An ordinary story

My experience of sciatica

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Like many sciatica stories, I had a history of rumbling, on-off back pain for a few years before anything started in my leg. The first time I ever got proper back pain, it was because I fell out of a tree. I was too old to be falling out of trees: twenty-one. I fell right on my back and couldn’t move for about ten minutes. In the next few years I’d have about one episode a year, usually triggered by exercise.

The sciatica started when I was about twent-six. I was deadlifting. I remember being tired that day, but I tried to do one more rep than I was planning to. I felt something go. I immediately packed everything up, got changed and went home as quickly as I could before everything seized up.

The back pain calmed down after a couple of weeks. As it calmed down, the leg pain started.

That’s a pretty common pattern for extrusions. The theory is that the back pain is caused by the disc material pushing through the inflamed rupture in the outer layers of the disc. Once it finally pushes through and out, the disc can start to calm down and heal, so the back pain dies down. But now the material is on the root, so the leg pain starts up.

The leg pain was never that bad. It was an aching or tugging down the back of my leg into my calf. I guess you’d call it neural sensitivity or mechanosensitivity; the nerves of the nerve were sensitive. But no neuropathic pain. The injured nerve root never developed a hot-spot to send crash-cymbals of action potentials up to my brain.

It was a while before I worked out I should sleep and sit with my legs curled up. I was a physio student at this point. We hadn’t studied this yet.

I never felt that worried. I’ve been ill and injured before when I’ve felt a sense of dread and doom, not to mention severe pain. I also catastrophise about stuff at times. But I was never that worried about this. I was more just annoyed about it.

I went to see a physio. I’m not sure I would have done except I saw it as an opportunity to learn as a patient from a local physio with an excellent reputation. I was surprised when he demonstrated that my plantarflexion was markedly weaker on my affected left leg. He sent me for an MRI because there was enough other stuff going on that I might have had inflammatory spondyloarthropathy. The MRI showed I didn’t. I had a big disc extrusion.

I think the MRI might have been the most unpleasant thing about the whole affair. You can never unsee your MRI scan. I think the fact that the remaining disc was just black, so different to the others, bothered me more than the extrusion. This load-bearing aspect of my anatomy was now a failed joint?

The physio advised I keep going to the gym, which I had been doing. But to avoid stretching out my nerve while loading my back, I should stop squatting for a few weeks and deadlift off pins. That did take the edge of the post-workout flare-ups.

He also recommended neurodynamics, which I did regularly throughout the day. I’m not sure they helped but they didn’t do any harm. Maybe they kept the nerve mobile and prevented adhesions.

He didn’t recommend any core stability exercises. But I did keep doing core exercises, as in ab and back exercises - just not the rehab ones, like the McGill Big 3.

(By the way, I kept in touch with that physio and he ended up as my co-author, we wrote a book on CES together).

I also did a lot of Jefferson curls. I imagined curling my spine down and vertebra-by-vertebra. With just a 10kg bar. I think they had a good psychological effect because they reassured me that the supposed worst movement could actually feel kind of nice. They also helped me ‘practice movement’ again, working through little catches of pain or parts I was holding stiff. They probably had some physiological effect too by preventing or reversing some spinal muscle weakness. (All this could also be said for the core exercises I kept doing, too.)

Getting back to running was a case of building up slowly, doing too much, cursing myself, resting for a few days, then building back up even more slowly.

I can’t even remember the rest of the story. The pain just gradually died down over the next couple of months. I think there were one or two little blips where it threatened to come back.

That was now almost a decade ago.

Today, my left-sided plantarflexion is still slightly weaker, and, although it’s my jumping leg, that leg is still not as springy when I skip (jump rope). If I work in the garden too long my left calf starts to throb again.

I still have a little thing in my head that tells me to worry about my back in a way that I don’t worry about any of my other joints. It’s always there. But it’s extremely low-level. What’s less than a worry? A subdued awareness. Almost subconscious.

I think the radiculopathy was the end of my back pain story. If I could place a bet, I think all my back pain episodes were sparked by the fall, which set off (or accelerated) some disc degeneration. The yearly episodes in my early twenties were probably the gradual progress of degeneration and herniation. The culmination was the eventual extrusion, which caused radiculopathy.

Since that resolved, I’ve had almost no spinal pain. I feel like that disc’s dance is done. It hasn’t rehydrated (it can’t), but the inflammation has died down and there’s not enough internal pressure to force out whatever nucleus is left, if there’s any.

I still squat and deadlift. (Very modest weights, but they always were - you are definitely not reading the story of an athlete here). I run and play sports and pick up my children and throw them in the air - all with that ‘subdued awareness’ of my back. If I’m lifting anything above, say, 60 pounds, I consciously brace my back and posterior chain in a way that some physios might consider an undesirable ‘safety behaviour’, but it works for me. My back feels better when I do.

I do see how lucky I am that 1) I never got proper neuropathic pain, and 2) this just resolved by itself. I can take some credit for not doing anything too stupid while my body recovered. And for being pretty healthy when it started. But the rest is good fortune.

Most people who get radiculopathy are lucky, though. I didn’t do anything special and I got better anyway, just like people and proto-people have been doing not much very special and getting better anyway since our mammaliaform ancestors first developed intervertebral discs, however many hundreds of millions years ago.

One of the first recorded cases of sciatica might be in Genesis. Jacob fights an angel and the angel touches the hollow of his thigh, on a 'sinew' that is probably the sciatic nerve. Jacob's leg buckles and goes limp. We never hear whether Jacob gets better. But given that he goes on to travel the known world extensively on foot, we can assume he recovered. It is unlikely he did any core stability exercises.

Mine is a very ordinary story, as old as time.