DEAR DOCTOR K:
I have sciatica. Is it safe for me to ride a stationary bike for exercise?
Sciatica is persistent pain felt along the sciatic nerve. This nerve runs from the lower back, down through the buttock and into the lower leg. Pain results when this nerve is compressed or injured. It most commonly results from inflammation, bone chips caused by arthritis, or a herniated (“slipped”) disk in the lower spine. Here is an illustration showing some common causes of sciatica :
Sciatica causes sharp, burning pain, or tingling or numbness along the nerve. In many cases, symptoms are worse at night. And the pain is aggravated by motion.
Many people with sciatica avoid exercise altogether for fear of making things worse. That’s usually not the best option. I commend your approach of exercising while being thoughtful about which exercise you choose.
As for which exercise, my advice is no different probably than what your grandmother might have given: Avoid exercises that hurt, and seek exercises that make you feel better.
You ask specifically about riding a stationary bike. Sciatica pain is often worse when sitting on a firm surface because the sciatic nerve passes right through the buttock. When you sit on a bicycle seat, it can put pressure on the nerve. But sitting does not always make symptoms worse. For example, if your sciatic nerve pain results from a problem higher up near the spine, you may tolerate riding a bike.
So let your symptoms be your guide. If biking makes your symptoms worse, then try something else for exercise. Good choices may be walking or swimming, as they don’t put pressure on the nerve — particularly swimming.
In the meantime, try alternating hot and cold compresses to ease inflammation around the nerve. You also may need to take acetaminophen (Tylenol) for pain. Or try anti-inflammatory drugs such as naproxen (Aleve, Anaprox), ibuprofen (Motrin, Advil, others) or aspirin for pain and inflammation. Prescription medications that treat chronic nerve pain may also help. Talk to your doctor about those. In severe cases, an injection of a long-acting anesthetic with a steroid medication can provide relief.
Some people with sciatica find relief from chiropractic manipulation, acupuncture, massage and yoga. The value of these “alternative” or “complementary” therapies has been shown in several studies.
Sciatica usually improves within six weeks. Once the pain passes, specific exercises and stretches may prevent it from returning. Your doctor may refer you to a physical therapist who can guide you through a personalized exercise program. Exercises that strengthen the muscles of the back and abdomen are often prescribed. This stabilizes the spine bones and eases the pressure on the sciatic nerve.
Most people get relief with today’s treatments for sciatica. Still, one of the most potent ways of reducing future bouts of sciatica is exercise.Don’t stop your exercise program once your pain has subsided: Keep it up!