Follow this cycling physical therapist's approach to prevent and treat sciatica pain when cycling.
Sciatica is among the most common and puzzling sources of pain and debility. Statistics show that as many as 40 percent of individuals will experience a bout of sciatica in their lifetimes, and the chances increase with age.
An October 2022 study published in The Physician and Sports Medicine asked almost 63,000 recreational riders about their cycling-related pain history over five years. The researchers found low back pain was the fourth most common recreational cycling injury.
What is Sciatica?
It’s a common misconception that all low back or leg pain is sciatica. That’s not the case. Sciatica pain results directly from disease or injury involving the sciatic nerve and its nerve roots.
The sciatic nerve forms from the nerve roots exiting the lower spine (the fourth lumbar vertebrae) through the sacrum (the second sacral) nerve root—L4 through S2. The L4 through S2 nerve roots come together at the pelvis to become the sciatic nerve. The sciatic nerve is the largest in the body, typically 2 cm in diameter. The sciatic nerve travels down the leg to the toes and provides movement signals and sensation to a large portion of our lower extremities.
Sciatica symptoms differ from muscle soreness or joint discomfort that cyclists often complain of. Sufferers describe sciatica as sharp shooting pain, numbness, pins and needles (tingling), or burning. Be aware if you experience the sudden onset of profound weakness in specific muscles of your lower extremities.
A Self-Test To Tell if You Have Sciatica
Orthopedists, neurologists, and physical therapists use The Straight Leg Raise test to get a clearer picture of nerve root-related pain or sciatica. It’s a simple test you can do at home with the help of a friend or family member.
- Lie flat on your back with both legs extended straight.
- Have your assistant raise your unaffected leg until you experience symptoms or tightness in your hamstring.
- Repeat with the affected and compare the range of motion.
- If the motion of the affected leg is markedly restricted and you experience the sciatica symptoms noted above, nerve irritation may be the reason.
Causes of Sciatica Pain
Most causes of sciatica result from an inflammatory condition that causes sciatic nerve irritation. Any disease, injury, or illness that impinges or compresses the nerve will cause sciatica symptoms.
Common causes of sciatica pain in the general public are:
Herniated or Bulging Lumbar Intervertebral Disc: The disruption of the structures that sit between the bones of the spine (vertebrae), causing impingement of the nerve roots.
Lumbar Spinal Stenosis: The narrowing of the spinal canal protecting the spinal cord that causes pressure on the nerves and exiting roots.
Spondylolisthesis: When a vertebra slips out of place relative to the one below due to degeneration or injury, placing stress on the nerves.
An injury to bones, muscles, tendons, bursae (pads between the tendons and bones), the hip joint, or a mass in the spinal region can cause similar symptoms. There are a few basic rules of thumb to rule them out.
- You may have injured your hip joint or suffered a stress fracture in your pelvis or femur (long thigh bone) if you experience pain hopping on one leg. An X-ray usually reveals a joint injury, but only a bone scan shows a stress fracture.
- If you experience pain in your buttock when you stretch your legs out straight, you may have a torn muscle or tendon running down the backs of your thighs.
- If you feel pain when you touch the outside of your hip or the lowest point of your pelvis (the part that touches a chair when you sit), you might have irritated your bursae (bursitis).
- If your lower-leg pain radiates into your buttocks, extends down to your feet, includes numbness, tingling, weakness, and lack of coordination, and doesn’t change with position or movement, you may have a mass pressing against your sciatic nerve. Seek medical consultation immediately!
In addition, lumbar or pelvic muscle spasm or tightness will impinge a lumbar or sacral nerve root or the sciatic nerve, causing inflammation and sciatica pain. That’s where cycling comes in.
Sciatica Pain When Cycling
The sciatic nerve exits the lower spine and travels down the back of your leg to below your knee. As it goes through your buttock region, it passes beneath, or in 20 percent of cases, directly through the piriformis muscle.
When you pedal, the piriformis muscle contracts and squeezes the sciatic nerve beneath it. Repeatedly contracting and relaxing the piriformis muscle irritates the sciatic nerve and causes severe pain from inflammation.
