Question: I am 71 and live in Ashland, Oregon, and am a passionate “roadie.” Have been riding for quite some time and am quite fit. Any thoughts or suggestions you can make about dealing with mild to moderate sciatica? Any resources you might suggest would be appreciated. Very much enjoy your contributions to the cycling community. Thanks! – Peter O.
Dr. Richard Ellin Replies: Sciatica is a term that describes a symptom, rather than a specific diagnosis. It is usually used to refer to pain that radiates from the low back or buttock area, down the back or the side of the leg. It usually waxes and wanes, often with specific activities or posture. It is sometimes associated with tingling or numbness in the same distribution.
Sciatica can be due to pressure or irritation on a nerve at several different locations. Most often it is due to muscle tightness in the gluteal (buttock) area, or in the lumbar spine due to something (such as a bulging disk, bone spur, thickened ligament, or arthritis) pressing on a nerve root.
Such instances can be very bothersome but are generally not serious. Less commonly, however, it can be due to a number of other causes, some of which can be serious. When one is relatively young (e.g. under 50), the cause is typically one of the more common, less serious ones. Over 50, the possibility of something more serious is increased.
In your case, Peter, since you’re 71, I would urge you to have a medical evaluation of your problem. In the best case, it will reveal that you not have anything serious, and you can get some recommendations for treating it.
Treatment usually consists of some combination of exercises, stretching, massage, physical therapy, or medication. Sometimes a chiropractor can help as well, although I recommend having a medical evaluation first, to rule out anything serious.
In resistant cases, sometimes steroids (either injected or oral) are used. When all else fails, surgery often helps, but only 1-2% of all sciatica cases end up needing surgery. Cycling may aggravate sciatica, in part because of the position of the body. Peter, you may get some temporary relief by altering your posture on the bicycle so that you are more upright (a higher bar, and perhaps a shorter stem). Even if this helps, however, I still
recommend you have a medical evaluation because of your age.
Richard Ellin, MD, FACP, is a board-certified specialist in Internal Medicine who practices in Alpharetta, Georgia. He received his medical degree and completed residency at Emory University, and has been in practice with Kaiser Permanente for more than 26 years. He is also an avid cyclist.