Sciatic Pain? Sciatic Pain?

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Thread: Sciatic Pain?

  1. #1
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    Default Sciatic Pain?

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    I'm in need of some help addressing a recurring issue that I believe is my sciatic nerve. At first I thought (and was told) it was likely a strained adductor and/or tendonitis.

    Shooting pain (almost like a really intense cramp) from my crotch to the back of my knee that will radiate a bit out into my general hip area. Feel like it's "behind" my gracilis. Sometimes also a charlie horse feeling on the outside of my leg, at the glute/ham fold. Takes about 3-6 days to subside and is completely debilitating during the first few days. Pain is most easily triggered by something like a hip bridge (worst), sitting, squatting, basically anything that closes the hip angle significantly or extend it from closed position. Squeezing a ball between my knees does not cause pain.

    Only crops up after strength training. Squats will do it. Deadlift doesn't seem to. Cleans and barbell rows also seem to guilty of causing issues. During the workout everything feels great, no pain etc. Nothing will appear to be wrong until 24 hours later. Prior to SS it sometimes happened following bodyweight workouts I used to do. I can't see a rhyme or reason to when it happens in relation to load. I'll be fine after a heavy day, but have an issue after an easy day.

    It was suggested I foam roll my piriformis, which does seem to provide very temporary pain relief but isn't stopping this from happening. If it is my piriformis pinching the nerve, is there something form related I may be doing wrong? Any help is greatly appreciated, this has stopped my progress dead since March.

  2. #2
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    This description doesn't sound like a common sciatica presentation, which will be more lateral and posterior than you are describing here. But maybe. A therapist needs to diagnose this with a physical exam.

  3. #3
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    Thanks for the fast response. I'll search out a different therapist. I've been to two with no results and was tired of throwing money away. Any thoughts what else this could be so I can go in better informed this time?

    One thought adductor strain or tendonitis, which is what we treated for initially. I also tried the treatment suggested by Nick D’Agostino in an article that was suggested by a SSC I visited in March (one off form check session). No luck there either.

    The other said piriformis syndrome and told me to stop lifting weights entirely (this was prior to SS) and suggested not going back. His suggested correction was lots of core work, stretching, hip bridges and clam shells. It didn't work. If time off is needed (didn't help when I was self treating), so be it, but not returning to strength training isn't an acceptable solution anyway.

    I should of noted, this is only ever in my right leg. Back (SI joint or otherwise) pain isn't usually present and is likely more related to hobbling around on one leg and having to do everything by bending my back instead of my hips.

  4. #4
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    Where do you live?

  5. #5
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    Near Charlottesville Va, which is about 90 minutes West of Richmond if you're not familiar with the area.

  6. #6
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    I'm a PT and can't stand hearing about these treatments based on theory which take weeks or months to see if they worked or not. Find a therapist that will move you and see what it does to your pain immediately

    Personally I would recommend you see an MDT clinician in your area. They will perform a mechanical assessment to understand and treat the pain. They will not work on theory but on how your symptoms respond to movement in the clinic. Which typically leads to less wasted on time on theories such as "piriformis syndrome" and they will be able to tell you if it is originating from your spine, SIJ, hip or if it is a true muscle strain or tendinopathy.

    The therapist will likely have little knowledge of barbell training and likely ask you to hold off on training for a short period of time but will likely encourage return to barbell training once the issue is understood.

    Here is the list of VA MDT clinicians. One with the Dip. MDT clinician is my recommendation as they have met nearly the highest level of MDT education.
    Last edited by Mark Rippetoe; 07-02-2019 at 09:59 PM. Reason: link removed

  7. #7
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    Tell us about MDT.

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    MDT is Mechanical Diagnosis and Therapy more commonly known as the McKenzie Method (but also more often bastardized as McKenzie exercises). It is a system for classification and treatment of musculoskeletal pain in which the symptomatic response to repeated movements and sustained positions are utilized to determine effective treatment. It can only be truly performed by a MDT credentialed clinician Cert. MDT or Dip. MDT with the Dip. being a higher level of training. In my opinion the system works well with the starting strength model. I use both in my practice almost exclusively. If your pain is of spinal origin they will likely quickly resolve it, if it is a derangement of the SIJ or hip it will also likely be quickly resolved. And if it is an adductor muscle issue they will tell you to progressively overload it to remodel the impaired muscle tissue.

    Here is a study that shows how it can make a big difference in the spine (I don't think we can rule out your spine as being the source of your pain yet).
    http://corydonphysiotherapy.com/file..._back_pain.pdf

    Anyone interested can find out more by searching McKenzie Institute USA and going to their website Welcome - The McKenzie Institute, USA.
    To locate a MDT clinician go to the Find A Provider link at the top of the page.

    Unfortunately I believe MDT has poor understanding of barbell training and lifters/coaches have a poor understanding of MDT. But Starting strength and MDT can work very well together in my opinion. In my practice (still working towards MDT cert so I don't "technically" use MDT) I try to get everyone to be able to perform the basic barbell movements with minimal pain/compensation. If I do that I feel I have done my job, which I mostly see as...get them healthy enough to train. The rest is up to them.

  9. #9
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    Quote Originally Posted by dwade View Post
    Unfortunately I believe MDT has poor understanding of barbell training and lifters/coaches have a poor understanding of MDT. But Starting strength and MDT can work very well together in my opinion. In my practice (still working towards MDT cert so I don't "technically" use MDT) I try to get everyone to be able to perform the basic barbell movements with minimal pain/compensation.
    Might be an article and/or case study there, if you think you can take on the challenge of the explanation.

  10. #10
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    starting strength nutrition camp
    Quote Originally Posted by dwade View Post
    Unfortunately I believe MDT has poor understanding of barbell training and lifters/coaches have a poor understanding of MDT. But Starting strength and MDT can work very well together in my opinion.
    I completely agree that SS and MDT could work well together, however, I've taken all of the MDT courses and I don't think these therapists would have any interest in barbell training as it relates to rehab. It's unfortunate because I think that PTs who use MDT methods could learn a lot. I've found the rehab techniques described on the forum by Rip and others to be much more effective in my practice and with personal injuries.

    The general prescription for MDT patients is some sort of unloaded, repeated movement that is completed throughout the day (ex. repeated prone lumbar extension) . While this may work for an untrained population, I think that a lifter or athlete needs repeated, loaded movement in order to more effectively recover ( deadlift, prowler). Both are emphasizing lumbar extension but in my experience the loaded option is always superior than the unloaded option.

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