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  1. #1
    ryanvatkins is offline Junior Member
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    Default Sciatic injury questions

    One of my friends has a client, probably 55+, who has moderate sciatic nerve pain. It exhibits when he is standing or walking, but he is fine lying and sitting. His ROM when laying on his back is one leg about 4 inches off the ground.

    My friend had him doing leg rotations, small circles with the foot to build some hip and core stability and mobility without compromising his injury. Also, his PT says that he is contraindicated to any type of spinal flexion. I don't know for sure, but I am assuming that he is ok to have proper hip flexion.

    Would he benefit from properly taught swings, with good hip folding and back position? (With a light bell, of course) Or would this be considered dangerous?

    If you need any more information, I can ask my friend, but that is about all that he had learned so far.

    Also, the client is seeing a PT, and has worked on various exercises including donkey kicks which the trainer thought would not be safe.

  2. #2
    Steve Freides is offline Senior Member
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    You are asking good questions, but many of them are best directed to this person's doctor and/or PT.

    If, and only if, the doctor or PT gives the OK for swings, then yes, they could help. In a nutshell, adding hip and hamstring mobility is usually good for bad backs, so I think you're thinking about this correctly.

    If it's decided to do swings, then I recommend ETK's progression, which includes wall squats and kettlebell sumo deadlifts before swings, the idea being that you must be able to do these things well before you have earned the right to swing the bell.

    Best of luck to all concerned.

    -S-
    KBNJ.COM - Steve Freides, RKC Team Leader

  3. #3
    Jordan Vezina RKCTL is offline Senior Member
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    If it's a piriformis related issue swings could actually make it worse. Correct the problem first. Also, don't assume a light bell will always be better. Sometimes going too light can exacerbate the problem.

  4. #4
    ryanvatkins is offline Junior Member
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    Ok, so I will have my friend give him a list of questions for his PT/doctor.

    1. Is it a piriformis related issue?
    2. Is hip flexion with neutral spinal alignment allowed?
    3. Are KB swings, emphasizing correct hip fold, hip and hamstring mobility, neutral spinal position and proper support contraindicated?

    If the 1st and 3rd are no, and the second is yes, then I will recommend the trainer have him follow this program. At that point should I use a 16 kg bell? (The next smallest I have access to is approx 9.5 kg).

    Thanks for your answers!

  5. #5
    Batman23 is offline Member
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    If it's a psiformis related problem them before you do anything, get him to do the following stretch for 3x30s 1-2x a day:

    YouTube - How to Do the Pigeon Yoga Pose

    Also see this thread:

    RossTraining.com • View topic - Piriformis syndrome

    If it is a psiformis related issue I'd put money on the first stretch helping ease the problem.

  6. #6
    Steve Freides is offline Senior Member
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    Lots of Party-approved things for piriformis tightness - windmill works for me, also getups if you really push into the hip when you're getting ready to come up into the lunge position.

    +1 to what Jordan said about kettlebell size - use the right tool for the job, which isn't always the smallest bell.

    -S-
    KBNJ.COM - Steve Freides, RKC Team Leader

  7. #7
    mc
    mc is offline Senior Member
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    Main thing is steve's advice about checking with one's doc
    the usual check is to make sure that it's ok to do flexion work right now.
    and swings have rather a lot of hip flexion, eh?

    if there's inflammation or stuckness so the nerve is compressed, flexion can exacerbate that rather than relieve it - there are ways to create space for the nerve that can be more targeted than stretches, like nerve glides for this area.

    I'm always a little hesitant to say oh sciatica - do this for that or it's the piriformis - whale on this muscle in this way - because as gray cook and brett jones often repeat - the site of pain isn't always the source of pain.

    So in asking the doc to focus on particular muscles may be misleading. What i'd suggest is
    - really check if the doc thinks it is sciatica or not - there are particular pathologies with this. - like standing rather than lying is not uncommon in terms of pressure/entrapment. but how the pain radiates is also part of the pattern.

    But after that - sure a piriformis may be tight, but why? what's happening in one's movement that's inducing this response?

    so AFTER getting the diagnosis, a good movement assessment can help. GP's aren't really trained to look at movement. I work with quite a few folks who have sciatica as diagnoses, and working with movement and sometimes related vision issues can usually sort it quite quickly. but as said, it's trying to explore movements rather than specific muscles.

    One big heuristic in the meantime: stay as mobile as possible without moving into pain. reduce load, range of motion, torque - anything that induces that ow, or contributes to any kind of numb sensation.

    best
    mc
    mc, phd, cscs,
    rkc ii, ck-fms, z-health master trainer, precision nutrition level 1
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  8. #8
    ryanvatkins is offline Junior Member
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    Wow, there's quite a bit more information here than I expected. I found out from my friend that it's a moot point, his client decided that he no longer wished to continue.

    But I now have renewed motivation to finish reading Movement. I feel like I'll be underqualified for this discussion until I've finished it, and probably after.

    Thanks!

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