Not Hamstring but Sciatic Nerve Injury

[Joanne]

Hi,

I posted here a little while ago and mentioned that I had a hamstring injury. However, after doing more research and going to another physiotherapist, I discovered that my injury is in my lower back - sciatic nerve. The pain moves from my lower back (I don't feel a lot of pain there), down my glutes, leg, calf, ankle and foot (left side). I have pain in my lower calf and foot today.

I injured my back about 8 years ago and went through physiotherapy for about 3 months. I went for a consulation with the therapist and she showed me 2 exercise moves that I could do for my back. I have been doing them and I have also been working out (lifecycle 10-20 minutes - low intensity and treadmill - 1.0-2.0 incline and 3.0-3.2 speed - about 30 minutes). I have been also doing upper body resistance training. I did this workout yesterday. I was feeling better and not limping for the past few weeks so I decided to increase my cardio because I wanted to feel like I was having some type of a workout however, I think I did too much.

I will go and see my doctor, again since now I know that it's not my hamstring. Physiotherapy is no longer covered by OHIP so I am scared of what it would cost to have therapy. I may go for a few visits to help me get started.

I have been doing a lot of research on the Internet - trying to find treatments and exercises that I can do at home in the meantime. Also, I want to understand what cardio workouts and stretching exercises I can do. I have been doing upper body workouts (chest/triceps, back/biceps, shoulders, abs - 4x8) and I was fine the next day. For back exercises I do supermans, seated row and back ext. (lying face down on floor and raising head and chest off of floor).

Has anyone else experienced this type of injury and could you give me some advice?
Thanks.

[smm3]

I have had a few clients come to see me for sciatica conditions. There are several causes for the pain. The most likely is a tight piriformis muscle (an external rotation muscle in the hip under the glute). If this is the culprit, proper stretching will go a looong way. A trip to a massage therapist will help with the pain and tightness, for short term, but if you don't stretch and re-educate the muscle it will keep acting up.

However, if the pain does start higher than the hip, like in the lower back, then it may be a structural issue (ie. herniated disk) or a muscle imbalance, or a few other things...

Did the doctor give you a diagnosis any more specific than "sciatica"?

[Joanne]

Hi,

The doctor didn't diagnose me. The physiotherapist suggested that it is the sciatic nerve - based on my description of the pain and my history of back injury (I went to the clinic 7-8 years ago and she was there). I had a lower lumbar injury at the time. She had me do a few exercises to see where the pain was coming from.

I went to urgent care a few weeks ago and the doctor didn't even examine me. She told me to swim and ice/heat my hamstring because at the time, that's what I thought it was. However, I then went to a physiotherapist and sports medicine doctor (#1) and they seemed to think that it was more then a hamstring injury - suggesting that it may be coming from my back which made me think about my back injury many years ago. This prompted me to go to physiotherapist (#2) and she mentioned sciatic nerve. I don't know what it might be specifically but I will make an appointment with my own doctor so that I can narrow down the injury and figure out what I need to do.

I have been experiencing more pain/tingling feeling in my left ankle and foot today. I have a feeling that I irritated the nerve yesterday during my workout.

I have been doing some stretching but I'm not sure exactly which ones are safe to do without feeling like I am putting strain on my lower back. I was doing child's pose (yoga move) and lying on my back while pulling my leg towards me but holding it straight up. Is this okay?

It sounds like the stretching will help alot so I will continue to do this. Would it be okay to continue walking on the treadmill and using the lifecycle?

Thanks.

[smm3]

Try this stretch...

Get a hold of something sturdy, immovable, like a doorjamb or powerrack at the gym. Cross the problem leg over the other, ankle at the knee, and sit back into it like a one-legged squat. Should feel a good stretch at the glute. You could also emulate that position either seated or laying on the floor. Just easier for me to describe in the former.

Walking and cycling shouldn't be harmful if properly warmed up.

What do you do for a living, are you sitting alot, or standing for extended periods of time? What type of injury did you have to your back?

[Joanne]

I think I know the move that you were describing. I have done that one lying down. If you were standing up doing it, it would almost look like a squat except that the one leg (problem leg) is resting with the ankle on the knee of the other leg - correct? Would this be okay to do standing up because I thought that it might aggravate and put more pressure on my back.

What type of warm up activity would you recommend and how long would you recommend warming up for? I usually warm up using the lifecycle machine for 10 minutes (L 8-9).

Also, how long would you recommend me working out if I continue to use the lifecycle and treadmill? 30-45 minutes okay or too much.
I had a trainer recommend to me the other day that I use 3lbs dumbbells in my hand and increase the incline while keeping the speed at a moderate pace. Is this okay?

I teach and tutor so I stand and sit quite a bit.

What do you do? I was wondering if you are a physiotherapist?

