Sunday, November 23, 2014

I Have Sciatica, Why Are You Grabbing My Foot?

It is 5 am in Badwater, CA. There are approximately 100 runners toeing the chalked line. There is 135 miles, over 10,000 ft in elevation gain and 120 degree heat under the Death Valley sun between them and the finish line. I see my runner crossing the horizon towards our support car, his stride looks shortened, but smooth for mile 60. Over the next 75 miles we take turns passing off race essentials. At 4 am, as a team, we cross the finish line at Whitney Portal.

So how did this journey begin?

From the moment I met him I could hear the “thud”. It was the sound that his foot made as it he walked through the clinic.  He tells me he is a runner, but not just a runner, but he is running in the Badwater Ultramarathon in July. 135 miles of “thudding” into the ground! To bring the pressure up a notch, this is going to be his 11th consecutive finish. As I watched him move and walk, I can't stop focusing on the stiffness of his foot which is causing the "thud". But how do I explain his lack of foot mobility is contributing to what he is actually coming to see me for… SCIATICA?

What is Sciatica?

Sciatica is a general term used to describe inflammation of the sciatic nerve or nerve roots which comprise it. Sciatica can be caused by a disc injury or stenosis (narrowing of spaces of the spine), which puts pressure on the nerve roots. When our foot hits the ground force is transferred up the leg and into our lower back. Our foot is designed to pronate upon impact to allow for shock absorption.  The bony anatomy of our foot and ankle causes a biomechanical chain reaction. This generates a rotation in the leg then into the pelvis which helps to recruit the gluteals to provide the stability of the back. However, if the foot remains supinated, ground reaction force is transferred into the spine instead of being absorbed through the foot and leg. When the mobility of the foot is limited, the lower back is forced to move more to compensate for the lack of motion. The increase motion of the back decreases the amount of space the nerve has to pass through the spine.

When the foot pronates it causes a rotation up the leg which
helps to dissipate force and maintain good motion of the back.

When the foot remains supinated the foot remains rigid forcing
the back to rotate more which decreases space for the nerves.

To improve his foot mobility I begin to facilitate pronation of his foot. IT worked! His sciatic pain decreased.  I worked on it some more and his pain was gone! He was able to walk and jog in the clinic without his symptoms. 

From the moment I helped his foot become more supple and pronate, his sciatic pain got better.

So when you foot hits the ground: is it supple (pronated) or rigid (supinated)?


You can even see from the pictures above the difference in the position of the pelvis.


The technique is performed to increase mobility of the foot to reduce stress to the lumbar spine. This will help minimize your risk of sciatica. Stenosis is narrowing of the canal in which the nerves exit the spine. If you have a herniated disc, this is NOT a technique for you.

For forefoot runners, it is also important to have a mobile foot. The motion of supination and pronation occurs in the forefoot instead of the mid and rear foot.

After mobilizing the foot, it is important to retrain the muscles and joints in this new motion. This allows the newly acquired motion to be recognized as a movement path. If your body doesn't use this motion, the foot and ankle will become stiff again.

Here are examples of exercises which use the muscles and joints in all 3 planes of motion to retrain the body.

Please consult with a health care professional prior to performing these exercises. If it increases your pain, STOP!