Squat and Deadlift Asymmetry and sciatica problems

[blowdpanis]

Hello,

I hope you'll excuse a long-ish post as this requires a bit of explaining. Any help offered would be appreciated, and in the past Tom C. has given some helpful feedback on my squats (~5 years ago I think now).

I have a history of pronounced squat and deadlift asymmetry due to having fundamentally asymmetric hips. I have a retroverted right hip, i.e. my femurs project out of my acetabulums at different angles. This has been confirmed via physical therapist in the form of Craig's Test and by MD in the form of X-rays of my hips and pelvis. Probably as a consequence, I also have a spinal scoliosis (confirmed via MRI).

Why do I give a shit? In my 20's I basically just ignored these asymmetries and managed a good amount of productive training. My best lifts in competition were a 155 kg squat, 125 kg bench, and 205 kg deadlift at a bodyweight of ~175 lbs at 5'9" a decade ago or so. Not great, but okay.

The problem arose in my 30's - I began having sharp pains in my left hip with squats and deadlifts, which wound up radically derailing training in these lifts for years. Eventually through lots of time off the acute pain in my left hip seemed to die down, however, whenever I began training squats/deadlifts for real again I'd invariably wind up with sciatica/radicular type symptoms down my left leg. What's extra weird is that nothing actually hurts during the performance of the squats or deadlifts besides an occasional twinge, normally, but in the hours/days following heavy squatting and deadlifts I'd wind up with these symptoms. An annoying buzzing/tingly feeling down my left leg. At that point I wound up getting MRI's of my lower back and left hip, which showed:

* Some degenerative changes in my spine that wasn't considered unusual given my training history and age (now 37).

* A few lightly bulging discs including l5-s1, but no outright herniations anywhere.

* A small tear in my left labrum, but no pain/provocation on diagnostic testing.

The recommendations I got included physical therapy or to try corticosteroid injections in my spine as the pain was deemed likely discogenic. I've tried a lot of PT-esque stuff for my problems, including extremely painful massage from a PT (elbow in glutes) and a shitload of stretching and "mobility" work (Starrett stuff), but nothing has actually prevented my symptoms from returning if/when I actually return to squats and deadlifts.

So with all of that said, I have videos demonstrating my squat and deadlift in a wildly detrained state:

Squats from the front and back Squat Assymetry - YouTube
Deadlifts from the back and side Deadlift Assymetry - YouTube
These aren't standard sets of 5 (they're 12's), but I hope you'll excuse that as I figure some fatigue will demonstrate the asymmetries even moreso.

Things I notice:

Squats
* The cues I'm concentrating on are basically opening the hips and midfoot balance, with an attempt to lean over and drive from my ass on the way up. I'm also trying to make sure my spinal position doesn't change, which I don't really think it does (i.e. I'm not actually rounding towards the botom).

* My hips in my squats have a very characteristic look of sort of down and to the left on the way down, and up and to the right on the way up. I've tried many different things to try to keep my pelvis as level as possible (shimming the left leg which almost seems short, having the right foot be more or less flared out, even offsetting my right foot forward or backwards), but what seems to work as well as anything is just a basic symmetric setup with feet pointed out about 30 degrees. If you pause on the ascent you can see pretty clearly that the left hip looks more open and the right more closed on the way up.

* My pelvis slightly unlevels on the way up and the bar slightly dips on the right side. I'm actually overcompensating in my setup by keeping the bar too high to start on the right side, which has a net effect of a level bar at the bottom. This is particularly evident in the video from the front.

* I am looking down, but perhaps not as much as you guys prefer.

Deadlifts
* The cues I'm concentrating on are basically to keep the bar over midfoot and to let the bar slide up/down the legs. I am attempting the 5 part deadlift setup, though I do have a tendency to drop my hips as part of establishing my neutral spine, though this doesn't really displace the bar forward.

* When viewed from the back, the same tendency as in squats appears in that the left hip looks more open and the right hip looks more closed.

* Like the squat, there's a tendency for the right side of my pelvis to rise slightly before my left on the ascent

* Overall I think I'm actually managing what appears to be a fairly solid looking neutral spine, evident from the side view.


