Janine arrived in my clinic complaining that the lift was a pre-war monstrosity and terrifying – she howled that she had contemplated using another osteopathic clinic because of the lift. Given that we were only on the first floor, involving precisely 10 steps, and she was 20 something, I was surprised at the extent of her irritation. Only someone in a great deal of pain reacts in that way, so I had an idea of what I was in for.
Janine perched on the edge of the chair holding her leg with an agonized look on her face. I sat down, waiting for the story of perhaps a disc injury, or back operation etc. It didn’t come. Her medical history was clear. No history of car crashes, no disc bulge, no falls, no operations….. She was fit as a fiddle, regularly attended the gym, cycled every weekend if she could, great diet, very health aware… and raging 9 out of 10 leg pain. On and off for 2 years, temporarily relieved by sports massage.
The pain ran down the back of her leg, which we call ‘Sciatica’ – meaning something is irritating the sciatic nerve. All tests that the GP had run were completely clear and he could find no cause for her leg pain – always my favorite cases!
Given her crystal clear medical history I had put my Sherlock hat on and had to dig deeper into her story.
“ So Janine, lets go over this all again in more detail. You regularly attend the gym. How many times a week?”
“14” Janine replied
My eyebrows raised. (Had I worn glasses I would have looked like Miss Marple, peering over my half moon glasses at her) “Twice a day?”
“Yes. 2 hours each time.”
“Talk me through your regime.”
“45 minutes on the stepper, 45 minutes on the bike, then weight lifting – leg toning, arm toning…”
“Any stretching after your gym sessions?”
I put my case notes down. I had my diagnosis right there without even assessing her.
The cause of pain
The movements that Janine was repeatedly carrying out (bike, stepper, glut presses) were all taking the leg into extension, and specifically tightening the gluteal muscles and the piriformis muscles – all found in the bum cheeks. The sciatic nerve runs between, around and sometimes even right through the piriformis muscle. If the gluts and piriformis tighten enough they can place pressure on the sciatic nerve, even pinch it directly if the nerve passes through the sciatic muscle, and cause extreme leg pain.
People who attend the gym a lot typically forget to stretch, or perhaps don’t realise the importance of stretching after intensive strengthening. Many musculoskeletal pain conditions arise as a result of over using certain muscles in the gym, or in a hobby or work activity where the same activity is carried out repeatedly over time.
Janine’s leg pain was one of the simplest I’ve ever had to treat. Simply reducing the tension in her gluts and piriformis muscles with osteopathy, a specific stretching yoga program and a complete re-education about her gym regime was all it took.
If you attend the gym a lot, try to ensure a balance between strengthening and stretching if you want to avoid unnecessary aches and pains in your body.