PITTSBURGH — As he trained for his first Pittsburgh Marathon last spring, Elam Gates thought he was doing everything right — building mileage, pushing his limits and chasing a new goal.

Then came the pain.

“A sudden, overnight issue” that began as twinges and tingling quickly turned into staggering nerve pain that originated in his lower back and shot down his leg, making it difficult for the 29-year-old Richland man to walk, let alone run.

The pain disrupted not just Gates’ training, but daily life. He remembers one day leisurely walking with his wife in North Park: “I kept constantly having to tell her, ‘Hey, I need to pause a second. I need to stretch my leg out, because it's really sore.’”

Gates had developed sciatica, a condition caused by irritation of a nerve in the lower spine.

While many runners encounter it at some point, medical experts say the condition is widely misunderstood. Running doesn’t cause sciatica, but training can aggravate underlying weaknesses, imbalances or prior injuries. Recognizing symptoms early — and adjusting training accordingly — can be key to staying on the road.

Up to 40% of the population will develop sciatica at some point in their lives, according to Harvard Health, Henry Ford Health and other resources. And the likelihood of developing it increases as we age.

“It might help to talk about what sciatica is,” said Jeff Fleming, associate medical director of the Pittsburgh Marathon and a UPMC primary care sports medicine doctor. “Sciatica is usually referring to irritation of a nerve, specifically one of the nerves that starts at your low back and goes down the length of your leg.”

That irritation — often identified by a feeling of “pins and needles” or electricity — is most often caused by compression in the lumbar spine, he said. Sometimes there’s also numbness, weakness and other symptoms.

While many runners experience sciatica at some point, both Fleming and Sewickley-based physical therapist Scott Szelong stress that running itself is not typically the root cause.

Instead, the condition reflects a broader reality: Low back pain and related nerve issues are common in the general population.

“We’re bipedal individuals, right? So we bear most of our weight down through those lower segments,” Szelong said. “So that’s why you statistically see more dysfunction in the lower lumbar spine, and it presents with that sciatica distribution.”

In fact, he noted, research and studies have shown that running can have positive effects on spinal health.

“Running has NOT been shown to adversely affect spine health,” Szelong said in an email.

When pain hits

For Bill Beckett, a 52-year-old endurance runner from near St. Clairsville, Ohio, sciatica traces back to a severe back injury with a few ruptured disks, long before he ever took up running.

His back surgery in 2017 had him “tied up, laid up for almost a year.” After recovering, he turned to running to stay active — and eventually became an ultramarathoner, logging about 60 miles a week and competing in races across the country.

But the nerve pain never fully disappeared. Beckett manages flare-ups by closely monitoring his body and adjusting his training.

When he feels that something is off and not quite feeling right, he stops and makes adjustments immediately. “Whether it's the surface you're running on, or maybe cut back the number of miles you're running, or maybe it's time for a shoe change.”

Shoes and terrain, he added, make a noticeable difference.

“Concrete is the absolute worst,” Beckett said. “The asphalt, a little better.” Trail running, in his opinion, is the best surface to reduce pounding on the body.

Gates’ experience was very different, and came during his first marathon training cycle.

At the time, he had only recently taken up running but had quickly ramped up mileage.

“I had never pushed my body physically this much,” he said.

A physical therapist diagnosed the disabling pain he was experiencing as sciatica and pointed to multiple contributing factors.

“Number one, just a general overuse,” Gates said. Second, he was under-fueling his body, making recovery from the intense training harder.

One of the reasons Gates started running was an attempt at weight loss. So while his calorie reduction had succeeded in helping him shed close to 100 pounds, it also derailed his training for the race. After his bout with sciatica, he said he came to understand that, “in order to be efficient and be your best in life, you have to fuel properly.”

With treatment and insight gleaned from physical therapy, Gates adjusted his approach.

The most common treatments for sciatica are conservative, non-surgical options including physical therapy, stretching and exercises, over-the-counter NSAID pain relievers like ibuprofen and naproxen, heat and ice therapy and continuing light activity, according to the Mayo Clinic. In some cases, doctors will prescribe a shot of a corticosteroid medication into the area around the affected nerve root or surgery to repair or correct herniated disks.

Now, Gates employs structured warmup and cooldown regimens, focuses on hip-strengthening drills in strength training routines and is more disciplined about post-run nutritional recovery.

Today, he’s back on track and preparing for his second Pittsburgh Marathon on May 3 — this time with nearly double the training mileage and a focus on staying healthy. His goal this year is to shave at least five minutes off last year’s finish of 3 hours 20 minutes.

Why runners feel it

Running may not cause sciatica, but it can trigger symptoms — especially when underlying issues are present.

“A lot of it has to do with the repetitive motion of running,” Fleming explained. A repetitive pounding of the lower back where the sciatic nerve originates “can cause that area to develop pressure on one of the nerves.”

Other contributing factors include muscle imbalances, weak core muscles and prior injuries.

“Weakness in the muscles around the back and the core is probably the most common cause,” he said.

Szelong emphasized the importance of “load management” — how much stress runners place on their bodies over time — as well as factors including training volume, lifestyle and biomechanics.

“A great predictor of injury is a prior episode of that injury,” he said. With a prior history of back pain, “There is a greater risk of experiencing it again.”

The telltale symptoms

Sciatica tends to feel different from typical muscle strain.

“Usually nerve pain is very easy for people to describe,” Fleming said. “It feels like burning or pins and needles or electricity, or like you're getting zapped.”

Unlike other types of pain, true sciatica often travels below the knee and into the foot, following a specific nerve pathway.

“That’s one of the few things that will cross beyond the knee and go down the entire leg,” he explained.

When to rest, when to worry

For runners, pushing through discomfort can be tempting. But that can lead to further problems.

“Rest from running is probably just the simplest thing that you can do,” Fleming said.

For many, symptoms often resolve on their own, but worsening signs should not be ignored.

“If it gets more severe, it can cause numbness or even weakness in your leg,” he said. If that happens, it’s time to see a doctor and hang up the running shoes for a bit, he warned.

Certain “red flag” symptoms — including loss of bowel or bladder control or significant leg weakness — require urgent care.

Strength, not just stretching

Prevention and recovery hinge on building strength — not just flexibility.

Exercises like squats, deadlifts and planks can help stabilize the core and reduce strain on the lower back, with Szelong noting that many runners overlook this aspect.

“Distance runners tend to avoid strength and plyometric training,” he said, recommending a dynamic warmup before runs and individualized programming based on a runner’s needs.

Ultimately, managing sciatica comes down to listening to the body and adjusting accordingly, he said.

Runners should vary surfaces, monitor training load and incorporate cross-training to stay resilient.

“It just makes you a little bit more rounded and less injury [prone],” Fleming said.

And while sciatica can be disruptive, it doesn’t have to mean the end of running.

“Running itself hasn’t been shown to be an adverse movement,” Szelong said. “It’s just a common pathology for a lot of folks.”

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