Sciatica-friendly weightlifting modifications for runners and lifters

You're listening to the Restoring Human Movement Podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's your host, Sebastian, with the Restoring Human Movement Podcast. Thanks for joining the show with me today. Today I wanted to cover a case presentation of an excellent case that I worked with today. And hopefully their story about sciatica can help you understand a little bit more about the things that tend to work in scenarios such as sciatica. So before I get too much into what we did, I will talk to you about what sciatica is just very briefly.

Just know we have other podcasts about sciatica, which is much more in detail. I did one with an expert named Michael Shacklock, which is an excellent one. He's one of the lead researchers on nerves in the world. And I got him to come on the show and talk about stuff. And sciatica is generally leg pain. It usually starts in the back of the hip. It feels like it's the butt cheek and it goes down to the back of the hamstring or the thigh and it goes down the back of the calf and then sometimes the foot. Now, for different distributions of sciatica, that's the S1 distribution. L5 is a little bit more to the side of the thigh and the side of the shin.

And then it goes to more of the top of the foot. So everyone's a little bit different because the sciatic nerve is a accumulation of L4, 5, and S1. So it's not just one level from the spine. And it could be multiple distributions. It could be just be single nerve root distribution. It all depends on what location the compression is and so on. I think the major takeaway that I needed Dr. Michael Shacklock to say was that he was about if everybody needs to have the classic sharp electrical impulse down leg. And he said no. And also said, do they need to have a line of pain down their leg? And he said no.

It can actually jump. So it may only feel like calf pain. It may only feel like calf stiffness. It may only feel like hamstring stiffness or ache or burner sheet or stab or even sensory disruption, which is like an abnormality. It almost feels like buzzing, sometimes muscle fasciculations or quivering. It almost looks like creepy crawls underneath the skin. So there's various different presentations of it. But this gentleman here today was a very classic scenario. It was leg pain down the back of the leg that you can almost trace a line with. It came on more with lifting. And we have worked with him in the past few years with hip problems.

So in the past, he did have a little bit of hip impingement, which sometimes it sacrifices how much hip range you have. If you know anything about hip impingement, which we've done on various shows recently, it is a bony abnormality, but also with biomechanical aspect to it. And so, but generally speaking, people's range of motion is limited with their hip, especially with squatting patterns. And then side to side movement, which makes them use other parts, which is their knees generally or their lower back. Now, if this sounds like you, by the way, and you want help, we do have virtual or telehealth sessions.

We're licensed in many states, and we have very affordable consultations, which you can find in the link description for the show. We also have a great online program that I wrote up myself, which are all the exercises and stretches that we typically use with sciatica cases. Just know that everybody is different. As they say, with cars, your mileage may vary. It all, it depends on your unique reason for it, which is why one-on-one suggestions are quite a bit better. But I show everything in our 12-week program on there, which is way more affordable than working with people one-on-one. So take advantage of that too.

Now, what we usually do with sciatica is, first off, we figure out if it's from something like foraminal stenosis or piriformis syndrome or a disc herniation. And so, generally speaking, this is fairly general, and I really hate telling people this, but I tell it to them to give them some context, is that if you were a 15-year-old kid coming in and you had ripping sciatica down your leg, you would probably respond better to what we call an extension-based approach. Usually laying on their belly, they feel no pain. Prop it up on their elbows, they feel no pain. They round or sit with bad posture.

It just rips down their leg again. If they pick up with, if they do a deadlift with bad form, it hurts. If they do a back squat and they let their depth go too low because their hips are stiffer and they start to round their back or what we call butt wink, then they tend to have more leg pain. It just aggravates them again and again and again and again. This isn't the case with everybody, and the reason why I hate telling them this is because with older individuals, no one likes to be called old, but as you start to get a little older or your injury age starts to get a little older, meaning you've had this repeated times over the years, you may end up starting to have this in your 30s and 40s, and I'm no stranger to this either.

My back seems to operate in this fashion from time to time, and when I have some leg pain or stiffness or hamstring stiffness, which is related to how my back is operating too, it tends to respond better to the opposite. It's not an extension approach, but it responds better to a lumbar spine rounding approach, which opens the intervertebral foramen, which is the small little bones between the joints of the back, and or also lateral bend, which is sideways bending or leaning to the side. Both of these approaches, again, tend to work better with the older the individual gets or the older the injury cycle is for them, the older the injury history, but it doesn't mean they can't be excluded from having the extension-based approach too.

