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.
Before you make yourself more upright I’d get a diagnosis. I tried going more upright years ago and it made my pain much worse. If you have a bulging, or worse, a herniated disc when you sit upright it squeezes the disc causing the bulge/herniation to press harder against the nerve root. This was my problem. When you stretch out it expands the discs and helps pull the bulge/herniation back. If the herniation becomes sequestered it will incapacitate you(extreme pain)and will not cease until its removed via surgery. From a guy, I was under 50 (38 and 42)at the times, that has had two discectomies at separate times and now need ablation treatments yearly I can tell you do not mess around until you find a good spine surgeon. And please please get at least two opinions, there are a lot of doctors that will tell you to have a spinal fusion, they make lots of money from these surgeries and the odds of success is not in your favor. By having discetomies over fusion I am able to keep my flexibility and my active lifestyle, and hopefully you will too.
Best of luck to you and Godspeed.
Excellent advice from Dr Ellin.
Dr Ellin is absolutely right. Herniated disk, degenerative disk disease, spondylosis, muscle strain, sacroiliitis, or piriformis syndrome can all have similar symptoms but very different treatments, so get a good medical opinion – or two! And be patient–it can take time to work through some of the more difficult diagnoses.
As far as riding a bike goes, my neurosurgeon recommended it! But only on smooth surfaces. I bought a new bike with an endurance geometry because leaning over too far on my racing bike caused my foot to go numb. Sitting up straight caused the most pain; but somewhere in between worked out best. I also lowered my tire pressure some. The best thing I did, BY FAR, was buying a suspension seat post and a suspension stem. For about $400 and 1 pound of weight you can have a full suspension road bike that turns chip and seal into new pavement. I wish I would have bought them a long time ago! I looked for components that were adjustable to my weight and ride preference. After the fine tuning process it didn’t take long to get use to the smoooooth ride!
I have been dealing with a Sciatica issue which is due to a bulging disk. A few months prior to this issue I had a bike fit. The stem for my drops was slightly shorten and drops turned up slightly. It feels like my back is flat. I was training for the Garmin Unbound and was moving back and froth from the drops to the hoods. Could I have been upright to much?