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Lower-back pain and shooting pain down the back of one or both legs, sometimes to the toes. It may worsen with sitting or bending forward. With piriformis-based sciatic problems, the pain hits the lower back and/or buttocks, sometimes feeling as if it’s deep inside the buttock muscles. It may be too painful to sit on the affected side. The pain and/or tingling can radiate down the back of the upper leg as well.
What’s Going On In There?
Sciatic pain comes from irritation of the sciatic nerve, a thick, ropelike nerve comprising several nerve roots in the lumbar (lower) spine that merge into one. Technically, sciatic pain is caused by irritation of this nerve after the nerve roots join together. Sciatic pain can come from two very different sources: the spine and the hip. Nerve roots, which are small branches of the spinal cord that exit at each level of the vertebrae and divide into smaller branches, are often pinched by a bulging or herniated disk in the spine. The nerve is compressed and pain, often excruciating, results.
Piriformis, or hip, sciatic pain comes from a spot deep within each hip where the piriformis muscle, a hip flexor, crosses over the sciatic nerve. If the muscle is tight or spasms, it can pinch or compress the nerve, causing pain, especially when you’re sitting on the affected side (this type of sciatic pain usually hits only one hip). The pain generally doesn’t shoot far down the upper leg.
Employ dynamic rest. You’ll want to lie down, but minimize the amount of time you spend on your back. Stay mobile, even if it means taking little shuffle steps around the house. Bed rest during spells of back pain only deconditions your muscles, which is the opposite of what you want to happen. During the acute stage, avoid straining your back, but do simple stretches to loosen your hamstrings, hip flexors and glutes. All of these can help alleviate any accompanying muscle spasms.
Ice it, then heat it. Apply ice for 15 minutes four to six times a day for the first two days. After two days, using a heating pad at the same time intervals can help relieve the spasms.
Try an NSAID. An anti-inflammatory like ibuprofen or naproxen can help with pain and inflammation.
Vary your therapies. Effective pain relief therapies are very individualized. For example, some of my patients respond well to massage therapy. Others swear by acupuncture. My point: Try different therapies until you get results. Everyone responds differently to different things.
Stretch and strengthen your kinetic chain. As the pain subsides, start the reconditioning process with basic core strengthening and stretching exercises. Go slow. Stretch your hamstrings, hip flexors, glutes and core. Do glute bridges and planks, adding reps and intensity as you improve. Once you’re pain-free, up your kinetic chain conditioning (see “Prevent It” section).
The more muscles you have supporting your back, the better off your back will be. Therefore, back pain prevention isn’t just about strengthening your back muscles. Your back is working in combination with the rest of your core and your glutes, hips, hamstrings and quads for optimal performance. Your fitness program must include dynamic, compound exercises that target as many of these areas as possible. Workout staples should include multidirectional lunges, core exercises with trunk rotation, squats, squat jumps, burpees, planks, mountain climbers and more. Plyometric total-body boot-camp-style workouts are terrific. I also recommend regularly attending Pilates classes. All of these things focus on strength and flexibility throughout your kinetic chain.
When To Call A Doctor
If you have pain radiating down the back of one or both legs, see a doctor. This is a clear symptom of discogenic back pain and you need to have an MRI to determine the size of the disc herniation and X-rays to reveal any other underlying bone problems.
A doctor can also give you a cortisone or anesthetic injection to help with the pain. Physical therapy is also a good idea in these cases, both to reduce the acute muscular pain that often goes along with this problem and to begin reconditioning your kinetic chain to bring muscular stability to the spine. The exercise and stretching ideas I offer here help, but a physical therapist can direct your care and teach you the correct form and how many repetitions to do based on your individual case.
New York City sports medicine specialist Jordan D. Metzl, M.D. is a 29-time marathon finisher and 10-time Ironman. His book, The Athlete’s Book of Home Remedies, has more than 1,000 tips to fix all types of injuries and medical conditions.
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