I know I asked a lot of questions but I am anxious to get back into my workouts while at the same time play it safe so that I don't re-injure myself.

thanks again.

Originally Posted by Joanne

I have been experiencing more pain/tingling feeling in my left ankle and foot today.

These symptoms are similar to ones I had when I blew a disk in my back. What kind of injury did you have in your lower back 8 years ago? Have you fallen lately? Or lifted something heavy in a awkward position? You should be diagnosed by a doctor - with xrays or an MRI to rule out (or confirm) the possibility of an injured disk.

If it is a disk a physical therapist can try traction to bring the disk back where it belongs. That does work with some injuries of this type. If traction doesn't work then surgery is the next option.

[Joanne]

I injured my lower back 8 years ago from lifting something at work. I was diagnosed with a lower lumbar spine injury. I would have to call the clinic and find out the specifics of the injury. I went to physiotherapy for about 3 months and had ultrasound, cold/heat applications and exercises to strengthen abdominals. I also used the treadmill and lifecycle but that wasn't for a few weeks into the treatment and the intensity and duration was very low.

The most recent injury I believe happened at the gym. I was doing a series of interval training and I think it was a combination of what I was doing. I may have not had proper form and possibly not enough proper stretching exercises afterwards. I was doing hamstring curls with a SB on the floor, power lunges, lunges with MB against the wall and rowing machine. These are some of the exercises that I was doing at the time that I noticed the injury but it was mostly in my hamstring. Also, I continued to work out during the week, believing that it was nothing more than needing to stretch. This probably made it worse.

Looking back now, I wish that I would have stopped and realized my injury but at the time, I didn't think it had anything to do with my lower back. The pain is in my glutes, leg, calf and foot (all on the left side).

I prefer therapy over surgery and I am hoping that it's not serious to the point where I will need surgery. I don't think that I will. I will tell my doctor that I want the x-ray done or MRI to rule out an injured disk. I would like to continue doing some exercises to help in the meantime.

I wish you well with your injury. From your message, it sounds like you are doing better now. Did you have surgery or was therapy enough for your injury?

Originally Posted by Joanne

I was diagnosed with a lower lumbar spine injury. I would have to call the clinic and find out the specifics of the injury. I went to physiotherapy for about 3 months and had ultrasound, cold/heat applications and exercises to strengthen abdominals. I also used the treadmill and lifecycle but that wasn't for a few weeks into the treatment and the intensity and duration was very low.

Most certainly talk to the clinic and find out what exactly was wrong with your back at the time. Back injuries are not to be taken lightly.

Originally Posted by Joanne

I prefer therapy over surgery and I am hoping that it's not serious to the point where I will need surgery. I don't think that I will. I will tell my doctor that I want the x-ray done or MRI to rule out an injured disk. I would like to continue doing some exercises to help in the meantime.

I never stopped working out after my injury (the doctor and physiotherapist cleared me). But I did stay away from exercises that would aggravate the pain/numbness. The only two exercises I stay away from now are squats (anything over 300 pounds and the pressure is too much for my back - no pain, just numbness) and deep leg presses (again, compression of the disk).

Originally Posted by Joanne

I wish you well with your injury. From your message, it sounds like you are doing better now. Did you have surgery or was therapy enough for your injury?

I've had surgery twice. The first time I came back 100%. After my second injury I lost the use of a portion of my left calf. Was walking to a meeting one day and my left foot started to flop around like a dead fish was attached to the bottom of my leg. No pain or discomfort, just an odd limp for no apparent reason. Within 10 or 15 minutes I had most of my ability to walk normal back but by that time the damage was done. I saw the doctor after that incident and he mentioned if I ever lost my bladder function to get to an emergency room immmediately. Fortunately that has never happened, and my left calf looks funky (and much weaker than my right), but I'm not in pain which is the biggest pleasure.

I'm not trying to scare you Joanne, but be careful and get it looked at by a professional. They can guide you on how serious your problem may or may not be.

[smm3]

Def. need to rule out the herniated disk. The prior injury may have been re-aggravated as it looks like you were doing one hell of a leg workout. If form faltered for a little bit, especially for the rowing machine, the stability in your spine was compromised. Make sure when you go to the doctor you get a thorough diagnosis. A lower lumbar spinal injury is vague at best and could be any number of things.

You keep saying that the pain runs from your hip down to your foot, is there any pain in your back at all?

oh, and I'm a massage therapist and personal trainer with a few years of rehab experience under my belt. Of course, what some guy says on the internet is no replacement for a doctor. Take care of yourself now, even if you have to ease up on the workout for a while, or you could be out for a lot longer!!!

[Joanne]

I never stopped working out after my injury (the doctor and physiotherapist cleared me). But I did stay away from exercises that would aggravate the pain/numbness. The only two exercises I stay away from now are squats (anything over 300 pounds and the pressure is too much for my back - no pain, just numbness) and deep leg presses (again, compression of the disk).