I've seen it work all across the board, but if I had to make a sliding scale, the older you get, the more you respond to rounding, the younger you are, the more you respond to repeated lumbar extension approaches, such as McKinsey extension protocol, which is all over YouTube and within our programs online too. I should warn you though, before you go look at McKinsey extension, that I observe, and a lot of my colleagues do as well, that the repeated extension tends to come with a side effect. If you use it too long, just like a medication you use too long, there are side effects. So don't use it too long.

It's intended to be used in a short dosage, such as a couple weeks, and then you start to slowly remove it and only use it again if you need that medication again. So just use your beware on those. Don't use them forever. Usually a couple weeks is typically enough. Now, now that we've talked about the basics of directional preference, that resolves what we call the interface. The interface is where the nerve pressure is at. So if it happened to be at the lumbar spine, L4, L5, or S1, based upon the distribution level, then that use of directional preference treatment of forward, backward, or lateral flexion usually works out really, really well.

And it can happen super, super fast. But also understand that this doesn't do with the other things that you need, which are other parts. So just because I did, let's just say I did an exercise to strengthen my glutes, it doesn't mean it strengthens my quads too. So the question I get oftentimes is that, well, which one should I do? Which exercise should I do? Which I'll mention in a moment. And I say, well, they both do different things. Well, so which one do you want me to do? Well, you can do both if you want to be comprehensive, but if you want to do one single thing, that's okay too. And as I discussed with some of the interns today at our facility, they said, well, how do you know which one works the best?

And I said, I don't, it doesn't really matter to me. And, but if you have someone like a engineer that we're working with, and they say, well, I really want to know which one's which, and they would like to kind of do in the scientific method with it. Sure, you can, but there's a chance that if you use a single variable approach that nothing changes. And then the next week you have to do the next one, and then nothing changes. And the next one, you finally do the third one. The third one helps you, which I'll mention in a moment. Then all of a sudden, everything gets better. So if you did all three at one time, two may not help, but one may help a lot.

Which one helps? I have no idea. It doesn't really matter too much to me. But what you benefit from is you feel better faster versus just scientifically methoding yourself and feeling terrible for two weeks and finally getting the right thing to do. So reason I'm bringing this up again is because interface treatment, such as I just mentioned, is important, but also working with the forces of the nerve and what it's tolerant of is the other part. So a lot of times, and you can look this up on our YouTube channel, we do, I will put a link in the description for some of our telehealth testing that we do.

One of them is called slump test and SLR. So these are nerve tension tests. These assess to see whether the nerve can tolerate tension or not, or tolerate stretch. If it can't, you cannot treat it with a stretch. Meaning doing hamstring stretching will probably make it feel worse temporarily. But we, so we remove that for a little bit and we replace that with what we call a slackener. It's the opposite. It requires more knee bend. And if we're talking about piriformis interface or piriformis syndrome, you can actually imagine you're laying on your back and you have the symptomatic leg kind of propped to the side.

The knee is bent and it's resting on the pillow. So there's a little bit outward frog flare. And there's also a generous amount of knee bends. So this slackens the whole path of the sciatic nerve, whether it be L4 or 5 or S1, it's the distribution, doesn't matter too much. Or whether it be the piriformis, which it slackens and takes the pressure off the sciatic nerve of the piriformis. What this does is it takes tension away from the nerve. Now, did this change the interface other than the piriformis one? No, it didn't do anything to the spinal part. But it doesn't mean you can't do both. The other thing you can do is flossing, unless it's a really acute case.

So flossing is where you would take a tension disorder or someone that doesn't not tolerate tension or stretch and you floss through the area where it's not tolerating it. And this is where strategic flossing or sciatic nerve flossing comes into play. This can be done and it starts to grease up the area. Motion is lotion. Does this do the same thing as slackening? No, it doesn't. Does it do the same thing as opening the interface? No, it doesn't. They're different things. So you can treat it three different ways and all of them can have some benefit. These are fairly low force techniques, so they generally don't create aggravation.

