Hi guys, my previous topic was closed so I created a follow up. I’ve been dealing with sciatica for about 6 months and the symptoms have gotten progressively worse. I did PT for 6 weeks to no avail and returned to my doctor last week after I started getting tingling in my foot whenever I stood up. Doctor noticed I have muscle weakness as well in my foot that they didn’t see last time. They’re recommending a minimally invasive microdiscectomy to clean off the disc fluid from a herniated disc.
I know sciatica and discs tends to resolve itself and I am not at a point where its keeping me bedridden or anything of that sort. But the progression of the symptoms and the pain/tingling has me seriously considering undergoing the surgery. Before I do, I did want to know if you guys know of or have coached anyone who continues to lift after undergoing a microdiscectomy or something similar. I do plan to consult my doctor asking about returning to lifting eventually and wouldn’t plan to go back until im cleared. I just wanted to get your guys’ opinion or if you could share any studies or anything because everything I’ve read on the internet is basically saying I would be screwed and would easily reherniate if ever lifting anything above 45 lbs.
What treatments have you tried previously? Specifically what did you do in PT?
What brought on your symptoms six months ago?
How progressive have your neurological symptoms been since onset to today? Has anything occurred that can be correlated with the progressive symptoms (i.e. any trauma / stressor?)
We don’t have a good understanding for timing of this type of surgery. Meaning, how long is too long to wait in regards to favorable outcomes. See this study: The timing of surgery in lumbar disc prolapse: A systematic review - PubMed. The authors find a broad timeframe recommendation of 2 - 12 months for positive surgical outcomes. They go on to state, “At this stage it is felt that time alone should not be the basis of recommending surgery, hence the practice of telling patients that they need “urgent” surgery for pain due to herniation of nucleus pulposus has no scientific basis.”
The only thing I’ve done is PT and even for that I waited 3 months into the injury. PT generally focused on building core strength and stability and the doctor that prescribed the PT told me to specifically work on the McKenzie Method and the static press up holds. Any core exercises prove to be painful as whenever I flex the core, I get shooting nerve pain down to my calf. I also try do McGill’s Big 3 regularly.
Regarding the initial symptoms I’ve had general sciatic pain on and off for a few years but it generally resolved itself within a week or two. This particular incident however I feel may be related to a back injury that occurred in early November. I had been warming up to a top set of 330 on squat and coming out of the hole felt a extremely sharp pain on my left side, racked the bar and packed it up for the day. I did not panic and run to the doctor for this because while the pain was alarming I figured the chances or any serious damage was unlikely. Pain was bad the next few days but generally cleared up in about two weeks. It did however keep me from squatting and deadlifting anything remotely heavy for a month or so.
The sciatica appeared in early March and the day to day pain was pretty significant. Standing up from a seated position sent shockwaves down my leg. That pain resolved in about a month and a half and since then I’ve been left with a nagging sciatic pain that I would categorize at a 6 on a pain scale. Not enough to impede most of my daily activities but enough to make me wince more than a few times a day. I don’t really have a problem sitting or standing. It hurts the most by far during transitional movements. i.e. getting up from a seated position or going to sit in a car. The tingling started early last month and happens mostly when I stand up from a seated position or getting out of bed. The only correlation with the start of the tingling I can think of is the frequency of McKenzie press ups. Around late June I had been increasing the frequency of the press ups quite a bit but backed off to see if there was anything to it but it hasn’t stopped.
I can tell you I have not trained any barbell movement in months because getting into position on any of the lifts causes the nerve pain. I also stretch my piriformis and hamstrings daily to reduce the pain but that generally only helps for an hour.
