L5-S1 level sciatica -> attempt to squat, but cannot keep heels on the ground. Worth continuing to try?

Question

60yo male, 176kg. Had L5-S1 protruded disk problems in my 40s - fixed with physical therapy. Then again around my 50s - same fix as before. Hit me again in my late 50s, this time with no relief from physical therapy. Switched to injection in the back (3 over the span of 9 months), which brought the 8-9 level pain to a 3-4. Started doing the mandatory three exercises by Dr. McGill, and got the pain to stabilize at a 3-4 level. Would like to start doing some squats, now, also based on som Dr McGill advice, but no matter what I do I cannot keep my heels on the floor. I read this old post but it seems to refer to a healthy individual attempt to getting into the "shape" of correctly squating.

Q: does anyone have any opinion on the worthiness in attempting to still do a squat with heels on the floor, or would - in my situation - even an incorrect squat provide some relief to the major issue of sciatica, vs just abandoning the attempt?

Answer 1

Heels raising at the bottom of a squat indicates that you are unable to get into the bottom position without more forward knee travel than your ankle mobility allows. However, this does not indicate that ankle mobility is necessarily the problem. In your case, where you have a history of back pain, the problem is almost certainly an unwillingness to lean forwards.

Here's what's happening: As you descend, your knees move forwards and your hips move back. If you try to keep your torso upright, then most of your bodyweight is shifting backwards, with your hips. As soon as you get to the point where your centre of mass if over your heels, you can't squat any deeper, as doing so would cause your weight to shift further back, and you would fall backwards. So you raise your heels and push your knees further forwards, bringing your hips and torso forwards too, and you're then able to continue squatting deeper. But the amount of forward knee travel required to keep your hips over your feet like this is ridiculous, and not something that could be achieved through ankle stretching. You're trying to do a deep knee bend rather than a squat.

This is what a deep knee bend looks like:

Whereas this is what a squat looks like:

You need to learn to lean forwards when squatting, as this is necessary in order to maintain forward-backward balance. Hopefully doing so isn't a sciatica trigger for you, but if it is, then it would be something to gently and gradually work towards, perhaps also incorporating squat variations that require less forward lean, such as squatting in weightlifting shoes that have raised heels, and trying goblet squats, front squats, or safety-squat-bar squats.

would - in my situation - even an incorrect squat provide some relief to the major issue of sciatica, vs just abandoning the attempt?

It's not clear here whether by an 'incorrect' squat you mean a squat with the heels leaving the ground, or a partial depth squat which stops just before your heels leave the ground. In either case though, any exercise that you can tolerate without causing a flare-up is good for sciatica, particularly if it is something that lets you gently push the limits of what you can tolerate.

Answer 2

Here is one more tip, from McGill himself, which I have personally found very useful, whether someone has back issues or not - it may be that your stance width is in need of adjustment:

In order to find the optimal hip width (...) have the athlete adopt a 4-point kneeling stance. From neutral, rock or drop the buttocks back to the heels. Mark the angle at which first spine flexion occurs. Then repeat with varying amount of space between the knees. Look for the optimal knee width that allows the buttocks to get closest to the ankles without any spine motion. This is the hip angle that will produce the deepest, and ultimately the highest performance squat. It is much wider than most people think.