And if I was having sciatica myself, I would probably do all three because I know that they all treat things in a very different way. One takes the load away from the nerve. The other one makes it so the nerve is more tolerant of the force. And the third one takes pressure and the third one takes pressure directly off of the nerve interface. They're all different things. Now, what we can do based upon the knowledge that we have now is that we know that the nerve doesn't tolerate stretch, so you can't really give them things to do with knee extension too much, or at least you minimize knee extension, is we take an audit to figure out, is this person doing anything which is unknowingly triggering their problem?

And unfortunately, they were. So, as we have kind of noticed over the years that when people feel better from, let's just say, something like hip impingement, they tend to become more confident and they start to go back to their normal activity, which is perfectly fine. But sometimes when they get back to their normal activity, they end up having problems of sorts or they start to add more things. Like they see a new thing on YouTube or Instagram and they start adding that program. New Year's Eve comes around, they have a New Year's resolution. They want to lose a little weight, they start running.

So, there's different things that you might start to add and they start to do that. Sometimes we have a little bit of collateral associated to it. And so, this person, after asking a little bit, how are your squatting? How's your squatting doing? Great. Squat feels good. Of course, because there's knee bend. So, that makes a lot of sense logically. It won't be a mystery with it. The knee bend is there, so it'll probably feel okay. Toe touching, probably won't feel good. Forward fold and yoga, not going to feel good. Hamstring stretching, won't feel good. Downward dog, will not feel good. All these things won't feel good because there's straight knee associated to it.

I asked, how's deadlifting going? Well, I'm doing some version of deadlifting. I said, are you doing it with a bar or a hex bar or a trap bar? And they said, none of it. I see you doing hip thrusters. No, I'm not doing that. So, what are you doing? He said, stiff-legged deadlifts. So, that would then be a knee extended version. So, we remove those just temporarily. I'm not a big fan of doing stiff-legged work. I feel like there is not a big need for it. In less than special circumstances. And I would, I replace it with more of a greased up pattern. Such as, if you're going to pick up a car to save a child, would you do a stiff-legged version or a bent knee of a deadlift?

You would probably pick a bent knee because it's usually used to add more weight or add more load. Your body is more powerful in that position. So, we added a hex bar to add lift in because that's just what we had available at the time. But barbell is okay. There is more stiff-knee version with it unless you're doing a pseudo-sumo stance, which is okay as well. Then, usually, we need to elevate the bar for people who don't have the ability to actually bring a straight leg to their 290-degree angle or they can't touch their toes. That's a limitation in the leg range. We already kind of know that from an assessment.

If they cannot touch their toes, then maybe we raise the bar up a little higher for them and that comes with just adding some blocks or adding safety bars to a squat rack or something like that usually work out really well. So, we did that and all those lifts actually felt really good. Not the stiff-legged one. We took that away. So, we have goblet squatting which is really good. He wasn't getting back into barbell squatting at the moment so there's no really need to press it and so when we asked how hard is this lift, we loaded the goblet squat up pretty good and so he said, oh, this is pretty hard.

In that case, let's just keep that for now. We can add the other that lifts back in if we need it to later and we changed the dead lifting to, again, more greased up pattern. Now, let's get back into the elephant room and talk about if we actually need to add a stiff-legged virgin back. Personally, I'm not a big fan of things like Jefferson curls and stiff-legged lifts. Again, they do hold some value. There is some benefit to it but do we really need the risk-reward with it especially if the weight goes up? Now, whenever there's constraints like this, I would just notice, does your body tend to like it over time?

Whenever you add stiff-legged work back in, do you feel better or not? Some of you, like myself, may say, you know, I always feel worse when I do this. In that case, you don't need to do it. You can just do something else and there's no real big need to force stiff-legged work back in. So, that's the first thing. If you want to add it back in, sure, there's ways to do it safely and there's ways to make it work but we may have to assess to figure out do we need to improve your hamstring length first. If you don't have the length without load, don't expect the bar to do or the bar or the weight to do it any better for you.

So, we may have to work a little bit on improving hamstring or ability to touch toes first and then we would add those other things back in like a stiff-legged work or a jeffeson or deficit work. I hope this was helpful to everybody. Again, if you're looking for a consultation or telehealth and you're having trouble solving this on your own, we do have the services available and we love to see people on telehealth. We're licensed in different states and we can help you with corrective exercises and structures and so on. So, reach out to us and we have consultations available for that. All right, guys, we'll see you next time.

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