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Running Doc on sciatica and why it is not a diagnosis!

Running Doc on sciatica and why it is not a diagnosis!

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Dear Running Doc:

For the last 6 months, I’ve had pain and tingling going down my right leg. I can’t run without getting more pain. My personal physician said it is “sciatica” and sent me to physical therapy, but I am no better. What should I do? Will I be able to run again?

Jeff G. – Virginia Beach, VA

Jeff, I hear this all the time! Runners are the most sophisticated medical consumers I know, but they’re still getting – and buying – one of the big, bogus diagnoses of all time: “sciatica.” It’s bogus because it somehow makes you feel good without actually revealing a thing about what’s wrong.

Sciatica is a symptom, not a diagnosis!

Why, then, do some physicians simply stick “sciatica” onto so many athletes like a diagnostic Post-it, give them a couple of generic exercises, and send them away? Because, frankly, a lot of back patients don’t get better. They return repeatedly with the same complaint, and the doctor eventually begins to wonder whether they even want to recover, overlooking the fact that it could be the treatment that’s not hitting the target. A more refined answer takes time and effort, as I said back in my first column post, whereas a “sciatica” diagnosis is an easy way of sending the patient away happy. (Plus, “sciatica” is a reimbursable diagnosis code.)

That tingling or painful sensation going down your leg could be caused by any number of things happening to any number of nerves way “upstream.” Degenerative disk disease, which we all get as we age, can let a vertebra settle onto a nerve and irritate or pinch it. A facet joint at the back of a vertebra can get out of alignment. A strained back muscle might go into spasm and painfully squeeze a nearby nerve or nerve sheathe. Even running with a leg-length discrepancy, the most common back pain culprit among my patients, can cause “sciatica.”

The list goes on and on, but fortunately these are not unfathomable mysteries. They can, and will, be found by someone determined to get to the bottom of a patient’s back pain because we now have the diagnostic tools to do that. And each cause has a specific treatment.

If “sciatica” is as far as you can get with your physician, consult someone else. You don’t want a Post-it – you want a probe. I’m sorry I can’t tell you that “you can run” without the real diagnosis. Please write back when you do get that real diagnosis, and let us know how things turned out. Good luck.

Enjoy the ride!

* * *

Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

Want your question answered in this column? Write to running doc at running doc@nydailynews.com.

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