This month, we sat down with Dr. Michael Fredericson, Director of the Physical Medicine and Rehabilitation Sports Medicine Service at Stanford Medical Center. Dr. Fredericson has spent a career addressing the needs of athletes at all ages and ability levels, and here, he provides some insight on sciatica, one of the most common ailments for adult athletes.
FNF: What is sciatica and what are signs you might be suffering from it?
MF: For most people, it relates to a bulging or herniated disc in your low back that is pressing on a nerve. You feel it through the sciatic nerve. That nerve goes all the way down your leg, so you’ll feel it there as well. Sometimes your back is fine, and the problem is pirformis syndrome. Your sciatic nerve goes through the pirformis, one of your smaller backside muscles that helps rotate your hip. That muscle can get tight and it can compress your sciatic nerve. The biggest reason to see a physician is that you want to make sure it is not a bulging disc pressing on your nerve, as this requires more aggressive treatment.
FNF: How do you typically treat sciatica?
MF: First, we try to figure out if there was something that got them into this situation. A lot of people don’t realize that it isn’t from their activity, but from their work. Maybe they sit too much or drive a lot, which can put increased pressure on their discs. The piriformis muscle can also get tight from driving too much. So a lot of it is getting them out of the activity, and then calming down the inflammation. We’ll advise over-the-counter products like Aleve or ibuprofen, and then prescription anti-inflammatories and so forth, in combination with physical therapy. If it is a bulging or herniated disc in the back, sometimes we recommend an epidural corticosteroid injection and very rarely, surgery.
FNF: What can we do to prevent sciatica?
MF: Everyone is typically given core exercises as a part of their physical therapy, so that is something we should do prophylactically as well. It takes pressure away from the disc. We also should take care with our back mechanics. People don’t think about simple things throughout the day such as how you lift, or how you sit and stand. You should. Also, it is wise to be careful with the downhill running. It is easy to get out of control downhill running and put too much stress on the low back. Likewise, overstriding [landing with your foot too far in front of your body] can lead to overstress on the back.
