nerve pain

Question
Hi. I have been experiencing nerve pain in hamstrings for about 6 months now. I am a keen runner and like to do marathons (1 a year) but have pulled out this year because my speed has gone and also it gets very painful after a few miles. This pain literally came on over night. It feels like something is squashing my sciatic nerve possible. Its in the left buttock at side too. The pain only goes about half way down the hamstrings. Not to my toes. They tighten up completely. I have had an MRI which is clear and seen 4 physios. I am currently seeing a chiropractor ad having acupuncture. I think the acupuncture helps. I am so fed up in not being able to run. It is painful to sit and the pain seems to change daily. One day its in right leg, then another its in the left and sometimes its in both. I religiously stretch and my flexibility has greatly reduced but over the last couple of months it has a got a bit better. Most pain is felt when bending forwards. Its not piriformis syndrome and my spine / hips / pelvis / SI is fine. It has been so long now and seems to have plateaud out. I just want to get back to my normal running routine. I can run about 3 miles (slowly) but I feel my legs after about half a mile and it gets gradually worse so 3 is my limit at the moment. Can you help or give me any advice? Have you had a runner who has had this before?  
Thanks for your time.
Gillian

Answer
Gillian:

Your condition sounds absolutely terrible!  I can take a stab at providing you some advice, however, your question is not technically a running question, and I am not a doctor.

The term sciatica refers to a collection of related symptoms.  The underlying cause involves irritation and/or compression of one or more nerves.  The pain may manifest in the lower back, buttock, leg and/or foot.  The pain is almost always limited to one side of the body, except in rare cases where similar nerves are affected on co-laterally.  Based on your description of your symptoms, it sounds more likely that your problem is a result of a lower back issue (lumbar spinal) rather than sciatica.

Back problems often result in referred pain.  This is because the nerve that transmits sensations in, say your foot, passes into your spine at some point.  And if this nerve is compressed or irritated at at the point it enters your spine, you can perceive the pain as originating in your foot.  A lower back issue would explain why your pain seems to change daily, as well as moving from one leg to the other (or sometimes both.)  It would also explain why the pain gets worse when you run - the incidental spinal compression from jogging can acerbate compressed nerves that pass where they pass between your vertebrae.

Once again, I'm not a doctor.  And even if I was, I've neither seen you in person nor had access to any diagnostic tests you've had.  However, based on my own knowledge of anatomy as well as having some back issues of my own, the most place to consider when looking for the cause of your symptoms would be your lower back.

So let's assume this is your problem.  Some spinal issues are very serious and require surgery in order to avoid permanent nerve damage and/or paralysis.  For this reason, you should most definitely see a doctor who specializes in back problems.  On the other hand, if your condition is not one that requires emergency surgery, I would like to point out that the medical establishment has a poor track record treating generalized back issues through surgery.  Long term improvements are often better in people who opt for non-surgical treatments.  In other words, it may be possible that you absolutely need surgery.  But beware of non-essential surgery that a doctor recommends in order to ease pain.

If you don't absolutely need surgery, there are a variety of therapies you might try.  Several people I know have had great success with inversion therapy.  This involves strapping yourself into a machine that allows your body to rotate upside-down.  By hanging upside-down from your ankles, your spine is put under tension (rather than compression), which gently pulls vertebrae apart.  This can greatly ease compressed nerve symptoms.  In fact, one of my coworkers uses an inversion machine and has told me that his back problems have completely went away.  He uses it for about 10 minutes each day, which is all that is needed to eliminate his symptoms.

Another thing you might consider is postural analysis.  This involves analyzing the way a person stands, sits, walks, etc. and evaluating deviations from the ideal.  It turns out, as shown by many recent studies, that irregularities in a person's posture can greatly increase the chances of back issues over a lifetime, as well as injuries to other parts of the body.  For example, if you exhibit lumbar lordosis, where your lower back curves inward too much, you are at elevated risk of having lower back issues.  This inward curvature results in extra compression on the dorsal side of your spinal disks, which in turn can bulge, develop fissures, or otherwise degenerate in ways that can cause nerve irritation.  There are a variety of other postural irregularities that can also cause spinal compression.

Thirdly, I would highly recommend a retinue of stretching exercises used by physical therapists to treat lower back issues.  Don't just "stretch" - lookup online the actual stretching exercises that have been clinically shown to help people get over lower back issues.  I would NOT recommend yoga, Thai massage, or other exercise that involves excessive flexion.  These types of activities are likely to make your condition much worse.

Lastly, if you are suffering from spinal compression issues, you may need to lay off running for a while.  It doesn't mean you have to give it up the rest of your life.  But you should not run while your back is trying to heal.  A frequent running schedule is analogous to picking at a scab - you are causing damage at the same rate your body is healing, with the net result that you never get better.  Most back issues do get better over time, so don't give up hope.  Be realistic and realize that it won't get better in a few days.  Most likely it will take several months.  In the meantime, you might take up swimming or some other low-impact activity to keep your aerobic fitness level up.  Once your back is better, you can try running again.  However, since you know you are susceptible to back issues from running-induced spinal compression, you ought to limit your running to grassy turf or other soft surfaces.  You might also want to look into barefoot running or minimalist running shoes.  Although running with minimal footgear means you have less padding, which you might think increases the shock on your back, your un-protected feet will feel pain first from high-shock landings.  This will cause you to run with a different stride : one that involves significantly less impact forces on your spine.  Lookup "barefoot running movement" to read more about running stride and back issues.

Good luck!