In addition, our body weight on the saddle creates significant pressure on the piriformis muscle, increasing irritation. An ill-fitting saddle without adequate padding or support of your sit bones (the ischial tuberosity of the pelvis) will irritate the piriformis muscle and sciatic nerve.
Causes of Sciatica Pain When Cycling
Prolonged sitting on the bike and off is a reality of our sedentary lifestyle. The primarily forward-flexed posture places imbalanced stress on the musculature of the spine, hips, and thighs. Cyclists engage the hip flexor muscles with each pedal stroke, and repetitive contraction in a flexed position causes them to become tight and weak.
Improper pelvic positioning, described as an anterior pelvic tilt or “sway back,” results from the pull of the Psoas on the spine. The opposing glute muscles become weak and ineffective. A seated lifestyle and forward bike position contribute to hip flexor muscle shortening, inactive glutes, and core weakness.
Muscle imbalance can cause piriformis syndrome when cycling. When our quads overpower the glutes, piriformis, and hamstrings, they become overworked to compensate for the weakness. Strengthening the specific muscles will correct compensation patterns and release the tension in the piriformis caused by overworking them. In turn, the sciatic nerve is relieved from compression.
Core Weakness is also a factor. Without solid back and abdominal muscles, there is no foundation for strength production by the legs, and an inconsistent and improper pedal stroke can result.
The repetitive nature of an inefficient pedal stroke, especially if improper positioning causes excessive hip and trunk bending and the hip’s inability to extend or open up (straighten), irritates, leading to piriformis syndrome when cycling.
Treatment and Prevention of Sciatica Pain When Cycling
The prolonged posture and repetitive cycling motion are problematic without an optimal bike fit. The repeated stress and strain on the spinal structures and lower extremities will progressively worsen sciatica pain when cycling.
An excessive forward bend at the trunk causes the hip to maintain a flexed position without the opportunity to open up. You can correct this by adjusting the crank length, handlebar size and position, saddle height, and fore-aft position to avoid the excessive range of hip motion at the top of the pedal stroke or rocking in the saddle.
Focus on a comfortable cadence and smooth pedal stroke, and avoid pushing too hard during the downstroke. Follow a consistent and effective recovery strategy.
Address muscle imbalances through a focused strengthening and stretching plan, ensuring that exercises are pain-free and without residual soreness.
If your sciatica pain when cycling persists, gets worse, or significantly interferes with cycling, seek the assistance of a Sports Medicine Physician or Physical Therapist. An expert biomechanical and musculoskeletal assessment or consultation with a physician is always a good idea.
A Four-Step Sciatica Pain When Cycling Plan
Step One: Perform a Foam Roller Routine
Rolling the muscles of your legs will make them more relaxed, making it easier to stretch, thereby improving your flexibility. In addition, by relaxing the glute muscles, the spasm which occurs due to being overworked will decrease too. Here’s how:
Foam roll the piriformis!
Roll out the hip flexors!
Foam rolling is okay for the hamstrings!
Step Two: Perform a Stretching Program
Adding hip flexor, adductor, piriformis, and hamstring stretching to your daily routine will counteract the adverse effects of prolonged periods in the saddle. Here’s how:
Seated piriformis stretch
Hip flexor stretch
Hamstring stretch with strap
Do NOT stretch your hamstrings if you’re experiencing sciatica pain. It can make it worse. Add hamstring stretches when your pain subsides, and only if you can do them without pain.
Step Three: Perform a Muscle Activation Routine
Muscle activating your glutes before riding will stimulate inactive muscle groups to improve their function. Focus on the glute muscles and visualize them to fire. It will improve contraction strength through enhanced fiber recruitment.
Concentrate on the muscles you’re trying to activate in your mind. Perform each exercise slowly and control the movement through a full range of motion. The goal is to warm up and engage the specific muscle groups without fatigue. Follow this link to learn more.
