Chronic low back pain and new sciatica

Pain & Rehab Forum [Moderated]
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Hi everyone,

I’m starting this thread to chronicle my experience with chronic low back pain and a new onset of sciatica. Sorry if it’s “TLDR.”

I started lifting in college around 2005 mostly with bodybuilding-type routines and exercises. I would occasionally experience low back tweaks here and there that would last for a few weeks and then dissipate. In early 2010 I was picking up an EZ-curl bar off the floor and experienced a shooting pain in my low back. This went away after about 3 months. A few months after that I experienced another back “tweak” while deadlifting (I think I was doing way too much at the gym during this time; I was unemployed and really bored). This back pain stuck around for well over six years. I continued to mess around in the gym; not really making any progress in anything but staying active.

In 2017 I found some of the talks and interviews about pain and low back injuries on the Starting Strength YouTube channel. I was eventually persuaded to start doing the barbell lifts again. After a few months “doing at” the SS method (however it was definitely YNDTP) my back pain went away for a short time. After that I had a series of back tweaks where the pain would last for about 8 weeks and then I’d be pain free for ~12 weeks before I would tweak it again.

In 2018 I graduated from grad school and was job hunting. In late October I was doing The Bridge V1. During squats one day I was resting between sets, sitting down, and had an onset of back pain. For the subsequent weeks and months I tried to work around and reduce loading (probably not enough). When the Low Back Rehab template rolled out the following spring I had a consult with Dr. Ray and tried to follow the template. I did everything I could think of to try to find an entry point to start making progress. Following the prescribed RPEs generally increased pain so I would drop the RPEs. Even RPEs of basically zero would result in increased pain the following day. I tried modifying the exercises to shorten ROM and that never really helped either.

I had another consult with Dr. Miles this spring. The routine he devised allowed me to put in more perceived effort but I never had any pain reduction and wasn’t able to increase loading without also increasing pain. Then, the coronavirus shutdown occurred and I was out of the gym for a couple months. I modified the exercises to be able to do something similar at home. After the gyms re-opened I followed this for a few more weeks.
I then switched to doing fahves (which after all were what helped with my pain in 2017) on high pin squats and deadlifts. I was able to increase the load some but after a few weeks the loading was increasing my symptoms in the subsequent days.

One of the most difficult things about my experience is that I get very little intra-training feedback from my body as to what is “too much.” It’s usually the next day that I end up paying for what I had done.
I went back to the low back rehab template for a few weeks but wasn’t able to move on past week 1.

A little over a month ago while helping a friend move I was adjusting the ramp on the loading truck and my low back did not like something I did. I had an immediate increase in pain but I kept moving around and helped to carry some of the lighter things. The pain hung around for about a week and then I started experiencing some symptoms of sciatica. My range of motion was decreased in my left leg and had pains down through my glute and thigh. I tried some different exercises and did quite a bit of walking but I was not improving.

I had another consult with Dr. Miles in late October and was following his advice regarding programming and some stretches to do. This went on for about 2 weeks. 5 days ago (Wednesday) I had started to get some range of motion back and was feeling pretty good. I did 2 sets of OHP and felt fine but the 3rd and 4th sets were more painful but I finished training and went home.
I woke up Thursday with pain down my leg. It was difficult to get comfortable at work, especially seated, but I was able to get some relief standing so I stood for much of the day. I spent 30 minutes on the elliptical machine after work; I don’t recall any pain there.

(If you read this Dr. Miles - sorry I haven’t told you yet!) Friday I woke up with substantially more pain. Driving (I have a manual transmission) was torture; every shift made my glute shoot with pain (which kind of felt like a cramp or extreme soreness). I ended up leaving work early because I couldn’t sit and my pain was increasing even while standing. The drive back surely set a record for fewest gear changes. I was able to sit in the recliner in relative comfort and hobble around the house to get things done. I called my doctor’s office and spoke to the on call doctor. He didn’t think I had any “red flag” symptoms and said I should continue to self-manage.

Saturday I woke up and could barely move without intense pain in my glute and leg. It took me about 10 minutes just to get my feet to the floor. When I tried to stand I had the most intense pain I had ever experienced run through my leg. It was searing, sharp, and felt like intense pressure. I collapsed back onto the bed. I tried to stand a few more times over the next several hours but there was no standing to be done.