So yah, any thoughts or suggestions would be helpful. What's odd to me is that I think I manage (and have managed for a long time) to keep a fairly neutral spinal position in both squats and deadlifts, which I'd think would go a long way towards preventing discogenic issues, but my inherent assymetry may still be exacerbating things.

[Tom Campitelli]

B,

The amount of asymmetry you display is not very large. I can see it if I squint at it, but you are less asymmetrical than several of my trainees. The pain in your back is probably not purely due to outwardly visible lifting asymmetries. With regard to your retroverted hip, you may need to take an asymmetrical stance. One of your toes may need to point out more than the other. Back pain can be very tricky. As the good Dr. Baraki has pointed out, pain is not always the result of a structural problem. I have a potential solution for you that I doubt you will like, but certainly worked for me – gain weight. I am not kidding. You are a fairly skinny dude. Being bigger and stronger can help with back pain.

I recently responded to a thread in the training forum where the claim was made that there is no difference in quality of life for someone who deadlifts 225 pounds vs. someone who deadlifts 500 pounds. This is false. My back tends to hurt when I get weaker from a layoff. It is happiest when my 1 RM is above 450 lbs. I have at least one disc herniation and have suffered a few back injuries in my time. Getting bigger (going from 172 lbs to 235 lbs at 6'2") and stronger has helped immensely with my back. My back rarely bothers me now. I can sit on a plane for over 15 hours to Australia without a problem.

Here is something for you to consider: put on 20 pounds. Slowly drive your lifts up. It does not have to happen in a hurry. See how you feel. You may find it helpful, believe it or not. If you decide nothing is better, getting back down to a lower weight will not be terribly problematic. You were in California at one point, yes? Is that still the case?

[Austin Baraki]

OP, does it not strike you as odd that you have no pain during your loaded, "asymmetrical" movements, and yet everyone wants to blame your pain on these miniscule asymmetries?

As Tom suggested, I am skeptical that your symptoms are caused primarily by structural asymmetry, or that you have primary discogenic pain. I think that you developed nonspecific back pain (as people tend to do), and then incidentally found a bunch of shit on scans and physical exam maneuvers that was conveniently attributable to your pain post-hoc. Not surprisingly, none of the traditional interventions for these issues have helped you.

How are you approaching your programming each time you return to squatting and deadlifting? Is there a weight at which you don't experience pain? Presumably there is, since you were previously able to achieve a 155 kg squat pain-free despite your perceived skeletal inadequacies. You have lots of reading to do; for the first steps of your rehabilitation, start here: Aches and Pains | Austin Baraki and here: Your Back Is Not Out of Alignment

[blowdpanis]

Hi guys,

I appreciate both of the responses. To Tom C, I actually live in Illinois (southwest suburb of Chicago), not California.

As a clarification, my primary symptoms aren't actually in my back, they're in my hip-->down my leg. I'm looking at my structural asymmetries because my issues seemed to have a pretty clear original cause and effect. The first symptoms I got weren't just these radicular/sciatica type symptoms. I originally presented with sharp, acute pain in my left hip and glute region that radiated down my left leg in squats and deadlifts. In squats the pain was during the concentric portion of the lift, right past the sticking point out of the hole and similar for the deadlift when the bar was above the knee on the way up.

I spent a full year a few years back sort of spinning my wheels trying to deal with the pain, including breaks of ~1-2 weeks and frequent deloads that didn't seem to be resolving the issue, whatever it was. What wound up working was just sheer time off - I stopped squatting and deadlifting for several months in frustration altogether (I still did upper body lifts) and most of my symptoms at that point were gone upon resuming lower body training.

The problem was that, upon resuming squatting/deadlifting, I wound up developing other symptoms in that same left hip/leg, it's just that I didn't get outright pain in the hip anymore during the movements themselves. But the cause and effect was/is still pretty evident - if I lay off squatting/deadlifting, these sciatica-y symptoms basically disappear. I am open to the possibility that this is a coincidence (i.e. the original pain I had back then doesn't relate to the sciatica-like symptoms I have now) but the presentation has seemed pretty straightforward.

