Sciatica Ė Piriformis, Hamstring syndrome, or SI issue?

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Thread: Sciatica Ė Piriformis, Hamstring syndrome, or SI issue?

  1. #1
    Join Date
    Feb 2020
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    Default Sciatica Ė Piriformis, Hamstring syndrome, or SI issue?

    • texas starting strength seminar september 2020
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    Relevant info and history

    -34 yo male, 185 lbs, 5í 10Ē
    -HS football (cornerback) and HS track (sprints, long/triple jump)
    -Hamstring tear (canít remember which side) freshman year in high school practicing handoffs for 4x100 relay
    -Sedentary lifestyle essentially since graduating HS (2004).
    -First low back tweak was chicken fighting in the pool with my gf on my back (2006, 20 yo).
    -Engineer with desk job since 2008.
    -Purchased a mint 2004 Mustang Cobra with an extremely stiff clutch in Jan 2009. I live in Houston (re: traffic).
    -Unexplained right knee pain for a few months around 2010.
    -Low back pain, sciatica, and hip pain came on suddenly with no perceivable causation in May 2013 (began on the right side, then after six months switched to the left side and has persisted on the left since Nov 2013).
    -Sold the Cobra. Got a car with an automatic. Sad day for me as a car guy, but I literally couldnít drive it anymore due to the pain.
    -PT through an outfit called Airrosti within 2 months of initial symptoms. Typical PT treatment: introduced me to foam roller to roll out glutes/hams, glute bridges, hamstring towel stretches, etc. No help.
    -Proceeded to go to neurologist to get an EMG, but nervous system checked out fine for lower limbs. Also did an MRI, x-ray, and bone scan. Prescribed codeine, but that did absolutely nothing for the nerve pain.
    -Ortho said I had 4-5mm bulging in L4/L5 and L5/S1. No other issues.
    -Neuro then recommended I see a rheumatologist. Rheum checked me for spondyloarthropathies but no markers for any sort of autoimmune diseases, recommended NSAIDs (meloxicam).
    -Dr. of naturopathy was next on the list. INFLAMMATION!!!1!1!! Cut essentially everything out of my diet except veggies, fish, and chicken and spent a shit-ton on supplements. Lost a ton of weight (down to 160-ish) but as expected, another dead end.
    -Got pissed with the system and spent the next several years in and out of depression about being in pain forever. Sometimes Iíd do NSAIDs overdose for a few weeks, sometimes not. In that time, found several short-term fixes that usually revealed themselves as placebos Ė lacrosse ball releases, foam rolling, stretches, Anat Baniel method, bodyweight exercises, etc.
    -Work got me a Varidesk in Dec 2018, which helps. However, right heel pain/burning can be an issue by mid day.
    - Both hips pop LOUD every morning, and will pop throughout the day. This feels good, but seems strange.
    -Throughout the day I am able to crack my SI joint by placing clenched fists between my bent knees and squeezing. This also feels pretty good.
    -Pain will inexplicably reduce or disappear every once in a while. Sometimes after a walk. Sometimes for no reason at all. These ďpain-freeĒ episodes are rarely more than an hour and donít happen with any regularity.
    -Soft chairs are out of the question. I prefer a hard, plastic chair to a big cushy couch as this slows the onset of pain in a seated position.
    -Friend introduced me to SS Dec of last year. Began presses and deadlifts only at first, not having a rack. Began the full program January 2, 2020 after purchasing a squat rack.
    -Squat has gone from 85 to 170, Press (1.0) from 25 to 85, Bench from 85 to 110, Deadlift from 70 to 135

    Most days, and I mean 360 out of 365 days for 7 years, I feel pain primarily in the left hamstring and high, deep left butt cheek near the top of the sacrum, with occasional left calf involvement. Sometimes itís in the left outer butt cheek, and rarely the left knee is involved as well. Sitting always aggravates it, so I usually end up standing at work most of the day. Being startled can take the pain from a 2 to a 6 in an instant. Sudden jolts of motion (e.g. tripping, missteps going down stairs) will do the same escalation of pain. Highly tense situations (even intense movies) or other stressors can affect it. If the pain gets intense enough, the lower left back also begins tightening up. In general, I donít feel a tremendous amount of pain in my lower back. Iím an extremely violent sneezer, but unless the pain is already bad, that doesnít usually cause a sudden onset of symptoms, but it can.

    Lifting helps. A lot. Post workout I feel great. Iíve actually noticed a sort of going back in time for the radicular symptoms. The day after I lift, my right side is actually the side thatís experiencing pain/radiculopathy. However, when the pain is on the right side, the right knee seems to be where the pain resides. Then, the next day, back to left side hamstring, butt pain.

    I do not experience pain during squats and I loved them even back in HS. PR at 17 yo was 335 when I weighed 165.

    Deadlifts felt fantastic for the first month (when I was only doing deadlifts and presses). But progress stalled quickly after introducing the other two lifts. When I got to about 120, I would feel pinching (assuming radiculopathy) in my right inside heel. The next day I would feel a 4-6 paint in my right hamstring. I havenít felt any pinching like that on my left foot. I switched to deadlift PRs on 1st and 5th workout, with 80% deadlift on the 3rd, and RDLs on workout 2/4. This seemed to help the radicular pain. Iíve got a garage gym, with about 1-1/8Ē slope so standard deadlift setup is a little tricky.