Based on your opinion, what types of exercises can I do?
A trainer at the gym told me to stay away from many of the exercises that I was doing and I did because I was scared of making things worse for myself. I have been bored with the lifecycle and treadmill but only because I keep the intensity and duration at a low level. I walk when the weather is nice and that doesn't seem to bother my back.

I have been doing upper body resistance exercises (chest press, lat. pulldown, flyes, rear deltoids, biceps, triceps, hammer curls, lateral raises, bench press, abs, shoulder press, seated row - all exercises in the 4x8 or 3x8 range). These are the main ones that I have been doing and I didn't seem to notice any major pains afterwards.

I'm not trying to scare you Joanne, but be careful and get it looked at by a professional. They can guide you on how serious your problem may or may not be.[/quote]

I understand although it is scary to learn how much an injured back can really affect other parts of your body so much e.g., bladder function and loss of sensation in calf and foot. I will be going to my doctor again and requesting the x-ray's. I don't want to prolong this any longer. It took me a long time to strengthen my back from my injury 8 years ago. I just remembered today that I slipped and fell on ice about 5 years ago while at University. My gosh...my poor back. lol. I'm not laughing about it but I can't believe how much it has gone through. It's probably ready to kick me in the ass. It hurts enough as it is. lol.

[Joanne]

Originally Posted by smm3

Def. need to rule out the herniated disk. The prior injury may have been re-aggravated as it looks like you were doing one hell of a leg workout. If form faltered for a little bit, especially for the rowing machine, the stability in your spine was compromised. Make sure when you go to the doctor you get a thorough diagnosis. A lower lumbar spinal injury is vague at best and could be any number of things.
I was following the routine for a while and I think I was somewhat anxious about getting back into shape. I use to do the routine with just a chair, SB and tubing band plus walk/jog for cardio. It seemed much safer and more relaxed for me. I was in my own environment and enjoyed it a little more.

I was a little frustrated at the time that I was at the gym because it was busy and there is not much room to do certain activities. The gym is smaller compared to what I am use to and I wasn't focused or concentrating on what I was doing. I should have just left. I realize now how important it is to be mentally prepared when working out.


You keep saying that the pain runs from your hip down to your foot, is there any pain in your back at all?
I don't have much pain in my back. If there is, it's mostly in the lower part of my back, going right down into the glutes. I notice that when I sit for longer periods of time, there is pain in my lower back. I can feel the pain in my vertebrae (lumbar) and sacrum. I have my anatomy book out because it's the only way that I can explain it. lol. And like I mentioned, it goes to my glutes, down my leg to my foot. I did have pain in my lower abdomen for some time but I didn't know if that had anything to do with my injuries.

oh, and I'm a massage therapist and personal trainer with a few years of rehab experience under my belt. Of course, what some guy says on the internet is no replacement for a doctor. Take care of yourself now, even if you have to ease up on the workout for a while, or you could be out for a lot longer!!!

I appreciate your advice. I will be seeing my doctor and take the necessary steps in order to nurture my back so that I can function more comfortably. I'm not sure about what types of workout I can continue to do because a trainer at the gym has said no to many exercises - yoga, tai chi/pilates class, which I can understand because you are using leg and back muscles but I thought that it might help stretch the muscles.

I wish that I could go back and undo whatever it was that lead me to this pain because it's not fun. I think I need to re-evaluate my goals at this point and put my 'getting back into shape' goal on hold. It doesn't mean that I can't keep up the diet part of it but breaking a sweat and feeling that pump certainly made me feel good and I miss that part of it. Like I mentioned previously, I have been walking outside when the temperatures have warmed up and I am enjoying that.

[Joanne]

I want to rephrase what I said about not having much pain in my back. Up until recently, I wasn't having much pain but I have noticed this evening that I do. I went to Urgent Care to get a requisition for an x-ray or MRI and I could feel pain in my back. I didn't notice it much before because the pain was more in my glute, leg, and mostly recently more noticeably in my ankle and foot.

Unfortunately, I didn't get in to see the doctor because the waiting room was very busy and the clinic closed at 8p.m. I was there at 7:40p.m. thinking that it would have quieted down from this afternoon, when I tried going after lunch. Obviously not. It was just as busy. I will try again tomorrow and hopefully have success.

A fall on the ice is what started my problems too, so I was relieved to hear you went to the clinc. It is always a good idea to let the professionals tell you what is wrong.

Most of what you are doing for a workout sounds really good. Walking is usually a low impact exericse that you should be able to keep up with regularly, as would a life cycle or elipitical trainer. Like you said, a breakdown in form is probably what aggravated it. Keeping focused on your form is the best thing you can do. And that includes moving weight plates on and off the machines/bars.

Please let us know what your results were from your next visit.