Sciatica - exercise is painful, should I di it?

Hi,

I've been suffering with sciatica for some time now, and it seems to be getting worse. Within the past year I've seen two physios but they haven't really helped. I'm currently waiting to see an orthopaedic practitioner (who I understand is a physio with extra training).

My immediate question (while I'm waiting to see the orthopaedic practitioner) is to what extent I should exercise, given that any exercise (even standing still) brings on the pain. I’ve read that I should I exercise as much as possible, but given that exercise makes the pain worse, I'm worried that I have a specific (muscle/tendon) injury which is not healing.

I'd also welcome more general advice on anything (I guess I'm thinking of stretches here) that may help.

Background

Last year I started to suffer with pain in the back of my left leg. The pain was principally when sitting down. It didn't affect my main exercise activities (cycling, running). Initially I thought it was a hamstring injury so stopped running and reduced cycling. This didn't make any difference, so I saw an NHS physio who diagnosed sciatica, but seemed rather vague about the exact cause and treatment. I saw her 6 times all together. She did a bit of spinal manipulation, but spent most of the time doing diagnostics and teaching me new stretches (the prescribed stretches changed each time I saw her).

I resumed running and cycling, and these didn't make any difference to the problem.

In March this year (6 months after resuming running) I got a more serious pain in my right leg. The leg pain was 'nervy' in nature (sometimes pins and needles, exact location varying randomly) with some static pain in the region of the glutes. Unimpressed with the NHS physio, I didn't bother going back. The pain gradually got worse so in June I saw a private physio for 4 sessions. He diagnosed lack of movement in two spinal joints (either side of L4??), pressure on the sciatic nerve at various points, and general tightness in all the muscles on the right of my body (there's a big difference between how far I can lean to the left and the right).

His treatment included spinal manipulation, acupuncture, stretching (him stretching me) and massage. The only stretch he gave me to do was for piri formis. The treatment moved the pain around but didn't really reduce it. I stopped going because of going on holiday and also because I wasn't sure if the treatment was really working, and I don’t have spare money for something that doesn't work. (He has a good reputation, with at least one Olympic runner as a client.)

Since getting back from holiday, the pain has got worse. I was running 20 - 25 miles a week before I went away without problems, but tried one training session when I got back and my right hand side felt too tight to run. (I don't think the holiday made things worse, I just tightened up when I stopped running (and the associated stretching) and can't get the flexibility back.

Where it hurts: I have specific and non-varying points of pain in my back at around waist level, a little to the right of my spine and another point 5 cm below that; the whole of my right buttock feels bruised and sensitive in a non-specific way; when I sit down I usually get strong pain in the back of my right thigh; and my right calf frequently feels as if it has cramp (but I'm sure it doesn't).

If go for a walk, I limp (I think because my right hamstring is much too tight), which may or may not disappear after a little while. Some of the time my right hamstring is so tight, if I put my right leg on the bottom step of the stairs, I can't straighten it. If my partner (who has some massage training) massages my right buttock/leg, things improve for a few minutes, then the tightness comes back. I can do the piri formis stretch with some tightness but no pain.

I’ve kept getting more powerful painkillers from my doctor. I’ve just switched to 400mg of Tramadol (Zydol) per day, the first I’ve had that have had any effect - I’m now pain free when lying down. However, the pain returns within minutes of standing up and walking around. Standing still is much more painful than walking. I’m also taking Diclofenac.

My impression is that the private physio's diagnosis was generally right, but his treatment didn't seem enough to fix the problem.

Possibly relevant fact: I recently realised I have a habit when cycling of stopping with the front of the saddle pressing into my back, pretty much exactly where one point of pain is. It doesn't press very hard but I used to do this very regularly (I've obviously stopped doing it now). Occasionally when riding, I stand on the pedals to take a break from sitting - again, the saddle touches my back, but lower down, corresponding to another sensitive point. (I’ve only realized this since I saw the physios.)

Marginally relevant fact: I was doing yoga every week for the past year, so while my general flexibility isn't great, it's not that bad. (The yoga ended in May for the summer, and at present I feel too stiff and painful to go back.)

If you’ve made it this far, thanks for reading. Any advice on whether I should exercise despite it bringing on the pain – and anything else – would be appreciated.