    Any help would be appreciated. The program and book are fantastic and Iím hoping Iím just early enough in the program that the impending strength will help put all of this behind me.

  2. #2
    Join Date
    Feb 2020
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    6

    Default

    One more note that seems relevant: the radicular pain can completely switch sides during the day. A good example would be today. Even though I did not lift yesterday, right side knee pain was present the first half of the day. Then, around lunchtime is switched completely to the left side hamstring, high in the butt cheek, and left lower back. The right felt completely normal with no knee pain whatsoever. I will note, I was sitting more than usual after lunch.

  3. #3
    Join Date
    Aug 2010
    Location
    Olympia, WA
    Posts
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    Default

    So, if we take stock of the entire post: 1) your MRI and EMG have ruled out any radiculopathy (at least at the time of the test). 2) Symptoms are being improved, albeit slowly, with training. 3) Increased sciatic pain with sitting is a bit more indicative of hamstring syndrome than the other diagnoses in the title of the post. I treat similar conditions quite effectively. I'd certainly recommend getting a coach who is well versed in training through and around injuries because that is going to be the single best thing you can do for this.

  4. #4
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    Feb 2020
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    Thanks Will!

    One follow-up question: do you think performing RDLs is a bad idea if hamstring syndrome is in fact the culprit? I've only just begun to incorporate them in my programming, but a cursory search of hamstring syndrome yields consistent recommendations against stretching the hamstrings.

  5. #5
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    Feb 2020
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    Nevermind Will. After searching through the forums I found a similar thread discussing high hamstring tendinopathy. It appears that RDLs seem to be a good, albeit painful, way to proceed with this issue (assuming PHT is the culprit).

    I plan to do normal RDLs with both legs, without the healthy leg setback for the eccentric phase, for a 3-1-2 count. We'll see how that goes.

  6. #6
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    Olympia, WA
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    Even if it is hamstring syndrome, realize that a slow RDL is not a stretch in the normal sense. The RDL has a very strong eccentric component, but it is a very active movement, whereas a passive stretch is not. The idea of the of the RDL is to put a strong eccentric load on the hamstrings with an anchored pelvis and then use a forceful concentric contraction to return to the top. A passive stretch is done in order to cause tissue creep to elongate a muscle belly. I think the lack of an active contraction of the hamstrings during passive lengthening is why hamstring stretching should be avoided at all costs with true HS syndrome.

  7. #7
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    Feb 2020
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    It's been about a month, so a good time for an update. Not a huge change to daily pain, but certainly not going backwards. Squat is up to 180 and deadlift is at 185 (finally caught, and passed, squat).

    I've modified my program to fully separate A and B days for the lower body lifts. Left hamstring started to hurt too damn much doing squats on deadlift days, even with a reduction to 80%PR squats.

    Since my OP, my program looked like this:

    A Day
    Deadlift
    PR x 5 x 1
    Press
    PR x 5 x 3
    Squat
    80%PR x 6 x 3

    B Day
    Squat
    PR x 5 x 3
    Bench
    PR x 5 x 3
    RDLs
    PR x 5 x 3

    After reading the article on elbow tendinitis, volume seems to be important when using eccentric loading for healing tendinitis. So I reduced my RDLs to 10lbs below my previous PR and plan to proceed like this:

    A Day
    Deadlift
    PR x 5 x 1
    Press
    PR x 5 x 3
    RDLs
    80lbs x 5 x 5

    B Day
    Squat
    PR x 5 x 3
    Bench
    PR x 5 x 3
    RDLs
    80lbs x 5 x 6

    A Day
    Deadlift
    PR x 5 x 1
    Press
    PR x 5 x 3
    RDLs
    80lbs x 5 x 7

    etc...

    Left hamstring pain was very present at the bottom of RDLs each set, but it recovered to baseline after the 1 min rest between sets. Pain hasn't been particularly bad, so hopefully I'm working them hard enough to elicit an adequate inflammation response. Slept great, didn't keep me awake, and feels decent today. We'll see how the pain progresses as I play this program out over the next few weeks.

  8. #8
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    Feb 2020
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    starting strength coach development program
    It's been a little over a month, time for another update!

    Pain is getting a bit better. I have a feeling that the hamstring pain I have is more mental more than anything at this point. I've been dealing with this for about 7 years, so the pain patterns are deep within my psyche. As strange as it sounds, I've actually tried to focus on my tinnitus on really bad days. The ringing has never bothered me, but it does give me something consistent to focus on to keep my mind off my hamstring.

    That said, I'm still progressing nicely - gaining weight and putting more weight on the bar. Squat is now up to 205 and deadlift is at 220. Not particularly commendable numbers, I know, but both the lifts are now performed pain-free. This is particularly good for deadlift as I hit a stall at around 125 lbs because of nerve-like pain in my right foot arch. As previously mentioned, breaking the lower body lifts up on separate days has helped tremendously.

    I'm continuing to do RDLs after each workout with a few modifications. On deadlift days, I do about 80% of my "max" for the RDLs as a "light day" due to lower back fatigue (e.g. I do 85 lbs on RDLs on squat days, and 65 lbs on deadlift days). In addition, I've honed in on doing 6 sets of 5 reps on both days. Any more and lower back fatigue seems to be the limiting factor, whether its a squat day or deadlift day. I've progressed pretty slowly on increasing the weight on these and focus primarily on strict form.

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