Hey Sockin,
I am sorry to hear about your leg pain. I have experienced the initial shockwave pains as well and can attest to the lack of fun that sensation brings. I also understand the frustration with the duration of symptoms. That being said, often reintroducing movements that elicit some symptoms can be useful from a habituation standpoint. Avoiding activities tends to make it so that any reintroduction of the activity can bring on a return of symptoms. I’m not advocating returning directly to a 330 squat, but often getting a bar on your back or against your shins can start the process of getting back to normal activities as well. Even if you go from being able to squat to 60 degrees this week to 90 degrees next week that is progress for regaining range of motion not just with a bar on your back, but with activities of daily living as well. As with most things, consistency is key here. If you think about the amount of time you spend either sitting or standing it is likely not surprising that you have adjusted to those activities. Transitioning from sit to stand tends to happen much less frequent throughout the day though. I can think of few better ways to practice an activity that mimics sit to stand like at least working the tolerable range of a squat.
To your point about stretching, this would fall into the habituation category as well. Getting used to being in a slightly new position tends to get you used to being in a slightly new position for a short period of time (stretching doesn’t change tissue which could contribute to the short term effect). I would propose getting into a slightly new position with a bar again as determining how far your are stretching can be arbitrary where starting to get more depth, then starting to add more weight is quantifiable progress. I had my radiculopathy flare up the last week of June and earned myself a trip to the empty bar for a little bit. After two months I do still experience some occasional symptoms when training but the bar is much better stocked these days.
Thanks Derek. I should note that I still have full mobility and can squat to depth without issue. Bracing is my issue when it comes to lifting as when I attempt to brace the shooting nerve pain starts. I cannot lift with a belt because of that but I could go beltless for a while. Hip hinging is also a little problematic.
Just to be clear it sounds like both of you don’t believe the microdisectomy would be the best option and this may resolve on its own given enough patience? Granted I know neither of you can give me a definitive yes or no but I’m just worried if I undergo the procedure that I’ll never be able to continue with lifting. I just felt after 6 months this would have resolved or gotten progressively better and the static state I’m in now is frustrating to say the least.
And also to note on the muscle weakness. The doctor noticed that my left foot, namely my big toe was generating less resistance than my right when he was applying force down. Outside of that there is no foot drop or anything of the sort.
Thanks for the additional information. I understand this process can be frustrating which drives our desire to seek out other treatments. I’m in agreement with Derek, and recommend you start trying to complete the activities you’ve been avoiding. Just be contentious of load intensity (external weight) and progress slowly. The methodology here is like anything we want to accomplish, small and consistent steps towards the goal will help with goal acquisition. Often, our own desired timeline doesn’t match up with realistic expectations, which means we need to adjust our expectations to small victories over time until we accomplish the end goal. It’s difficult to give direct advice regarding the appropriateness of microdisectomy without consulting on the case. With that said, I’m a proponent of least invasive treatment as possible and I’m not entirely sold that approach has failed just yet.
Ok thank you Michael. They had originally scheduled the surgery for the middle of September but I have already postponed that due to some work and life related commitments. I was told to call back to reschedule after September. For the next month or two I will slowly try to work my way into training again and re-evaluate.
That being said how should I approach this? I normally trained low bar squat, sumo deadlift, bench and press. Should I swap low bar squat to a front squat and deadlift off blocks? Should I start with an LP? I’ve also been told that anything overhead would only make the injury worse so should I cut out press altogether?
Thank you again for the guidance on this. Its very much appreciated.
In order to maintain exercise specific to the end goal for training, I’d at least attempt the movements you prefer to complete and modify load accordingly. If for some reason you take the load all the way down to an empty barbell and still can’t complete the full range of motion then it’s likely time to alter range of motion. See if you can squat to a particular depth or pull from a particular height then slowly over time try to improve the range of motion back to full. If you still can’t seem to find a comfortable range of motion then I’d select alternate exercises that will, at minimal, allow you to train. LP is a solid approach with moderate - high volume and low intensity. I have no reason to believe overhead pressing would worsen your condition. If you need more in-depth help with the programming, we’d be happy to consult with you: Contact Us | Barbell Medicine