Hiking and "Sciatica": Back Surgery Helped but I Still Get Pain

“It’s my sciatica!”

If you or a friend have ever experienced pain shooting down the leg, starting at the hip and sometimes going past the knee, there’s a good chance you or someone else has mentioned “sciatica”.

Sciatica is often a catchall for this lower limb nerve pain, but truthfully a diagnosis of sciatica tells very little about what is actually going on. Generally speaking, sciatica refers to the condition that the sciatic nerve, which is the common nerve bundle that runs along the back of your thigh, is irritated and causing pain. Many potential causes exist which could create sciatic nerve irritation, ranging from a nerve root impingement at the spine to piriformis syndrome. Careful diagnostics involving a combination of a physical exam and often imaging help rule in or rule out various sources of this nerve pain, and accurate diagnostics are paramount to effective treatment or management.

I have seen many cases of sciatica and they all present slightly differently. In one particular case, the client was referred to me after undergoing months of rehab following (successful) surgery to relieve a condition known as spondylosis, which was putting pressure on the nerve root at the spine and causing radiating pain into the thigh and shin. Her symptoms had mostly improved after surgery and she had begun hiking for distance once again. While her pain had ultimately improved, it was not resolved. She was still feeling pain in her shin after some distance, and this pain would sometimes persist into the next day.

Since she would only experience symptoms after some distance, she was referred to me for a gait analysis to help determine if there was something she was doing while walking or hiking that may explain the remainder of her pain. After undergoing that gait analysis, we discovered impairments that could contribute to her pain, namely compensatory low back extension (instead of hip extension) and poor timing of the gluteal muscles to provide proper lumbopelvic stabilization over the same side as her pain. With this knowledge, we have been able to establish a plan to target these impairments. By restoring hip range of motion, strengthening weak musculature, and training her muscles to fire properly, she has increased her tolerance and symptom frequency has reduced further. Additionally, we were able to measure progress in muscle activity and joint position using the lab during her care plan to confirm we were making changes. This has allowed her to continue to work toward less painful and longer distance hikes.

Surgery alone often isn’t enough

Surgery alone often isn’t enough to “fix” a condition. Habits developed as a result of being in pain over time do not suddenly correct themselves once the problem is “removed”. It often takes training and proper diagnostics to correct a persistent movement pattern compensation, even after surgery. If you have had surgery recently but don’t quite feel 100%, reach out for a consult to discuss options.