Sciatic Pain?

[dwade]

I agree that most clinicians that use MDT have a poor understanding likely limited due to their lack of interest however I believe this is true for most PTs. You and I see this as an obvious problem but many do not. I can count the number of PTs I know that squat at all, much less with heavy weights 3 days per week. I did a journal club presentation of the LiftMor trial and almost all the PTs in attendance were shocked that these exercises were performed because they were always told that these exercises (especially deadlifts) were dangerous.

I think that unloaded exercises have their place even for the barbell athlete but performing loaded exercises does not contradict MDT principles so the use of these loaded movements within the MDT framework is still an option. A therapist employing the MDT methodology should experiment with all movements and loading options until an effective movement is found.

steph,
I agree there could be a case study there. I probably won't be publishing one any time soon but maybe in the future. For me MDT makes the most sense for many of the patients I see in daily practice while Starting Strength makes the most sense for training. I try to use them both as needed.

Oh and if ceast wants to correct this with a Starting Strength guided rehab approach that is totally fine.

But if he is going to see a therapist I recommend an MDT therapist....or a PT that is also a SSC (harder to find though). I personally wouldn't go to any other PT. Not that some others aren't good but if they don't carry those credentials or I don't know them personally I have no way of recommending them. Be careful about getting recommendations from friends or family as well. For some reason most people love their PT even when their results are sub par.

[ceast]

Thought this thread had died but just noticed the responses. Thanks a bunch. It's been frustrating for sure since many PTs top solution to pain from strength training is to just stop altogether. After a lot of looking around I met with someone who had some strength training background. I was pain free on the exam, so figuring things out exactly was tough, but he's pretty positive it's not sciatic or piriformis related. Tendonosis is what he's thinking, likely adductor magnus. Maybe semimembranosis, but less likely. Either way, likely from overuse.

He suggested light eccentric loading for a week and assuming all goes well to resume lifting at about a 50% de-load but try to ramp back up somewhat quickly since load doesn't seem to trigger the pain as much as volume. No stretching. 2-3 (4 if needed) days rest between workouts once back to 75% of pre-injury weight. No hard bike rides the day before or after lifting. This all sounded solid and agreed with much of what related info I can find on here.

The other suggestions I was hoping to get some feedback on here.
No cleans. No squatting and deadlifting on the same day. Cut a little depth and toes more forward on the squat. No bounce out of the bottom. Bring these back slowly (or during warm up sets) once I'm back to pre-injury weights and making progress again w/o issue.

Sound reasonable? Thanks.

[dwade]

The other suggestions I was hoping to get some feedback on here.
No cleans. No squatting and deadlifting on the same day. Cut a little depth and toes more forward on the squat. No bounce out of the bottom. Bring these back slowly (or during warm up sets) once I'm back to pre-injury weights and making progress again w/o issue.

Sound reasonable? Thanks.

Seems like this is avoiding loading of the adductors. Why not just drop weight, slow down the tempo, decrease depth only if needed? In my experience you have to load a tendinopathy.

What during your assessment reproduced your symptoms?

[ceast]

Seems like this is avoiding loading of the adductors. Why not just drop weight, slow down the tempo, decrease depth only if needed? In my experience you have to load a tendinopathy.

What during your assessment reproduced your symptoms?

I appreciate the feedback. Definitely was trying to reduce some load on them, but not drastically. I certainly don't want to completely work around the weakness, it won't ever get stronger that way.

Nothing reproduced the symptoms since I'd been resting it while waiting to find someone to see but I could what tests seemed to pull on the affected area. Single leg hip bridge seems the worst followed by squat and high step or lunge. Squeezing a med ball did not. Anterior pelvic rotation seems to be the big part, most significantly when combined with knee flexion.

For example, a low bar, lean over, sit my butt back squat puts way more load on it than a front squat other upright squat. I have no interest in switching though (not that I expect that suggestion), since I've started LBS the low back pain that's plagued me for years has nearly vanished.

[dwade]

Personally I would investigate lumbar spine contribution further especially with your history of back pain more for referral rather than radiculopathy.

However it does seem to behave very much like an adductor tendinopathy so decreasing stress for a short time and then starting light and building back up is a good approach. I would just do this with "The Squat" proper as described in SS. But you should pick a plan (if that is your new therapist plan then great) and go all in and follow that plan perfectly before you try changing/tweak it. I would not want you Not Doing the (Rehab) Program by trying to combine advice from your therapist and this site. Pick something and go all in until you are back to normal or have decided that plan didn't work. Tendinopathies can take a long time to heal though so be patient.

[ceast]

Personally I would investigate lumbar spine contribution further especially with your history of back pain more for referral rather than radiculopathy.

However it does seem to behave very much like an adductor tendinopathy so decreasing stress for a short time and then starting light and building back up is a good approach. I would just do this with "The Squat" proper as described in SS. But you should pick a plan (if that is your new therapist plan then great) and go all in and follow that plan perfectly before you try changing/tweak it. I would not want you Not Doing the (Rehab) Program by trying to combine advice from your therapist and this site. Pick something and go all in until you are back to normal or have decided that plan didn't work. Tendinopathies can take a long time to heal though so be patient.

Thanks much for your thoughts. One PT said that the particular low back pain I had was definitely due to a "stuck" SI joint on that side. He did some stuff on it, but nothing made a huge diff until I started SS and switched to a LBS and conventional DL. It seems my issue was most likely due to being skinny and weak, particularly in the glutes and low back. It's not perfect, but not the constant ache that it used to be.

I probably just came back too fast when I did the adductor tendonitis rehab that was suggested to me. Instead of fully building back up, I got about halfway through what was suggested but since it wasn't bothering me any longer rushed the next few weeks of increases. I'm going to try Nick's treatment again and be more patient.

FWIW, the guy I went with wasn't a PT. I'm friends with a guy who runs a Westside (affiliate? don't know how they work) gym and asked him for suggestions on who to see that was familiar with real strength training. He's the one who got me interested in strength training, but Westside was needlessly complicated and I needed something I could do at home. One of his clients is a sports med doc and was willing to sit down with me and my friend to try to hash things out. He made his suggestions, but I've had good experience getting help on here as well so I'll probably stick with a rehab program that more aligns with SS.

[dwade]

Sounds good. Good luck!