I had an appointment with my doctor late Saturday morning. After going through my symptoms he didn’t think there were any red flags but prescribed prednisone and hydrocodone. I started taking these Saturday evening. My symptoms got a little better throughout the day and I believe I was able to sit up some towards the end of the day but I spent the entire day in bed. I don’t think the hydrocodone made a dent in my pain, though.

Sunday I woke up with less pain and was able to move around in bed a little better but I still couldn’t stand up. I called my doctor and he said to increase the hydrocodone. So I was up to 10 mg every 4-6 hours. I don’t think it was helping so I called the doctor and he prescribed gabapentin. He said that if I don’t improve soon I would need to be admitted to the hospital. My symptoms were gradually improving throughout the day but I was still unable to stand. Being bedbound is torture and completely destroys your pride and sense of self-efficacy. At the end of the day I was able to get into a chair and scoot around a bit and go to the bathroom, etc.

Today (Monday) I woke up in a little bit more pain and had a difficult time finding a comfortable position in bed. I got in my chair and was able to tolerate it and I’ve spent most of the day there. I’ve actually been able to take a few very short, very awkward steps several times.

The pain was unreal; like nothing I’d ever experienced before. I thought I might pass out a few times but never did. My body would bow up as if the rest of my body was trying to get away from the back of my legs. One of the more frustrating parts about this is that some positions are fine but the next time I get into the same position it’s unbearable.

I wasn’t able to find any people sharing their experiences online about being completely debilitated by sciatica so I thought I’d share mine. I hope it’s helpful to someone. I’m hoping I can bounce back from this and get back to training. I’ll continue to provide updates and I’m happy to entertain discussion and suggestions. Cheers!

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Derek,

I will go ahead and respond here as there is certainly some more background information than was garnered during out conversations. We have discussed attempts at finding an entry point in the past and with the additional history here, I think it is worth expanding upon that conversation. It appears from going to the beginning of these episodes that there are a few themes here that I would like your feedback on. The first of which is an apparent propensity to overshoot when you are bored as evidenced from the initial episode in 2010 and the switch to fives with the most recent group of exacerbations. The conversation of finding the entry point is inclusive of a certain degree of patience and an attempt to grind reps is often counterproductive to overall progress.

This brings me to your statement of *“*One of the most difficult things about my experience is that I get very little intra-training feedback from my body as to what is “too much.” It’s usually the next day that I end up paying for what I had done.” An important part of RPE in the rehab sense in the conversation of “could versus should.” By textbook definition of RPE an “8” is “I could do two more reps” but if the goal is to start progressing through exercises and chaining together training sessions the better frame is “I should do two more reps. If every workout is causing a setback, then the intersession feedback should be just as important as the intrasession feedback. I have a feeling you are familiar with some of the posts in the group in various places of people “failing sets at 8,” and when the goal is to train minimizing symptoms, I would argue that if symptoms are increasing the next day by a substantial amount, it is likely that there needs to be a recalibration of what constitutes an “8.”

In terms of the most recent exacerbation helping a friend move in October, we discussed how the novelty of the activity could contribute the these symptoms as much as anything else. Having radicular symptoms sucks, there is no denying that. Anyone who has experienced them, myself included, can tell you they often come with numerous flares that are often not related to an activity that most would think bring them on. Two years ago, I got the chance to do the “shoe dance” of not being able to tie my shoes without a form of interpretive dance for the better part of a month after putting my boxers on. It happens. That statement is not to undermine your experience on Saturday, but more to convey that as much as this sucks, it is not outside the realm of normalcy.

In terms of the medication recommendations, I will leave that discussion to you and your physician, but I can tell you that typically the more worked up one gets over the situation, the more intense the symptoms are. If you look at the phrasing of your sentence “bed bound is torture and completely destroys your pride and sense of self-efficacy,” you did make progress later in the day to being able to sit up and move around. There is a more broad point to make here in terms of focusing on what you can do versus what you cannot. When symptoms are bad, or even when they are mild and you are attempting to return to prior levels, it’s easy to focus on all of the things you cannot do, but that makes it nearly impossible to see progress. If you can go from struggling to sit up to sitting for 30 minutes, that is progress. If you can go from limping around the house to going on short walks, that is also progress. I have been there, and as miserable as it is, it does get better. The things that you can do with which to assist in expediting that is finding ways to take your mind off of it whether that be watching a comedy, or calling a friend. The more you sit there and dwell on problems the harder it is to find solutions. Ask yourself what you can do today that you weren’t able to do yesterday. And know that many flares take 4-6 weeks to resolve.

