neural Dynamics). These symptoms can be manifested in various differing parts of the body. In runners, typically we see symptoms following the distribution of the sciatic nerve (buttock, posterior thigh, calf and heel pain) often referred to as ‘Sciatica’. This type of sciatic pain often gets misidentified as a hamstring strain (or chronic hamstring tightness) in distance runners and triathletes.
As examples of a few other commonly affected areas, we also often see neural symptoms in the mid-back region and on occasion we see symptoms linked to the femoral nerve.
On occasion (particularly after long periods cycling) my neural irritation still acts-up. Over the years I’ve learnt to manage it very effectively. Here’s a video which does a great job of describing the specific exercises I use on myself and my clients when neural irritation / tension is part of the cause of their symptoms…
As ever, I’m interested in understanding the supporting research. Ellis and Hing (2012) conducted a systematic review with the aim to provide an overview of the literature surrounding the therapeutic efficacy of neural mobilization as a treatment option. They concluded:
Neural mobilization is advocated for treatment of neurodynamic dysfunction. To date, the primary justification for using neural mobilization has been based on a few clinical trials and primarily anecdotal evidence. Following a systematic review of the literature examining the therapeutic efficacy of neural mobilisation, 10 RCTs discussed in 11 studies were retrieved. A majority of these studies concluded a positive therapeutic benefit from using neural mobilization. However, in consideration of their methodological quality, qualitative analysis of these studies revealed that there is only limited evidence to support the use of neural mobilization. Future research needs to examine more homogeneous studies (with regard to design, pathology, and intervention), and we suggest that they combine clinical outcome measures with in-vivo objective assessment of neural movement.
At the time of their systematic review, the evidence-base while seemingly in favour of Neural mobilization as a treatment option, was limited at best.
Personally, I know it works for me, and for many of my athletes. My suggestion is to see a Physio, then if indicated give these exercises a go… but only gently to begin with – I can’t emphasize that enough 🙂