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Other/Mixed Training with Sciatica

Other strength modalities (e.g., Clubs), mixed strength modalities (e.g., combined kettlebell and barbell), other goals (flexibility)
John K

John K

Level 8 Valued Member
Certified Instructor
Hello,

I am working with an individual who has diagnosed with sciatica. Their doctor has basically said it's there and it'll go away eventually, but hasn't really provided any "guidelines" for training. This individual still wants to come in and train, but I'm kind of unsure/hesitant how to move forward with them. I've never had sciatica or worked with someone who has.

What tends to irritate sciatica? What tends to decrease symptoms? Are there training exercises or strategies to avoid during a "flare up?" Or any thing to include during a flare up that can help?

Obviously, I'm not a medical professional and I'm not looking at getting or giving medical advice, but I am looking for hopefully a better understanding of this so I can train my client better.

All the best and thank you in advance for your thoughts!

j
 
I don't have expertise in this area. So my answer is more along the lines of setting expectations. I think it's great when a professional trainer has medical knowledge, but it shouldn't be expected, and in fact there are times when if we do use what we know (but know causally, not professionally) we are straying out of our lanes. A similar thing happens often with nutrition. As a fitness professional, I know more than the average person about nutrition... but I am not a nutrition professional, therefore I don't give nutrition guidance to trainees.

So I think if you train the person normally... perhaps a bit more cautiously... and proceed assuming there won't be any increased problem resulting from the training -- and if there is, back off or modify appropriately -- you should be fine.

One thing I would NOT do is continuously ask, "Does that hurt?" or "Do you feel any increased pain or problem?" as you train. Let them know up front that they should let you know if that happens, but other than that, don't bring it up unless they do. This avoids a "nocebo" effect.

My husband has sciatica and I can't seem to train him at all without aggravating something in his bad back, so I wish you luck. :) And maybe someone will have some good input here that will help, so I'm looking forward to the answers.
 
Anna C said:
One thing I would NOT do is continuously ask, "Does that hurt?" or "Do you feel any increased pain or problem?" as you train. Let them know up front that they should let you know if that happens, but other than that, don't bring it up unless they do. This avoids a "nocebo" effect.
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Oh that's a great point Anna. I totally would've been constantly asking that.
 
John K said:
Hello,

I am working with an individual who has diagnosed with sciatica. Their doctor has basically said it's there and it'll go away eventually, but hasn't really provided any "guidelines" for training. This individual still wants to come in and train, but I'm kind of unsure/hesitant how to move forward with them. I've never had sciatica or worked with someone who has.

What tends to irritate sciatica? What tends to decrease symptoms? Are there training exercises or strategies to avoid during a "flare up?" Or any thing to include during a flare up that can help?

Obviously, I'm not a medical professional and I'm not looking at getting or giving medical advice, but I am looking for hopefully a better understanding of this so I can train my client better.

All the best and thank you in advance for your thoughts!

j
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Train them like someone with weak and tight legs-hips- and back, which is damn near everyone.
 
My limited personal experience with it and what I observe in friends, there will be painful spasms that are impossible to ignore. These are the shooting pains opposed to nagging pain that has a strong postural component. Mine wascat its worst when sitting (nagging) and when walking if my leg swung free just-so (shooting pain, the kind that will make you suck air).

Exercise selection and within that, working with reduced ranges of motion will be important. I don't know that foam rolling or stretching will help much. For me, it went away with the isometric training, so I'd say start them with iso deadlift and or lunge (is likely they'll feel less bad with one or the other leg foreward) at a few points in the ROM, get them used to ramping up and bracing against that tension. Move on to dynamic work when they've demonstrated they can work through stages.
 
As someone who has had sciatica this year - and backed off most strength training because of it - I found that it is not always the back that has the issue.....

As we all know, sciatica is a trapped nerve, but the pain can be anywhere from the lower back down to the foot. I would hope the student has been provided some exercises to do (most are useless from my experience). The useful one, I believe, is termed "nerve flossing".

So, depending on the pain location:
- I couldn't do glute bridges
- anything lying on the floor
- squats

I could do:
- macebell / kettlebell halo
- pullups / hanging
- dips

Good luck
 
I’ve had it come and go for years, though I genuinely don’t know if it’s sciatica, piriformis syndrome, whatever.

I have found that my QL tightening up or being “overly active” causes me problems, as does tight hammies. I have worked on releasing both these muscles when suffering and it has helped.

