Driving (with) a Wedge
I have little doubt that just about every runner will experience some form of “sciatica” sometime during his/her running career.
As described in greater detail in an earlier column (Article #12),sciatica is really a generic term typically applied to vague, non-specific pain in the back of the thigh and perhaps the calf. It can start in the low back or buttock, but symptoms in those areas may not be present in every case. There is no single cause of sciatica, so the challenge is to determine the source of the symptoms in order to effectively treat this condition. Often, that cause has nothing to do with running itself, though it certainly can then affect the individual while running. Here is one such case:
A few months back, a runner who was being treated at the time for left foot pain mentioned to me that he had just that weekend started to experience pain in the back of his right thigh, with some pain in the buttock and low back. After asking several questions to try to determine the nature and possible causes of his problem, he mentioned to me with some chagrin that the pain had appeared soon after he bought and started driving a new car. He noted that when he drove his wife’scar, he did not feel any discomfort, which was true also of his previous vehicle.
Upon further questioning and direct viewing of his brand-new pride and joy, it became apparent that the most obvious feature found in this sporty car, as opposed to his wife’s or his old car, was the presence of very deep bucket seats. Observing this runner in his seat, it was not difficult to see that his knees were at least a half to a full foot higher than his hips.
The consequences of this position are predictable. Even with the lumbar support that many car seats feature,the angle of the hips – coupled with the outstretched leg reaching for the gas and braking pedals – places a prolonged strain on the lumbopelvic joints. Specifically, the right sacroiliac is susceptible to ligament injury as a result of the extended period of backward force imparted to the pelvic bone. These ligaments are already at risk in the runner due to the forces transmitted to the SI joints every time the foot makes initial contact with the ground, so it is not a great surprise that sitting in the described car seat adds to, or is the final straw that leads to this problem. And as described in the earlier column, SI joint sprains are one of the frequent causes for sciatica symptoms.
The good news is that there is a simple solution that is very often amazingly effective. A minor change in sitting position is all that is needed in many cases to alleviate the stressful factors leading to this type of sciatica. The necessary change involves raising the level of the rear portion of the seat (not the seat back) to bring the hip joints at a height equal to the knees. Many cars are equipped with mechanical means to do this, but if yours isn’t one of those, a cushioned wedge will do just fine. Before running out to purchase such a wedge (many discount stores such as Target, Wal-Mart, and Bed, Bath, and Beyond often carry them),you might first make a rudimentary one with a folded towel to see if it helps you. Use a good-size bath towel folded two or three times into a square and place it under the buttocks; be sure it doesn’t extend too far forward under the thighs, though.
This fix works well in most cases. Unfortunately, it wasn’t so successful with this patient – at 6’4″, there was no room for his head in his spiffy sports car once we raised his seat height. Too bad, but that’s the price he paid for being sixteen inches over normal height!