Sciatic nerve pain redux.

? I am a 160-pound, 58-year-old male who usually averages 15 miles a week at 9 or 10 minute pace. I had also been using weights three days a week to strengthen my chest, back, shoulders and arms until three months ago, when I started experiencing sciatica-like symptoms down my left leg, with no direct pain in the back. [Sciatica is a swelling of the nerve near the hip.] The pain was severe enough to cease both my running and my weight training. I began to make good progress with regular back stretching exercises, acupuncture, muscle relaxants, anti-inflammatories and chiropractic adjustments. I see a sports medicine doctor who oversees these treatments.

I had reduced my pain considerably in the mornings, with no pain for the rest of the day. I gradually started walking, then walking and running, then running for three miles. I was down to just the anti-inflammatory drug and regular stretching when I had a major setback a month ago, while I was out of town. I was unable to even stand from the terrible pain down my leg. I ran the day before this occurred without any problem. I am back on acupuncture, avoiding the chiropractic, and making progress, though the numbness on the bottom of my left foot continues. I am only taking an anti-inflammatory. I walk as much as I can, which is only for about 10 minutes. How should I go about starting my weight training and running once the nerve heals?

Steven Lowry, Charlotte, NC

I think your spine is a likely source for your symptoms. Even without back pain, sciatica usually arises from the spinal nerve roots. Some practitioners diagnose piriformis syndrome as a sciatica source when back pain is absent. This is a deep muscle in the buttock that lies over or around the sciatic nerve. The notion is that the nerve gets compressed by this muscle when it is tight, spasmed or externally compressed, such as by a wallet. These scenarios are medically possible, but in reality probably very rare. The problem, if it is truly nerve related, is almost always the spine.

A combination of degenerative disc bulging and bony joint enlargement compresses an existing spinal nerve root, usually the lowest lumbar or the first sacral nerve. The majority of sciatica resolves. But your case is unique in that you are 58, you want to get back to running and you may not be getting better. I recommend an MRI study of your lumbar spine; recommendations for activity will be in part based on the results. This can also help the chiropractor determine how best to apply his/her skills.

The initial rehab sounds like it was appropriate. You will have to start from scratch again. When symptoms return like this, you need to see your doctor and work up the problem for a more definitive diagnosis. Generally speaking, return-to-running programs involve starting at a pain-free level and only increasing mileage by 10% per week.

Rob Scott, MD, San Diego, CA