I have backed well off back squats and OHS this year owing to it. I goblet squat now and am ok. I also RDL and Trap Bar DL rather than conventional, though both BSQ and DL were “strong” - just afterwards was not worth it. I am going to take it super slow and earn them back (or maybe not… I’m sort of fine without actually!)

I have always found that bodyweight work has helped and never triggered an issue. Running aggravates. Walking and elliptical do not.

Biggest one: Being fat makes it worse. Don’t be fat. Losing weight after being fat is also a risk area. Best to just stay lean.
 
John K said:
I am working with an individual who has diagnosed with sciatica. Their doctor has basically said it's there and it'll go away eventually, but hasn't really provided any "guidelines" for training. This individual still wants to come in and train, but I'm kind of unsure/hesitant how to move forward with them. I've never had sciatica or worked with someone who has.

What tends to irritate sciatica? What tends to decrease symptoms? Are there training exercises or strategies to avoid during a "flare up?" Or any thing to include during a flare up that can help?

Obviously, I'm not a medical professional and I'm not looking at getting or giving medical advice, but I am looking for hopefully a better understanding of this so I can train my client better.
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I know only how little I know about this, but one of those things is that apparently not everyone's sciatic nerve runs in the same path (through the same muscles/tissues in the same way). I think this is a thing to keep in mind.

In the case of your student, a second medical opinion sounds like it would be a good thing, perhaps from someone who's worked with athletes.

Don Fairbanks said:
Train them like someone with weak and tight legs-hips- and back, which is damn near everyone.
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There's a lot to be said for this thought.

The kettlebell windmill is one way. I really kick out the bearing side hip to start, and I finish with the non-bearing side hand touching the other foot. It's important to add, I think, that for me this is not an extreme stretch and I am not "looking for the stretch" but it's a range of motion I own, can hit cold, etc., and the windmill helps me keep it. So perhaps it's better said that I do mine the way we teach them now and have much more flexible hips and hamstrings than most people. In part, it's my hip mobility that allows me to do this without requiring as much hamstring flexibility as one might think.

And for my purposes, I use light weights for this, thinking of it as loaded mobility work. Currently my 6kg kettlebell is my weight of choice for the WM. @Brett Jones, whenever I discuss the WM, I like to know that you're looking over my proverbial shoulder and I'm not misstating anything.

NB: Just like one can use a shoe for teaching the getup, a shoe Windmill is a fine movement. I hadn't tried this before but I just tried it on both sides and it feels like a good teaching tool. The light weight serves the same function, to make sure the bearing-side arm remains vertical.

-S-
 
John K said:
Hello,

I am working with an individual who has diagnosed with sciatica. Their doctor has basically said it's there and it'll go away eventually, but hasn't really provided any "guidelines" for training. This individual still wants to come in and train, but I'm kind of unsure/hesitant how to move forward with them. I've never had sciatica or worked with someone who has.

What tends to irritate sciatica? What tends to decrease symptoms? Are there training exercises or strategies to avoid during a "flare up?" Or any thing to include during a flare up that can help?

Obviously, I'm not a medical professional and I'm not looking at getting or giving medical advice, but I am looking for hopefully a better understanding of this so I can train my client better.

All the best and thank you in advance for your thoughts!

j
Click to expand...
Pre-COVID I sat in a lot of airplane seats. I had awful siatica. Painful to walk. The magic bullet that cured it all was KB swings. It was very uncomfortable for the first couple of weeks then 100% disappeared. And it didn’t take a lot of weight. I started with a 16kg bell. I also don’t travel as much but…..
 
Just to share my experience, although I'm not sure there's necessarily a lesson in it:

Many years ago, I lost a squat forward, tried to save it, but dumped the bar on the safety pins, and afterward I had fairly severe and persistent sciatic pain (left leg numbness and sharp shooting pain down the leg). I don't recall exactly how long this lasted, but it was probably in the range of weeks to months.

Over time it resolved itself to the point where I would only get occasional random flare ups, usually while bending forward casually, unloaded, such as to pick something up off the floor. These flare ups would be intense (I would sometimes collapse on the ground like I was struck by lightning), but brief. I could basically do anything I wanted to in terms of training and sports outside these occasional random flare ups. Most of my deadlift training and all of my PRs (425lbs sumo and 465lbs trap bar) were set during this period.

Over more time, the flare ups became less and less frequent, and I can't specifically remember the last time it happened.