As to programming, I've just run simple iterations of linear progressions for the most part, sometimes 5's, sometimes higher reps (e.g. 10s) to see if absolute loading was an issue, usually squatting once to twice weekly and deadlifting once weekly. Frequency to a point is definitely an aggrivator, i.e. it's easier to manage squatting once weekly versus twice, probably for obvious reasons. At this point I don't experience pain in my hip as a primary symptom (though do feel an occasional "twinge" in the glute/upper hamstring area that's like a much lighter form of my original pain), but no, there isn't a particular weight at which things go haywire, at least not one I could easily identify.

I posted the videos to make sure I'm not missing anything obvious, I guess. I don't feel like my asymmetry is overly terrible either, but given that I have some natural asymmetries in my pelvis, it did seem like a reasonable place to look. I agree that it seems odd I was able to train for a long time without any issues, but in fairness, I was in my 20's back then, and some issues are probably cumulative. E.g. some people can go bananas barbell benching heavy earlier in their training career but this winds up a problem later in their 30's and 40's, that type of logic.

I am open to the idea of gaining weight, it definitely sucks to have lost as much size as I did when I was never remotely big to begin with. I just want to make sure I have a safe base form-wise before attempting this sort of thing. Previous wheel spinning efforts left me probably overly skeptical about minor form faults and how they might relate to issues I wound up having.

And to Austin, I think I actually read these when these came out (I'm interested in literature on pain too), but I'll reread these again now.

Thanks again, guys.

[blowdpanis]

For what it's worth, one more video (all one video, but timestamps for each of the angles of the two lifts):

Squat:

Behind: Squat and Deadlift Symmetry part 2 - YouTube

3/4 Behind: Squat and Deadlift Symmetry part 2 - YouTube

Deadlift:

Behind: Squat and Deadlift Symmetry part 2 - YouTube

Side: Squat and Deadlift Symmetry part 2 - YouTube


I bumped working weights and wore my pair of Adipowers. I also filmed things vertically (my apologies) as I think it gives a much better perspective than horizontal (which cuts off top and bottom).

For squats I concentrated more on staying in my hips, the "point my nipples at the floor" cue in particular. This definitely had me more bent over, though by my eye things are just a little GM-y this way as the set progresses, but nothing too bad. Spine seems neutral.

For deadlifts I just set the position and dragged the bar up/down my legs. From the side my spinal position looks ever so slightly "softer" than flat shoes, probably due to the tiny deficit and my hamstring flexibility (or lack thereof). Still within the range of what I'd probably call neutral.

I think from the view directly behind you can see my pelvis is slightly askew (higher on right side, particularly during setup of the first rep). I can correct for this by putting a small (~3/8") lift under my left leg, but when I do so, my pelvis is visibily unleveled when standing upright, so I'm not sure that's a great idea. So far nothing sciatica-y happening really, though obviously the weights are crazy light.

[Tom Campitelli]

B,

Honestly, your lifts look pretty good. From an asymmetry standpoint, I probably would not even have noticed had I not be looking for it. You can see a hint of a shift on the deads from the back, but nothing that I would even need to comment on. While I don't minimize the pain you have experienced lifting, I don't think it is related to any significant shifting around during the movements. You have a touch of overextension in your back as you ascend on the squats, which is probably correlated with you lifting your chin. Even that level of overextension, however, is unlikely to be problematic. The only reason your back is not set in hard extension on your pulls is because you don't actually squeeze the spinal erectors prior to breaking the bar off the ground. You are not flexing your back during the lift, but you skip the step where you actively set the back. If I were to make one change to the deads, it would be to put your hips a little higher at the start. Other than that, you look fine.

Once again, if I had to suggest anything here, it would be to put on some muscular bodyweight. Given your history of experiencing pain, I would approach the weight increases on the bar more conservatively. Smaller jumps in weight that occur on a weekly basis. I would keep an eye on things to avoid irritation so that you don't squat yourself into massive irritation. Maybe you squat twice a week instead of three times a week. PM me if you want to chat further.