When you start back to training I would recommend starting with maybe 10 minutes of elliptical work. It is much better to get a little bit of work in every day than overshoot out of the gate and not be able to do anything for the next few days. But this is really the crux of much of this discussion regarding finding an entry point. Even if it is just starting with a 5 minute walk then the next day taking it to a 10 minute walk and so on, that is better than shooting for a 30 minute walk then not doing anything for the next 6 days. As you get back to moving and picking up weights…….undershoot. Ask yourself if you should be doing as much weight or volume as you return, not could you. There also appears to be a theme of attempting things for a few weeks then pivoting to something else. I would highly encourage you to find one thing/program and stick to that. If not, a bit of a whack-a-mole game of variables comes into play in figuring out what does work and what does not.

Anytime we see a cyclical nature of symptoms where there is episodes of “tweaks” followed by resolution, followed by tweaks and so on, it is indicative that some variable in training needs further calibration. The first goal being to break that cycle, then to discuss variables to reduce the risk of it happening again. In this instance, I do think there needs to be a recalibration of your rate of perceived exertion with a focus on long term consistency versus daily intensity. I would be curious in the past, during blocks when things are feeling well, to know what the variance was in weight from week to week on your sets of squats and deadlifts. If it is the case that during those times, there were not really weeks where there was less weight on the bar for any sessions, that could be indicative that the overall programming was being approached too hard.

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Thanks for your reply, Dr. Miles.

Just as an update on how things are progressing: I made fairly linear progress through Nov19 and had a couple rough days after that. Since then my progress has been slow and nonlinear. I’m still in the “limping around the house” stage although my ability to tolerate walking is increasing. I often feel better limping around than standing. I think it is helpful to know that what I experienced is within normalcy; I wasn’t able to find anyone discussing things that severe online.

I think I generally do have a propensity to overshoot RPEs which I know I’m going to need to kill for finding an entry point and moving forward. I knew nothing about programming in 2010 and since I was bored I just went in gym and did stuff. My propensity to overshoot RPE is probably the result of wanting to make progress, as defined by weight on the bar, all the time. I don’t have much of my training recorded but you’re probably right about weight on the bar staying roughly the same or increasing week to week.

I do appreciate the admonition to think of what I can do. I have tried to focus on what I can do and that I’m not laid up in bed. I think other people have catastrophized my situation more than I have; thanks to BBM’s content I think I’m inoculated.

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I’ve had a flare up of sciatic pain again over the past 3.5 weeks.

I was making progress in recovering from the last episode, albeit very slowly. I had eased my way into the gym after seeing a physical therapist in person for a couple months. My training in the gym was very light.

About 3.5 weeks ago I started experiencing an exacerbation of the pain. I’m not sure I can trace it to anything in particular but I do recall having some very slight discomfort in my hip after a session on a stationary bike. The following week I had pain in the mornings that gradually decreased as the day progressed. Standing was more comfortable than sitting. The Monday following this (about 2.5 weeks ago now) I stood most of the day at work but the pain never really subsided. Tuesday I went to work and couldn’t tolerate sitting or standing so I grabbed my things and went home to work. I had discovered that sitting in the recliner with the legs extended was the most comfortable position in the previous week.

Now, the recliner is the only position that’s reliably tolerable. I can stand for a few minutes, at most (although this might depend on ibuprofen timing and dose). I’ve been able to sleep lying down for 4 hours at most but only on my left side.

I spend almost all of my time in the recliner. This flare up is different in that my body seems to prefer hip flexion and knee extension. The pain levels haven’t been as high as last time but I have fewer positions that don’t hurt. My pain has decreased some in the past 2 weeks but not by much. Pain has been reliably alleviated by ibuprofen.

The past 2 days I made a point to get up and move around at least every 30 minutes. I’m not sure what that has done for my symptoms but it has been good for my soul.

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Thanks for sharing your stories, guys. It’s been a long time since your last replies, so I hope you’re doing better now. Personally, I’ve never faced any of the mentioned issues, but my brother has. So, about 2 months ago, we went to a sports physiotherapist near me. He was the only available specialist, so we had no choice. So, the doctor eventually helped my brother by prescribing him to do certain exercises according to his issue. Actually, he feels much better now. Have you guys been to a physiotherapist?​