I've never done any specific treatment or exercise to address it, just did whatever I wanted when it wasn't hurting and whatever I could comfortably tolerate when it was.
 
Was there a mechanism of injury?
(in other words...how did it happen)

Do you have a Physio you work with that could provide a consult?
(if direct access state or cash etc.)

"Most" (but not all) sciatica folks will likely be provoked by flexion and/or "stretching" (think hamstring stretches).

Avoid the movements and positions that provoke and find patterns where you can train without symptoms—quadruped, tall kneeling, half kneeling etc.
 
My sciatic pain would cause my leg to buckle and give way.
I had sacroillitis and strengthening my core helped; TGU, dead bugs, planks.
Also symmetrical posture post exercise was a necessity.
 
John K said:
No known injury as far as I know.

I don’t, they’re a distance trainee
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I would ask about any injuries, falls or car accidents.

See if they have a trusted Physio in their area.
 
Make sure you keep yourself and other students (and fragile things) well clear of this trainee when s/he is doing ballistics, and make sure the trainee knows it's okay to let go of the bell if a shooting pain occurs. No exercise you prescribe is likely to hurt the trainee unless s/he doesn't know how to properly fail a rep.
 
Physio here.
It so depends reason for the sciatica (or the trigger if it's long term). Do you know of a physio to refer the client to?

This is not medical advise since I have never even talked to this patient, but "nerve flossing" usually does wonders, make sure its "100% symptom free and pain free ". Usually a pretty safe exercise

I.e. this one: do 10 every or every other hour throughout the day:
sciatic-1-1024x606.jpg

Stole the picture from
www.disc-me.com

Nerve Flossing

What is nerve flossing? Nerve flossing is a method of treatment comparable to stretching of muscles. Flossing helps to gently work the nerves without pain to regain strength and mobility. […]
www.disc-me.com www.disc-me.com
Skimmed the text, could be worth a read.
 
Joel the Savage said:
Physio here.
It so depends reason for the sciatica (or the trigger if it's long term). Do you know of a physio to refer the client to?
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They're a distance client, so sadly no.
Joel the Savage said:
This is not medical advise since I have never even talked to this patient, but "nerve flossing" usually does wonders, make sure its "100% symptom free and pain free ". Usually a pretty safe exercise

I.e. this one: do 10 every or every other hour throughout the day:
View attachment 23484

Stole the picture from
www.disc-me.com

Nerve Flossing

What is nerve flossing? Nerve flossing is a method of treatment comparable to stretching of muscles. Flossing helps to gently work the nerves without pain to regain strength and mobility. […]
www.disc-me.com www.disc-me.com
Skimmed the text, could be worth a read.
Click to expand...
Thank you, I'll check it out and might send them the link.
 
I deal with it from time to time and it sucks! I have stopped doing barbell work as far as squats go and rely on goblet squats, Zercher's don't really bother me too much. Since I bought a really firm mattress the issue has been better, but not all the way clear. I don't change anything as far as training. If the nerve issue is shooting through my lower back and leg I will switch from heavy swings to lighter snatches. I don't let it dominate my life, I just work around it.
 
Can't add much to what's already been said, other than ask a few questions about lifestyle outside of training: does trainee do a lot of sitting? If said individual is a male, does he sit with his wallet in his back pocket? Lots of time at a computer with a mouse? Any of those things can create imbalances that manifest during high intensity activity. The best thing I have done for my sciatica was to stop sitting with things in my back pocket. The mechanism of injury is probably completely different, but lots of sitting / sitting with wallet, mousing, etc. can certainly aggravate or prevent healing.
 
mfbunch said:
Can't add much to what's already been said, other than ask a few questions about lifestyle outside of training: does trainee do a lot of sitting? If said individual is a male, does he sit with his wallet in his back pocket? Lots of time at a computer with a mouse? Any of those things can create imbalances that manifest during high intensity activity. The best thing I have done for my sciatica was to stop sitting with things in my back pocket. The mechanism of injury is probably completely different, but lots of sitting / sitting with wallet, mousing, etc. can certainly aggravate or prevent healing.
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So, I don't use a traditional wallet, I use a card carrier. And while I'm in my office I will every hour take the elevator to the first floor, walk around the building, and then take the stairs back to my office. When I run a meeting on the Amphib base I like to do meetings at, every 45 minutes I take a 15-minute break and get a quick walk in. Nerve issues suck! You can't become a slave to them. It's best to move as much as you can, when you can.
 
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