Severe L5/S1 degeneration: Can I squat/DL?

[georgemcfly]

Hello all,

I'm wondering if I can ever squat again.

I had a severe L5/S1 disc herniation with sciatica in 2011, with S1 nerve impingement (Imgur: The most awesome images on the Internet). This was corrected with a microdiscectomy and hemilaminectomy, and at the time disc height was still good. Since then, I began doing Stronglifts 5x5 program and watching videos on form, between June 2014-June 2015, reaching about 265lbs on squat. This program generally gave me increased back strength and decreased pain, which encouraged me, but there were periods of spasming and backing off at different points.

After laying off the lifts for about 10 months, I restarted SL 5x5 at 95 on low bar squat, and continued up to about 225. A couple of weeks ago, at 225, I was struggling to make the low bar squat lift, I think my lumbar spine was in extension through my efforting, instead of being neutral, and I felt something pop, had major spasms, and was laid out for about a week. Now I’m pretty okay, but there is some occasional numbness in my leg (though oddly not associated with L5 or S1 nerves), and general lumbar instability and slight pain, and pain while I sleep.

After imaging again (Imgur: The most awesome images on the Internet), it appears in the meantime since 2011 I have had considerable loss of disc height. As you can see, previously the L5/S1 disc was similar to the L4/L5 in height, but now it is very diminished, and there are some endplate changes seen (whitening on the image at the edge of the vertebra). In addition to the disc height loss, there is also a large anterior herniation (perhaps occurred that lift a couple of weeks ago), and some posterior bulging. I‘m not sure if these changes and the loss of disc height was due to bad form on my lifts 2014-2015, or just the inevitable continued degeneration.

My strategy now is to lose weight (I’m a 32 year old male, about 6’ and 215lbs., pretty high BF, which probably puts stress on my back) and strengthen my core. The question is whether I should return to squats and deadlifts very slowly while strictly maintaining form, with use of belt and weightlifting shoes, or just lay off these kinds of exercises completely. I feel I’m damned if I do and damned if I don’t, because I know these lifts can actually support my back if done properly, but poses a lot of risk.

I am worried that if I load my back the loss of disc thickness will continue and I will be more severely and permanently incapacitated if I reach "bone on bone". On the other hand I want to protect my back and be as strong as possible and am willing to work slow if compound lifts will help me get there.

Please let me know what you think.

McFly

[wmilas]

As an older guy with 2 herniated discs and sciatica, I'd say after the swelling is down start your lifting again. However forget the notion of ever pushing yourself for max prs without PERFECT form. There is no better exercise for core strength than the deadlift. The key is to keep your back in the proper position the entire time.

As soon as I feel the first twinges start I know immediately my form is slipping. I'm done for that session and maybe the next depending on how bad I messed up. Be smart about it and slowly progress.

Think about it this way. You could stop, lose all muscle in your back and suffer with it randomly from lack of support. Or you can work it smartly, add muscle and get on with your life.

Since I started deadlifting seriously I've only had one bad flare up and it was entirely my fault. My back feels much better now than when I started. Before deads I had flare ups at least 2 times a year, sometimes more, and some very servere. Think a week in bed in the fetal position.