Follow These Glute Muscle Activation Tips
Activation exercises are simple motions to isolate and activate a specific muscle group. A quad dominance routine targets the glutes and spinal muscles to help you feel them contract and know they’re engaged and ready. Here are a few tips you can use along the way.
- The key to pre-activation is waking up and activating the proper muscles by concentrating on a full contraction.
- Take it slow and controlled, making each repetition deliberate for a maximal contraction through a full range of motion.
- Focus on really thinking about the muscles you’re trying to activate.
- Maintain constant tension through the band during all phases of the movement
Step Four: Perform a Strengthening Routine
A program focused on improving and maintaining glute and hip extensor strength and addressing the core will prevent piriformis syndrome when cycling and improve performance. Follow this link to the Training & Performance page of The Zommunique’ to learn how.
Sidelying Elastic Band Clamshell
While lying on your side with your knees bent and an elastic band wrapped around your knees, draw up the top knee while keeping your feet together as shown. Do not let your pelvis roll back during the lifting movement.
Hip Abduction with Elastic Band
Lie on your side and align your body as straight as possible with a band around the thighs just above the knees. Flex the foot and lift the leg to the side, hold momentarily, and lower slowly to the starting position.
Clamshell Bridge with Elastic Band
Start on your back with knees bent and feet flat on the floor. Brace your abdomen and perform a bridge holding it at the top. Take a small breath and as you exhale pull your thighs apart as shown and inhale as you return to the start position. Perform the required repetitions and then keep your abdomen tight as you lower back down the floor.
Fire Hydrant with Elastic Band
Start in a quadruped position with an elastic band around your thighs. Hands should be directly under your shoulders and knees directly under your hips. Next, raise your leg out to the side as shown. Maintain a straight upper and mid-back as you rotate your hip outward while concentrating on your glutes.
Quadruped Bent Knee Hip Extension with Elastic Band
Start in a quadruped position, on your hands and knees, with a band around your knees. Hands should be directly under your shoulders and knees directly under your hips. Begin by extending your leg back, with your knee bent at 90 degrees. Make sure to keep your core engaged and squeeze through your glute at the top of this motion. Bring your leg back to starting position. Try to keep your weight center and do not use your back in this motion.
Quadruped Alternating Upper and Lower with Elastic Band
Start on your hands and knees with your hands directly under your shoulders and knees under your hips. Wrap an elastic band around each foot. Extend one leg while making sure the lumbar spine is held still throughout the movement and not allowed to arch. Extend the leg until it is straight as shown. Reach with the opposite hand with or without holding a weight.
Standing Hip Extension with Elastic Band
Place an elastic band around your ankles. With straight knees, move the target leg back and then slowly return.
Standing Clamshell Squat with Elastic Band
Start with a band placed directly above the knees and feet shoulder-width apart. Sit back into a deep squat and push the knees out and back to neutral in a slow and controlled movement repeatedly while still keeping good form. Be sure to concentrate on your glutes with your knees over your feet and your toes visible at all times.
Lateral Monster Walk with Elastic Band
Place a looped elastic band around both knees or ankles. Next, bend your knees and step to the side while keeping tension on the band the entire time. After taking sidesteps to the side in one direction, reverse the direction taking sidesteps until you return to the starting position.
Standing Clamshell with Elastic Band
Start by placing a band just above both knees. While maintaining a slightly squatted position slowly rotate one leg up and out from your body while keeping the opposite leg as still as possible. Slowly return to starting position and repeat.
Conclusion—Stop Sciatica Pain When Cycling
Sciatica is a common cause of back and leg pain impairing performance and riding enjoyment. Luckily, through knowledge of its underlying cause, it can be treated and prevented. Follow a sensible training and recovery plan to avoid overtraining your piriformis and the surrounding musculature.
Take the rest you need to ease the pain. Ensure that your hip flexors, hamstrings, and piriformis are flexible. Perform focused strengthening exercises to address muscle imbalance. A proper bike fit is essential.
If all else fails, seek guidance from a healthcare professional. But don’t give up. You’ll be back at it in no time!
Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!