Acceptable Pain in Herniated Disc Recovery Programming

[JR Johnson]

33 Year old male, 6'1" / 220 lbs
Best lifts: 230 Press / 315 Bench / 440 Squat / 510 Deadlift
I am an intermediate lifter who was doing HLM programming.

My back and left leg started experiencing bad sciatica and numbness on April 25, 2019. I got an MRI June 6th, which showed my L5/S1 spewing like a crushed jelly doughnut: Johnson Disc.jpg

I have since discovered that I have poor posture (maintaining a proper lumbar curve on my hour-long commute immediately reduced the sciatic pain). Also, I have been doing excessive bent-over work the past few months on a fixer-upper house, and I did tweak my back squatting in early April 2019 but I worked through that to the point where I had no back pain before the onset of the sciatica. I figure a combination of these things was enough cumulative stress to herniate the disc at some point.

Since the onset of the sciatica, I have been trying to execute a recovery protocol with light squats and deadlifts since it seems like so many people on this forum have had luck with that approach. I got up to 315 lbs for three sets of five squats, but the pain got sufficiently bad where I had to back off of that weight down to the bar. Even with perfect form, squatting and deadlifting just the bar still causes sciatic pain down through the hamstring. In fact, just doing an RDL with the bar or doing an air squat causes a sciatic flare-up. Does anyone have any rules of thumb for acceptable levels of pain in the disc recovery process in order to keep the disc from leaking more jelly unnecessarily? Should I only work a range of motion that doesn't cause pain for now? I am not afraid of the pain, but I want to be prudent and not cause unnecessary further damage to the disc.

Thanks in advance for any input.

[Mark Rippetoe]

It may well be that the sciatica has nothing to do with the disc. Investigate this possibility.

[JR Johnson]

I conducted a thorough interrogation of my sciatic nerve with a painful session of squats. It finally broke down and claimed that the culprit of my sciatic pain was a lack of core strength, and that if I only stopped squatting, it would tell me about some moves involving instability and a bosu ball that would sufficiently strengthen my core in a functional way so as to alleviate the pain. I then proceeded to cross examine my L5/S1 disc with a session of deadlifts, but no matter how much pain I inflicted on it, it just looked at me all stupid-like with jelly oozing out of its ugly orifice.

[JR Johnson]

I have been trying a linear progression for the past two months by adding 5 lbs/workout to the squat and the deadlift. Over the past month, I have not been able to get over 225 lbs in the squat and 250 lbs in the deadlift for sets of five, and have made no progress over the past two weeks. I was able to go heavier than this with less pain within a few weeks of herniating the disc, so things are not heading in the right direction. Oftentimes, the pain in my lower left back and butt will cause me to bailout in the middle of a set of five. Presses are also painful above 165 lbs.

Has anyone had any luck with just taking a month or more off of squatting and deadlifting with a disc herniation, or with just doing some kind of assistance exercise like back extensions? Squats and deadlifts just seem to be aggravating it more with every workout.

[Will Morris]

In imaging, one view = no views. One must see multiple views of the same area to make any reasonable analysis of the situation.

Level of pain = not that important

Peripheralization versus centralization = more important

Progressive neurological deficits = most important

[JR Johnson]

The jargon the doctors came up with from the imaging (there were a hundred pictures and I only posted the one) was:

"Diffuse mild lumbar spondylosis with large left paracentral disc extrusion at L5-S1 blurring the left lateral recess and severely compressing and displacing the left S1 nerve root."
"L5-S1: Very large left paracentral disc extrusion obliterates the left lateral recess, severely compressing and deviating the left S1 nerve root. Mild bilateral foraminal narrowing due to disc bulging without L5 nerve root compression."

If the pain is the limiting factor in force production in the deadlift and the squat, and not peripheralization or progressive neurological deficit, then how does one go about increasing force production most efficiently if progressively loading the squat and deadlift are causing force production to stagnate or decrease? Taking time off? Backing off the squat/deadlift intensity and increasing the volume? Trying some type of assistance exercise until the thing heals more? Just keep grinding out sets of five and hope something eventually changes?

[Will Morris]

The jargon the doctors came up with from the imaging (there were a hundred pictures and I only posted the one) was:

"Diffuse mild lumbar spondylosis with large left paracentral disc extrusion at L5-S1 blurring the left lateral recess and severely compressing and displacing the left S1 nerve root."
"L5-S1: Very large left paracentral disc extrusion obliterates the left lateral recess, severely compressing and deviating the left S1 nerve root. Mild bilateral foraminal narrowing due to disc bulging without L5 nerve root compression."

If the pain is the limiting factor in force production in the deadlift and the squat, and not peripheralization or progressive neurological deficit, then how does one go about increasing force production most efficiently if progressively loading the squat and deadlift are causing force production to stagnate or decrease? Taking time off? Backing off the squat/deadlift intensity and increasing the volume? Trying some type of assistance exercise until the thing heals more? Just keep grinding out sets of five and hope something eventually changes?

What are some other ways you could increase the stress of the training session without necessarily increasing the load?

[JR Johnson]

What are some other ways you could increase the stress of the training session without necessarily increasing the load?

Aside from the options I listed, you could increase frequency. I have been on novice LP sqautting and deadlifting 3x per week-is increasing the frequency prudent if the load has stalled for weeks due to acute pain?

[Will Morris]

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